HHSC Long-Term Care Regulatory Division - Provider Feedback Survey

Our goal at HHSC is to provide quality, consistent, efficient, and accountable regulatory inspection of our Long-Term Care Providers and Facilities (including the Home and Community-based Services [HCS] and Texas HomeLiving [TxHmL] waiver programs). Please take a few moments to let us know about the recent HHSC LTC Regulatory Services visit to your facility/agency/home.

If you have questions or concerns about the survey visit and would like to speak to someone directly, please call:

1-800-458-9858(Voice)
1-888-425-6889 (TDD)

	Always	Most of the time	Sometimes	Never
The conduct of the surveyor(s) during the visit was professional and courteous to staff.	The conduct of the surveyor(s) during the visit was professional and courteous to staff. Always	The conduct of the surveyor(s) during the visit was professional and courteous to staff. Most of the time	The conduct of the surveyor(s) during the visit was professional and courteous to staff. Sometimes	The conduct of the surveyor(s) during the visit was professional and courteous to staff. Never
The conduct of the surveyor(s) during the visit was professional and courteous to residents/individuals.	The conduct of the surveyor(s) during the visit was professional and courteous to residents/individuals. Always	The conduct of the surveyor(s) during the visit was professional and courteous to residents/individuals. Most of the time	The conduct of the surveyor(s) during the visit was professional and courteous to residents/individuals. Sometimes	The conduct of the surveyor(s) during the visit was professional and courteous to residents/individuals. Never
The surveyor(s) followed regulatory protocols and applied standard survey procedures.	The surveyor(s) followed regulatory protocols and applied standard survey procedures. Always	The surveyor(s) followed regulatory protocols and applied standard survey procedures. Most of the time	The surveyor(s) followed regulatory protocols and applied standard survey procedures. Sometimes	The surveyor(s) followed regulatory protocols and applied standard survey procedures. Never
The surveyor(s) considered all pertinent evidence.	The surveyor(s) considered all pertinent evidence. Always	The surveyor(s) considered all pertinent evidence. Most of the time	The surveyor(s) considered all pertinent evidence. Sometimes	The surveyor(s) considered all pertinent evidence. Never
The surveyor(s) kept you informed of their progress during the course of the survey.	The surveyor(s) kept you informed of their progress during the course of the survey. Always	The surveyor(s) kept you informed of their progress during the course of the survey. Most of the time	The surveyor(s) kept you informed of their progress during the course of the survey. Sometimes	The surveyor(s) kept you informed of their progress during the course of the survey. Never
The surveyor(s) considered all evidence presented to refute deficiencies/violations prior to exit.	The surveyor(s) considered all evidence presented to refute deficiencies/violations prior to exit. Always	The surveyor(s) considered all evidence presented to refute deficiencies/violations prior to exit. Most of the time	The surveyor(s) considered all evidence presented to refute deficiencies/violations prior to exit. Sometimes	The surveyor(s) considered all evidence presented to refute deficiencies/violations prior to exit. Never

Always

Most of the time

Sometimes

Never

The conduct of the surveyor(s) during the visit was professional and courteous to staff.

The conduct of the surveyor(s) during the visit was professional and courteous to staff. Always

The conduct of the surveyor(s) during the visit was professional and courteous to staff. Most of the time

The conduct of the surveyor(s) during the visit was professional and courteous to staff. Sometimes

The conduct of the surveyor(s) during the visit was professional and courteous to staff. Never

The conduct of the surveyor(s) during the visit was professional and courteous to residents/individuals.

The conduct of the surveyor(s) during the visit was professional and courteous to residents/individuals. Always

The conduct of the surveyor(s) during the visit was professional and courteous to residents/individuals. Most of the time

The conduct of the surveyor(s) during the visit was professional and courteous to residents/individuals. Sometimes

The conduct of the surveyor(s) during the visit was professional and courteous to residents/individuals. Never

The surveyor(s) followed regulatory protocols and applied standard survey procedures.

The surveyor(s) followed regulatory protocols and applied standard survey procedures. Always

The surveyor(s) followed regulatory protocols and applied standard survey procedures. Most of the time

The surveyor(s) followed regulatory protocols and applied standard survey procedures. Sometimes

The surveyor(s) followed regulatory protocols and applied standard survey procedures. Never

The surveyor(s) considered all pertinent evidence.

The surveyor(s) considered all pertinent evidence. Always

The surveyor(s) considered all pertinent evidence. Most of the time

The surveyor(s) considered all pertinent evidence. Sometimes

The surveyor(s) considered all pertinent evidence. Never

The surveyor(s) kept you informed of their progress during the course of the survey.

The surveyor(s) kept you informed of their progress during the course of the survey. Always

The surveyor(s) kept you informed of their progress during the course of the survey. Most of the time

The surveyor(s) kept you informed of their progress during the course of the survey. Sometimes

The surveyor(s) kept you informed of their progress during the course of the survey. Never

The surveyor(s) considered all evidence presented to refute deficiencies/violations prior to exit.

The surveyor(s) considered all evidence presented to refute deficiencies/violations prior to exit. Always

The surveyor(s) considered all evidence presented to refute deficiencies/violations prior to exit. Most of the time

The surveyor(s) considered all evidence presented to refute deficiencies/violations prior to exit. Sometimes

The surveyor(s) considered all evidence presented to refute deficiencies/violations prior to exit. Never

	Always	Most of the time	Sometimes	Never
We understand the survey preliminary findings.	We understand the survey preliminary findings. Always	We understand the survey preliminary findings. Most of the time	We understand the survey preliminary findings. Sometimes	We understand the survey preliminary findings. Never
The survey team explained the standards that resulted in citations.	The survey team explained the standards that resulted in citations. Always	The survey team explained the standards that resulted in citations. Most of the time	The survey team explained the standards that resulted in citations. Sometimes	The survey team explained the standards that resulted in citations. Never
We found the survey to be a positive learning experience.	We found the survey to be a positive learning experience. Always	We found the survey to be a positive learning experience. Most of the time	We found the survey to be a positive learning experience. Sometimes	We found the survey to be a positive learning experience. Never
We found the survey team to be knowledgeable of regulatory standards.	We found the survey team to be knowledgeable of regulatory standards. Always	We found the survey team to be knowledgeable of regulatory standards. Most of the time	We found the survey team to be knowledgeable of regulatory standards. Sometimes	We found the survey team to be knowledgeable of regulatory standards. Never
We can apply the information learned in the survey process to our program.	We can apply the information learned in the survey process to our program. Always	We can apply the information learned in the survey process to our program. Most of the time	We can apply the information learned in the survey process to our program. Sometimes	We can apply the information learned in the survey process to our program. Never

Always

Most of the time

Sometimes

Never

We understand the survey preliminary findings.

We understand the survey preliminary findings. Always

We understand the survey preliminary findings. Most of the time

We understand the survey preliminary findings. Sometimes

We understand the survey preliminary findings. Never

The survey team explained the standards that resulted in citations.

The survey team explained the standards that resulted in citations. Always

The survey team explained the standards that resulted in citations. Most of the time

The survey team explained the standards that resulted in citations. Sometimes

The survey team explained the standards that resulted in citations. Never

We found the survey to be a positive learning experience.

We found the survey to be a positive learning experience. Always

We found the survey to be a positive learning experience. Most of the time

We found the survey to be a positive learning experience. Sometimes

We found the survey to be a positive learning experience. Never

We found the survey team to be knowledgeable of regulatory standards.

We found the survey team to be knowledgeable of regulatory standards. Always

We found the survey team to be knowledgeable of regulatory standards. Most of the time

We found the survey team to be knowledgeable of regulatory standards. Sometimes

We found the survey team to be knowledgeable of regulatory standards. Never

We can apply the information learned in the survey process to our program.

We can apply the information learned in the survey process to our program. Always

We can apply the information learned in the survey process to our program. Most of the time

We can apply the information learned in the survey process to our program. Sometimes

We can apply the information learned in the survey process to our program. Never

HHSC Long-Term Care Regulatory Division - Provider Feedback Survey

Question Title

* Facility or Agency Name:

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* Demographic Information

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* Region Number? Please select the HHSC Administrative Region in which your facility/agency is located. If you do not know your facility/agency's region number, click here.

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* Facility/Agency Program Type

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* Survey Visit Exit Date

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* Type of Visit (You may check as many as required)

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* Surveyor Professionalism and Courtesy

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* Survey Feedback

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* Additional comments: