New SNF/NF Survey Process and New Requirements of Participation Member Feedback Please provide responses to the following questions about your recent MDH survey. * 1. What surprised you about the new survey process? OK * 2. What went well during the new survey process? OK * 3. What did not go well during the new survey process? OK * 4. How many licensed beds are at your facility? 1-48 beds 49-95 beds 96-174 beds 156+ beds OK * 5. How many total surveyors were on your survey team? 2 3 4 5 6 7 8+ OK * 6. If the survey team included surveyors "in training" or federal surveyors, please identify how many surveyors were in training or were federal surveyors. 1 2 3 4+ OK * 7. How many OHFC complaints were investigated during your survey? I do not know 0 1 2 3 4 5 6+ Other (please specify) OK * 8. How many days did your survey last…from entrance conference to exit conference? 3 days 4 days 5 days 6 days 7+ days OK * 9. Use the scale below to rate this statement: Surveyors showed respect towards staff during the survey. Strongly disagree Somewhat disagree Neither agree nor disagree Somewhat agree Strongly agree Strongly disagree Somewhat disagree Neither agree nor disagree Somewhat agree Strongly agree Any other feedback or examples you would like to share related to this topic? OK * 10. Use the scale below to rate this statement: Surveyors showed respect towards residents, families, and visitors during the survey. Strongly disagree Somewhat disagree Neither agree nor disagree Somewhat agree Strongly agree Strongly disagree Somewhat disagree Neither agree nor disagree Somewhat agree Strongly agree Any other feedback or examples you would like to share related to this topic? OK * 11. During the exit conference, was the facility provided the opportunity to discuss and supply additional information that you believe was pertinent to the identified MDH findings? Yes No Other (please specify) OK * 12. Do you feel information shared during the exit conference was understandable and provided you with enough information so you are aware of survey concerns and areas where deficiencies may be issued? Yes No Other (please specify) OK * 13. Based on feedback from surveyors and information provided at the entrance conference, do you feel information from either your Facility-Wide Assessment OR QAPI plan will be used to support deficiencies? Yes No If Yes, please explain: OK * 14. Please select all regulatory topic areas (F-Tags) that you anticipate being cited under. §483.10 Resident Rights (F550 – F586) §483.12 Freedom from Abuse, Neglect, and Exploitation (F600 – F610) §483.15 Admission Transfer and Discharge Rights (F620 – F635) §483.20 Resident Assessment (F636 – F646) §483.21 Comprehensive Person-Centered Care Planning (F655 – F661) §483.24 Quality of Life (F675 – F680) §483.25 Quality of Care (F684 – F700) §483.30 Physician Services (F710 – F725) §483.35 Nursing Services (F726 – F732) §483.40 Behavioral Health Services (F740 – F745) §483.45 Pharmacy Services (F755 – F778) §483.55 Dental Services (F790 – F791) §483.60 Food and Nutrition Services (F800 – F814) §483.65 Specialized Rehabilitative Services (F825 – F826) §483.70 Administration (F835 – F851) §483.75 Quality Assurance and Performance Improvement (F865 – F868) §483.80 Infection Control (F880 – F883) §483.85 Compliance and Ethics Program (F895) §483.90 Physical Environment (F907 – F926) §483.95 Training Requirements (F940 – F949) Other (please specify) OK * 15. Please select all Emergency Preparedness (EP) requirements you anticipate being cited (E-Tags) under. EP Plan and Annual Updates (E-0006) EP Specific to Facility Population (E-0007) EP Plan Collaborative with Local Planning Authorities (E0009) EP Policies and Procedures (E0013) EP Addresses Subsistence Needs for Residents and Staff (E0015) EP Addresses Tracking Staff and Residents (E0018) EP Addresses Evacuations (E0020) EP Addresses Sheltering in Place (E0022) EP Addresses Resident Records (E0023) EP Addresses Volunteers (E0024) EP Addresses Transfer Arrangements With Other Facilities (E0025) EP Addresses Providing Care at Alternate Sites (E0026) EP Includes Communication Plan (E0029) EP Includes Required Contact Information (E0030) EP Includes Required MDH and Ombudsman Contact Information (E0031) EP Addresses Primary and Alternate Means of Communication (E0032) EP Addresses Sharing of Resident Medical Information (E0033) EP Addresses Sharing of Occupancy Information (E0034) EP Addresses Family/Resident Representative Communication Plan (E0035) Facility EP Training and Testing Program (E0036) Initial and Annual Training of Staff on EP Policies and Procedures (E0037) Full-Scale and Tabletop EP Drills Conducted Annually (E0039) Maintain and Inspect Emergency Power (E0041) Other (please specify) OK * 16. Any specific survey or regulatory compliance findings you would like Care Providers of Minnesota to be aware of? Yes No If yes, please share your thoughts: OK * 17. Based on your survey, are there areas where you believe Care Providers of Minnesota should provide new or additional training? Yes No If yes, please share training topic ideas: OK * 18. Do you anticipate initiating an IDR (Informal Dispute Resolution) or IIDR (Independent Informal Dispute Resolution) regarding any of the deficiencies? Yes No Uncertain at this time OK * 19. Please provide the name of your facility (in case we need to contact you for additional information or clarification): OK * 20. Please provide the date of your survey's exit conference: Survey Exit Date MM / DD / YYYY OK * 21. Anything else about your survey you would like to share? OK THANK YOU FOR YOUR FEEDBACK!