LTC Survey Readiness Checklist - FREE PDF

Prepare for annual state nursing home survey with F-Tag compliance review.

  • Industry: Long-Term Care / Skilled Nursing
  • Frequency: Ongoing / Pre-survey
  • Estimated Time: 4-8 hours
  • Role: Administrator / DON / QA
  • Total Items: 30
  • Compliance: CMS 42 CFR 483, State Operations Manual, F-Tags

Documentation Review

Review required documentation and policies.

  • Policies and procedures current?
  • Staff training documented?
  • Required records complete?

Practice Observation

Observe clinical practices for compliance with CMS 42 CFR 483.

  • Staff practices comply with standards?
  • Required equipment/supplies available?
  • Care environment appropriate?

Patient/Resident Safety

Evaluate safety measures and outcomes.

  • Safety interventions in place?
  • Quality outcomes monitored?
  • Quality improvement actions taken?

Regulatory Compliance

Verify compliance with CMS 42 CFR 483, State Operations Manual, F-Tags.

  • Regulatory requirements met?
  • Any deficiencies identified?
  • Deficiency Description

Corrective Actions

Document required corrective actions.

  • Immediate Actions Needed
  • Follow-up Actions Required
  • Follow-up Audit Date
  • Auditor Signature

Pre-Assessment Information

Initial assessment documentation and patient/facility identification

  • Assessor Name / Credentials
  • Assessment Date
  • Department / Unit
  • Assessment Type (Routine/Annual/Complaint)
  • Previous assessment findings reviewed?

Infection Prevention & Control

Verify infection control practices per CDC and Joint Commission standards

  • Hand hygiene compliance observed?
  • Appropriate PPE available and properly used?
  • Isolation precautions properly implemented?
  • Sharps containers available and not overfilled?
  • High-touch surfaces properly disinfected?

Patient Safety & Identification

Verify patient safety protocols and identification procedures

  • Two patient identifiers used before procedures?
  • Fall risk assessment completed?
  • Call light within patient reach?
  • Bed in lowest position with brakes locked?

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Why Use This LTC Survey Readiness Checklist?

This ltc survey readiness checklist helps long-term care / skilled nursing teams maintain compliance and operational excellence. Designed for administrator / don / qa professionals, this checklist covers 30 critical inspection points across 8 sections. Recommended frequency: ongoing / pre-survey.

Ensures compliance with CMS 42 CFR 483, State Operations Manual, F-Tags. Regulatory-aligned for audit readiness and inspection documentation.

Frequently Asked Questions

What does the LTC Survey Readiness Checklist cover?

This checklist covers 30 inspection items across 8 sections: Documentation Review, Practice Observation, Patient/Resident Safety, Regulatory Compliance, Corrective Actions, Pre-Assessment Information, Infection Prevention & Control, Patient Safety & Identification. It is designed for long-term care / skilled nursing operations and compliance.

How often should this checklist be completed?

This checklist should be completed ongoing / pre-survey. Each completion takes approximately 4-8 hours.

Who should use this LTC Survey Readiness Checklist?

This checklist is designed for Administrator / DON / QA professionals in the long-term care / skilled nursing industry. It can be used for self-assessments, team audits, and regulatory compliance documentation.

Can I download this checklist as a PDF?

Yes, this checklist is available as a free PDF download. You can also use it digitally in the POPProbe mobile app for real-time data capture, photo documentation, and automatic reporting.

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