Facilities, Providers & Managed Care Plans > Nursing Home Care > Nursing Home Inspection Information

Ederly and ChildLong Term Care Survey Process

For complaints regarding a Long Term Care facility or Nursing Home call: 1-800-254-5164.  For complaints regarding a Personal Care Home/Assisted Living Facility call: 1-877-401-8835. 
For other inquiries, call (717)787-1816

Who? When? Where?

Nursing homes are commonly referred to as nursing care facilities or long term care facilities.  Nursing homes are inspected annually by the Pennsylvania Department of Health. The Department of Health has been given the responsibility of inspecting Pennsylvania’s nursing homes by the Centers for Medicare and Medicaid Services, a branch of the federal government.  These inspections are called surveys.  The Department of Health conducts surveys in nursing homes to make sure they are following state and federal regulations (rules).  Nursing homes who have a history of serious problems are inspected more frequently.

The Department of Health reviews all of the available information about a nursing home and selects a team of surveyors to send to the facility.  The team includes a registered nurse (RN) and may include a nutritionist or social worker.  The composition of the team is unique to each facility and is determined by the facility history regarding past problems at the nursing home.  All surveyors, no matter what their professional background, have been trained as generalists.  This means that any of the team members have the skill to determine how well the nursing home provides services by all professions. The Division of Nursing Care Facilities has field offices located throughout the commonwealth.

Surveys usually cover several days and can take place at any time of the day or night.  Surveys are not announced in advance so nursing homes do not know when a survey might happen.  The surveyors can see how a “typical day” might be for the residents.  

What?

Individuals who live in nursing homes are called “residents.”  They are called this because they “reside” or live in the nursing home.  The nursing home should be considered the home of the resident.  For this reason it is important that surveys examine how well the nursing home ensures that its residents feel “at home” as much as possible.   

The survey also evaluates how well the nursing home provides care to its residents by meeting minimum regulatory standards.  To accomplish this the survey team focuses on how the needs of the residents are met.  This encompasses not only their medical and nursing needs but also their social, psychological, nutritional, emotional, spiritual and physical needs as well.  Surveyors try to determine whether the nursing home provides quality care that does not have a negative impact on the resident’s quality of life.  There must always be a good balance of quality of life and quality of care for residents to thrive in a nursing home.

Surveyors use some tools to make sure they look at all the important things that determine the quality of care and quality of life of nursing home residents.  These tools include checklists and forms that guide what the surveyor observes, reads and participates in while at the nursing home.  Surveyors throughout the United States rely on these methods to evaluate our nation's nursing homes.

If you are at a nursing home while a survey is in process, you might see surveyors doing some of the following things:

  • observing how the staff and residents talk and interact with each other;
  • watching how the staff provides nursing care to residents;
  • interviewing residents and family to see how they feel about the care they are receiving;
  • reviewing resident charts to see if necessary services are identified and provided;
  • touring the facility to see if the environment is comfortable and safe for the residents;
  • observing meals to assure the food is nutritionally balanced, attractive, the right temperature and tastes good;
  • observing nurses giving medications and providing treatment to residents; 
  • meeting with groups of residents such as resident councils to determine if there are widespread problems in the nursing home; and 
  • meeting with staff and administrators to see if they have developed ways of solving problems in the nursing home.

RESULTS, RESULTS, RESULTS

When the surveyors have made enough observations to complete the survey tasks, they will talk to the administrator, staff and residents before leaving the facility.  They will tell them what areas of concern were identified while they were at the facility.  The surveyors then return to their office to write the official report of their observations.  For every problem that they identify, the surveyors must decide how serious the problem is for the residents.  This is called “assigning scope and severity.”  It reflects both how serious and how often a problem occurs in the nursing home.  The surveyors write a description of the problems, which is then called a “statement of deficiencies.”  They send a copy of their report to the nursing home requesting that they submit a plan to correct the problems.  The nursing home must submit in writing their proposed solutions to the problems; this is called a “plan of correction.”  You can ask to see a copy of this report at any nursing home.  Nursing homes must have notices posted to tell you where the survey results are kept.  You can also view these reports on the Department of Health’s web-site. 

Depending on the seriousness of the deficiencies, different consequences may be given to the nursing home. These consequences are usually referred to as “enforcement actions.”  One enforcement action that can be imposed is a ban on admissions and/or re-admissions.  This gives the facility time to focus their resources on fixing the identified problem(s) before allowing new residents to be admitted.  If the problems are very severe, the Department may revoke the nursing facility’s license to prevent them from providing care to residents.  Sometimes the Department will issue what is called a “provisional license” to a nursing home.  This provisional license allows the nursing home to continue to operate while the Department monitors areas in which improvements must be made to insure the health and safety of the residents.  Another action that can be taken is to have the nursing home lose its right to participate in the Federal Medicare or State Medicaid programs.  The nursing home would lose funding from these programs if its services do not meet the Minimum State and Federal requirements (rules). One final action that can be taken is to fine the nursing home; this is called “Civil Money Penalty.”  The State survey agency or the Federal Medicare agency could impose these fines.  The nursing home must pay these fines and correct all of the problems that were identified by the surveyors.

By providing nursing homes with consequences for quality of care and quality of life problems, the Department of Health strives to protect the health and safety of our valued citizens.  The survey process lets nursing homes know what they need to do to make sure residents are receiving care and services to maintain their functional abilities in their “home.” 

Here is a review of the actions taken against nursing homes for the last several years.  As you can see, we’ve been very busy protecting our nursing home residents!

State Enforcement Action Taken 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Provisional Licenses 64 74 57 31 17 14 22 29 10 18 2
Civil Monetary Penalties 69 89 62 33 26 43 42 31 18 23 0
Bans on Admission 7 7 4 1 0 1 0 0 2 0 0
License Revocations 0 1 1 0 0 0 0 0 1 0 0
Federal Terminations 0 0 0 0 0 1 0 0 0 0 0