THE NEW VA SURVEY PROCESS
FOR STATE VETERANS HOMES
Presentation Date
Today’s Presenters
Nancy A. Quest
Chief, State Veterans Home Program
Clinical and Survey Oversight
Sheila Scott
Project Manager
VA Contract Supported Surveys
Donna Demaree
Contract Surveyor
Steve Matune
1st Vice President
National Association of State Veterans Homes
Fred S. Sganga
2nd Vice President
National Association of State Veterans Homes
Today’s Session
• VA Perspective
• Contractor Perspective
• State Veterans Home Perspective
• Answering Your Questions
DEPARTMENT
OF
VETERANS AFFAIRS
SURVEY PERSPECTIVE
Nancy A. Quest
Chief, State Veterans Home Program
Clinical and Survey Oversight
Why The New Format?
• Opportunity to Improve
– VHA was charged with improving the
survey process.
– Extensive consideration of a variety of
“in-house” approaches.
– Decision to contract with expert was
selected as the best option.
VA Defined Goals
• Transparency of information and
processes
• Public accountability
• Increased oversight of facilities that
provide care and services to vulnerable
populations
VA Contractor Selection Process
• Technical Capability
• Contractor Experience
• Qualifications of Personnel
• Past Performance
Vision of the Survey Process
• Consistency of survey approaches
• Clear protocol - pre, during and post survey
• Smaller numbers of experienced surveyors
• Clear and objective statements of findings
• Consistency in dealing with findings
• Timely reporting to State Veterans Homes
VA - SVH Survey Phase 1
Pilot Program
Survey Process Assessment
• Chelsea, Massachusetts
• Stony Brook, New York
• Quincy, Illinois
• Sandusky, Ohio
• Chula Vista, California
• Phoenix, Arizona
Review of VA Survey Prep Outline
• What to expect…
– Initial Tour
– First Day
– Second Day
– Third Day
• Required documents…
• How to prepare…
VA Lessons Learned
• The nuances of existing survey process.
• Coordination, Coordination, Coordination!
• How can we present as one team?
• SVH’s expectations & time frames.
Review of the Formal Appeal Process
38 CFR Part 51.30(e)(f) states in part:
If the VA Medical Center of Jurisdiction Director determines
that the State home facility or facility management does not
meet the standards…
The State must submit the appeal to the Under Secretary for
Health in writing, within 30 days of receipt of the notice of
the recommendation or decision regarding the failure to
meet the standards. The decision of the Under Secretary for
Health will constitute a final decision that may be appealed
to the Board of Veterans’ Appeals (see 38 U.S.C. 7104 and
7105 and 38 CFR Part 20).
Contractor Perspective
Sheila Scott
Project Manager
VA Contract Supported Surveys
Donna Demaree
Contract Surveyor
Analysis. Answers. Assurance
Corporate Overview
 Ascellon Corporation provides Management Consulting,
Program Management and Information Technology
Services.
 Over 13 Years in Business
 Serving CMS since 1997 and Conducting Long Term
Care Survey for over 6 years
 ISO 9001:2008 Quality Registration
 Over 90 Clinical Professionals on Staff
 Location – Landover, MD with Clinical Professionals in
28 States
14
Analysis. Answers. Assurance
Recognitions
 Washington Technology “Fast 50” & Government
Computer News (GNC) “50 Fastest Growing Firms” for 3
Years
 Business Week, Initiative for a Competitive Inner City
(ICIC) “Inner City 100”- 2009, Ranked #10, 5th
Consecutive Year
15
Analysis. Answers. Assurance
Core Competencies
 Quality of Care Evaluation
 Health Care Quality Management
 Metrics Development & Performance Monitoring
 Medical Record Review
 Data and Statistical Analyses
16
Analysis. Answers. Assurance
SVH Program Onsite Surveys
 Surveys apply VA Standards utilizing CMS Process
 30% of State Home are certified under CMS


Subject to Annual Unannounced Surveys by State Survey
Agency
Annual Unannounced VA Survey for Per Diem Payments
 For the Remainder of SVH, the VA is Only Oversight
Body
 Three-Year Contract – Health and Life Safety Code



137 Annual Surveys
Up to 10 Recognition Surveys
Up to 30 For Cause Surveys
17
Analysis. Answers. Assurance
Clinical Survey Process
Task 1 - Off-site Preparation
Task 2 - Entrance Conference
Task 3 - Initial Tour
Task 4 - Sample Selection
Task 5 - Information Gathering
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



Resident Reviews
Quality of Life
Environment
Kitchen Sanitation
Medication Pass
Abuse Prevention Protocol
18
Analysis. Answers. Assurance
Clinical Survey Process (cont.)
Task 6 - Information Analysis and Deficiency
Determination
Task 7 - Exit
19
Analysis. Answers. Assurance
Acceptable Plan of Correction
 Address how corrective action will be accomplished for those
residents found to have been affected by the deficient practice;
 Address how the facility will identify other residents having the
potential to be affected by the same deficient practice;
 Address what measures will be put into place or systemic
changes made to ensure that the deficient practice will not
recur;
 Indicate how the facility plans to monitor its performance to
make sure that solutions are sustained.
 Include dates when corrective action will be completed.
20
Analysis. Answers. Assurance
Most Commonly Cited Deficiencies
Tag #
Title
CFR #
87
Comprehensive Assessment
51.110 b
92/93
Develop and Review Care Plans
51.110 d
108
Accidents
51.120 i
125
14 Hours Between Meals
51.140 f
72
Activities
51.100 g
123
Food
51.140 d
147
Life Safety Code
51.200
66
Staff Treatment of Residents
51.90 c
67
Dignity
51.100
96
Quality of Care
51.110
102
Pressure Sores
51.110 d
105
Range of Motion
51.110 f
144
Infection Control
51.190 a
150
Resident Rooms
51.200 d
21
State Veterans Homes
Perspective
Steve Matune
1st Vice President
National Association of State Veterans Homes
Fred S. Sganga
2nd Vice President
National Association of State Veterans Homes
SVH’s Lessons Learned
• Preparation is the key!
• Understanding the process.
• Maintaining a professional tone.
• Opportunities to address issues before
they become cited deficiencies.
• Involving your residents.
SVH’s Concerns
• Will the new process be fair, balanced &
consistent?
• Can we maintain the positive tone?
• The need for ongoing communications
between VA, Ascellon and SVH’s.
SVH’s Concerns
• Identifying nationwide trends and
patterns, so we can continue to improve
quality of care and quality of life.
– Reports at every NASVH Winter & Summer
Conference.
• Timeliness of receipt of final written
summation.
Any Questions??