Nothing raises the blood pressure like an impending visit from a state surveyor or Joint Commission inspector. That is understandable given the huge stakes and the uneasiness that comes with being closely scrutinized.For laundry and housekeeping personnel, the thought of an organization’s certification status hinging on their performance can create some high anxiety in the weeks leading up to a survey. Yet with proper preparation, it doesn’t have to be a stressful experience, says Elaine Griswold, RN, founder of Lebanon, OR-based Best Practices in Long-Term Care.
“Surveys should be a time to shine—to be proud of your facility and what you do,” she says. “Your statement should be, ‘Come on in and let us show you what we have accomplished and who we are.’ If the facility only gets things done for a survey and lets it go back to the way it was before, it is apparent to surveyors and they can easily find out from staff and residents what is really going on.”
The focus of the survey process is to ensure regulators that residents are receiving the care they need in a clean, safe, home-like environment. Experts agree that first impressions are especially important.
“The impact on housekeeping is usually the first 10 minutes the surveyors are in the building. First impressions can be a key to setting the tone for the entire process, especially if it’s on the negative side,” says Mike McBryan, senior vice president of Bensalem, PA-based Healthcare Services Group. “A good-looking, well-organized building that has no odors will not draw the inspector’s attention and will allow the administration to handle the initial interviews and conversations in a casual and no-pressure manner. But if the inspector walks in the front door, smells odors, sees dirty floors or finds a public restroom in bad shape, the administration is backpedaling from moment one.”
Howard Nussman, principal with Charlotte, NC-based Premier, attributes some of the laundry and housekeeping staff’s jangled nerves to a fear of speaking with surveyors. It is up to management to offer the proper guidance about speaking with officials, he says.
“Adequate preparation and training is the key,” Nussman says. “Explain that surveyors simply want to know what the laundry and housekeeping staff do in their daily routines and all staff need to do is describe that in their own words, with pride and confidence. If they are well-trained and supervised, talking with the surveyor should be a piece of cake.”
Self-surveying
To minimize stress among laundry and housekeeping staff, the approach at Shell Point Retirement Community in Fort Myers, FL, is to “always be prepared and live each day like we are having a survey,” says Scott Moore, director of facility operations.
As a result, “we honestly do not do anything different in preparation for a survey,” he says. “The survey window is so large we would have to do ‘special things’ for months and it is simply more effective to maintain consistent standards every day, which allows us to be ready all of the time.”
Areas of focus are keeping all rooms clutter-free, maintaining an efficient biohazard waste disposal system and prompt handling of soiled laundry, Moore notes.
“One reason why surveyors have negative opinions of some facilities is because of poor quality control,” he says. “For instance, anything that might appear to be patient neglect—urine smell, soiled clothing and spills left unattended—would be examples of that.
“We make sure that cleanliness and a pleasant environment begin right at the front door and carry all the way through the entire building.”
Poking and probing
As a veteran of surveys, Moore says he has learned two of inspectors’ favorite “secret” spots to check: oxygen storage areas and the separation of soiled and clean linens.
Griswold agrees: “Surveyors have a way of poking into every bathroom, shower room, behind any locked door, resident room, laundry room and everywhere they want to look. They have been known to peer into dumpsters to check if they are clean, if they are too close to the facility, if they have flies and if they are covered.”
“They have been known to walk the perimeter of the facility to check safety and security. They peek behind the clothes dryers to determine the presence of lint and check water temperatures. They have been known to go out behind facilities into storage areas, down into the basements and even on the roof,” Griswold says.
McBryan adds that some other visuals also can leave a negative impression: carts with overflowing soiled linens, food on carts, cleaning products brought from home, filthy water in a bucket and bottles with no labels.
“These are all barometers surveyors use to see if they need to dig in,” he says.
Environmental services carts that are left unattended in public spaces are also problematic.
“It’s a sign that the organization is not ‘on its toes,’” he says. “Keep in mind that carts of any kind left unattended for more than 30 minutes in a corridor used for egress in the event of a fire are considered ‘stored’ there and will generate a Life Safety Code violation in both Joint Commission and CMS surveys.”
Be proactive
Housekeeping “cannot sit back and wait for the surveyors,” McBryan says, asserting that staff need to “be proactive” and emphasize the basics: infection control procedures, personal protective equipment and resident rights.
“The supervisor should be all over the facility to be sure the staff has dotted every ‘i’ and crossed every ‘t,’” he says.
In Nussman’s view, infection prevention is “job one” and that “all staff need to see the connection between what they do daily and the facility’s key strategies for preventing infection.”
This review includes: hand hygiene and use of personal protective equipment; procedures related to each type of resident isolation; basic principles of cleaning and disinfection; and separation of clean and contaminated linens.
“Safety and emergency procedures are also important,” Nussman says. “All staff members need to understand how to keep themselves and their residents safe and how to respond in emergency situations, such as a chemical spill, blood spill, fire and other facility-specific emergency codes.”
As the survey window gets closer and closer, the morning routine should be to get the front entrance and lobby area “spic and span,” McBryan says.
“It is the best way to get the survey off on the right foot. Otherwise, if the entrance and lobby are bad, it will put the survey in a weak position from the start,” he notes.
Lasting impressions
On the exterior, a clean and well-landscaped area leading up to the front door of the facility creates a positive feeling for surveyors before they even enter the building, Griswold adds. Staff also should be cognizant of what visitors see before they reach the front desk, she notes.
“While waiting for the administrator and director of nursing services, the surveyors are observing their surroundings before people are even aware of their arrival,” according to Griswold. “They are forming their opinions at that point. If they have been to the facility before, they are comparing it to their last visit. If they are new, the first impression can be a lasting one.”
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The surveyor’s perspective
The last thing Nancy Gorman wants providers to feel before a survey is anxiety. Instead, the field director of management and development for Oakbrook Terrace, IL-based Joint Commission wants the survey experience to be constructive and beneficial.
“My first piece of advice is to just relax and keep in mind that this is your moment to talk about how you go about doing your job,” she says. “We have experience talking to laundry and housekeeping staff across the country in different long-term care organizations. The questioning is conversational and in language the staff can understand. Joint Commission surveyors have a wealth of tips to share. We realize that the survey experience can be nerve-wracking. If a staff member ‘freezes up’ or cannot answer a question, the surveyor may ask it in a different way, say something to relax the staff member or just move on.”
Gorman says surveyors may ask the housekeeper to “walk through” the process used for terminal cleaning of a room for a resident on isolation precautions or ask how frequently they change mop heads. In the laundry, the surveyor may ask the laundry staff to explain and demonstrate how often the dryer screens are cleaned and may look at the space behind the dryers for dust build-up—a potential fire hazard.
If residents’ personal laundry is done on the units, surveyors also will check to make those machine dryer vents are kept clean, says. Surveyors may observe the processes for sorting soiled laundry, and how clean linen and lost laundry are distributed.
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A sparkling window
-Use the survey time span to identify and correct potential problems well ahead of the inspectors’ visit. By acting proactively, facilities can ensure a positive review. Here is a checklist of some essential actions:
-Check the linen supply to ensure that there is good quality and quantity.
-Make sure laundry equipment is on a preventative maintenance schedule by the maintenance department.
-Clean and check resident personal use equipment such as wheelchairs, walkers, poles and pumps on a routine basis.
-Be certain that department managers check resident rooms daily to ensure proper room cleaning, including privacy curtains and walls.
-See to it that housekeeping and laundry staff are reviewing the proper procedures for chemical storage, locking carts, MSDS information and infection control procedures. Note: Surveyors can tell if staff are performing the correct procedures all the time, rather than just at survey time.
-Talk to residents and determine any problems that may have arisen. Identify problem areas first and correct them prior to the survey.
-Review all clothing items to ensure that they are marked with the names and are delivered to the right resident.
-Locate sources of lingering odors and make a plan to prevent them from occurring. Daily cleaning schedules of some rooms may be necessary.
Source: Elaine Griswold, Best Practices in Long-Term Care, 2010
From the August 01, 2010 Issue of McKnight's Long-Term Care News
