1. Either you or someone within your organization fails to do the work required in an important area - an example might be the QIDP fails to type an annual staffing, the nurse does not do annual assessments, staff do not document data or goals, or the organization fails to get some required appointments or needs met per standards.
2. A negative surveyor acting out of line - let's face it, nobody wants to say it, but the truth is some surveyors act differently than others. While they should all hold the facility to the standards, there are simply some of them that have their own interpretations of what those standards mean. In other words, they may "see something that's not in the standards," or "hold the facility to different level of the standards" (quotes I have heard from providers). A surveyor that comes in with a negative attitude from the start can cause a difficult survey process to follow. They tend to look deeper and longer, they tend to complain about everything, and often they make statements about right and wrong that simply are not part of the standards, but instead opinion based. Surveyors will tell you that this doesn't happen; however, that would be to admit that surveyors are not human and subject to influences that can cause them to have a bad day. Sorry, the fact is, some surveyors act negatively during the survey process. Sorry - truth hurts.
3. The final reason for a negative survey is usually a combination of the above two. For example, you may have a really bad dietician who does not do his or her job. As a result all the diets are wrong or there is a lack of training on some special diets needed. Along comes a surveyor already in a "negative" mood and suddenly this issues is a major problem. The surveyor becomes visibly upset and then starts to, as many people have stated, "dig for more bad stuff". Often this process becomes extremely hard on the surveyor and the facility because it continues to grow.
So, with the above three potential situations in mind, what can the QIDP do to ensure a positive survey? There are actually several things the QIDP can do:
1. Try to ensure that all areas have been addressed prior to the annual survey. Do a mock survey, find your weak spots (yes, you have them, we all do) and work on correcting them.
2. Make the survey process positive by being honest. I'm not saying to go tell the surveyor something like, "Well, look over here on John's annual hearing test....we didn't get it finished for fourteen months instead within the twelve..." No, there is no reason to hand the surveyor the deficient tag, let them look, but when they ask you about it, be honest. This is your time to build a reputation and you want to have a reputation of being honest even in light of negative findings. In other words, it's better to simply say, "I see what you're looking at and agree, we did not get the vision test completed in a timely manner. We will correct that." Don't lie - it's your reputation and the reputation of the facility that you need to maintain.
3. If a surveyor becomes aggressive when seeking answers or is being negative, try to remain positive. We have all seen surveyors that appear to attempt to make everything that has gone wrong a terrible thing! I have heard QIDPs, staff, managers and even owners say things like, "Wow, we know it's a mistake and we need to correct it, but that surveyor is just hounding us over it," or "If that surveyor acts like that, I'm not coming back in the morning." Simply remain as positive as you can and answer the questions directly. I once had a negative acting surveyor asking me direct questions that to be honest I did not agree with the findings that were being presented. I could tell the surveyor was going to "jump" on anything I said in a negative manner based on the fact that they just had over two things I already answered. I simply changed my form of answers to "Yes" or "No". When the surveyor prompted me further on a question I had answered "No" to by saying, "So are you telling me that you did not do this?" I responded, "Yes, I am telling you we did not address that." Naturally, the 2567 had a statement that said, "QIDP A stated that he agreed and the facility did not address X".
4. Get the deficiencies, write the POC and address them. Simple.
5. If you truly feel that the survey was negative and it was not yours or the facilities fault, first complete the comment option (online in Texas), consider talking with the surveyor's supervisor, and finally if needed file a formal complaint following your state's guidelines. However, remember that you may have to deal with the same surveyor again, the surveyor may have just had a bad day, or maybe....just maybe, you did have a negative survey because of issues within your facility or you were having a bad day....
Ultimately, regardless of the outcome of any survey, you need to remember that surveyors are not there to "Pat you on the back" and tell you what a great job you and your staff are doing. They are there to ensure compliance with a minimal set of standards. They look for the negative things in the facility and that is their job. While they may like things you are doing that are positive, there is always a good chance they can find something wrong. They are human and just like you they can make mistakes or misunderstand something you have been working on for the facility. Just because one set of surveyors finds something wrong, it does not mean the next set will find the same issues. It's just part of the nature of the business. The bottom line though is that a survey process, the corrective action taken after the process, and the continued work between surveyors and facilities should have an end result of one thing: Improving the lives of people with Developmental Disabilities, and if that can happen in the end, that's all that really matters.