How the state surveys nursing homes

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Licensing and certification


All Colorado nursing homes are licensed by the state through us. Nursing homes are also certified to provide services to eligible Medicare and Medicaid beneficiaries, and are expected to meet federal regulations. We enforce state and federal regulations through unannounced annual surveys and complaint investigations.

Annual surveys take place every nine to 15 months, with an average of every 12 months. Complaint investigations are conducted whenever we receive a formal regulatory-related complaint that falls under our jurisdiction from a family member, staff member, resident or friend. We can investigate complaints relating to quality of life and quality of care at a facility, including residents' rights, abuse, dietary concerns, staffing and environmental concerns. We can't investigate complaints related to billing or insurance concerns.

During surveys and inspections, interdisciplinary teams evaluate the care and services provided to residents in accordance with regulatory requirements. Deficiencies may be cited if the facility fails to meet any of the requirements.

Each deficiency cited is assigned a scope and severity, which indicates the level of harm and the pervasiveness of the deficient practice. Scope and severity levels range from A, no actual harm on an isolated basis, to L, immediate jeopardy to resident health and safety on a widespread basis.

Before beginning a survey, team members review the nursing home's background. They look at previous survey results, complaint investigations, occurrence reports and quality indicators that give information specific to each facility. They also consult with the ombudsmen assigned to that facility to get an idea of whether there are special concerns or problems that they should be aware of during the survey.

All surveys are unannounced. Once in the facility, surveyors observe what's going on in the nursing home, review medical records and other documents, and interview residents, family members and nursing home staff. The surveyors summarize their observations to facility staff at the conclusion of the visit.

If there are deficiencies, the nursing home receives a letter and a survey form (Form 2567). It's given 10 days to respond with a plan of correction. The plan of correction is reviewed for acceptance. A follow-up survey, the revisit, takes place to verify the accurate and timely implementation of the plan of correction.