Survey Binder Audit Tab
(to be audited monthly and kept updated by the front desk person)
Required Info
Update
Names & Apt of every assisted and memory care resident
As Needed As needed
List of Medicaid residents with PIF accounts
List of move ins for the last 12 months in order by move in date Apt # & Name
Acuity/Characteristics Form
(use state specific form)
As needed
Move Outs
Name, Date and where they went for the last 12 months Resident agreement, addendums, fire arms, resident rights
As Needed
UDS
Uniform Disclosure Statement
Activity
Current activity Calendar
Update with ED change Monthly
Menu Management
Keep at least 3 months worth of meal Menu’s Names and Titles
Weekly As Needed
CEU’s
Copies of all Administrator CEU
yearly
Employees
Name, hire date, date they started working with residents & title
As Needed
Safety
Info on where the fire/safety binder is located
monthly
Criminal History
Info on where to find binder.
One time
Tab says (Policies) Firearms Addendum Conflict of Interest Incident Report Abuse Reporting Lost or stolen item Observing and Reporting Outside Care Service Provider Staff Training & Orientation Policy Resident Personal Funds Total Evacuation Policy
Copies of the policies in the ED office to be available when surveyors ask.
One Time
Resident Admissions
Admission Forms
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
As needed
As Needed
Tab sheet says – Available upon request from Executive Director
One time check for exp. As needed
Insurance
Copy of first page of Liability Insurance Coverage
Survey
Copy of last State Survey and POC – also a copy in lobby area accessible to public without having to ask
Facility Staffing
Copy of Facility Staffing Plan
One Time
Census
Private & Medicaid
Weekly
Ageia Health Services
Jan
January 19, 2012
Dec
