Strategy for Skilled Nursing Facilities: Quality and Safety State Survey Model

The Center for Health Care Quality's (CHCQ) Licensing and Certification program provides regulatory oversight of skilled nursing facilities (SNFs), in addition to many other types of health facilities in California. CHCQ is reforming the quality and safety oversight process to increase monitoring, provide timely feedback by way of statements of deficiencies, and ensure consistent accountability to promote sustainable regulatory compliance and improved quality of care in SNFs.

During the COVID-19 pandemic, CHCQ surveyors have been on-site in assigned SNFs at a minimum of every four to six weeks to conduct COVID-19 Mitigation Surveys, in addition to conducting annual Centers for Medicare and Medicaid Services re-certification surveys. CHCQ's increased on-site presence in SNFs ensure surveyors' efficiencies in evaluating assigned facilities and providing timely issuance of real-time feedback in areas of non-compliance. Surveyors also engage in constructive dialogue with facility representatives to explain areas of non-compliance, and how the facility's operations failed to meet the minimum standard, in an effort to improve quality and compliance. CHCQ's increased on-site presence has improved safety and quality in SNFs, and CHCQ will phase in the Quality and Safety surveys post-pandemic to replace the COVID-19 Mitigation Surveys, to maintain the level of on-site accountability. In addition, CHCQ has developed an implementation plan to remove the state's backlog of complaints and facility-reported incidents while visiting at this frequency rate.