| Beyond Survey Readiness: Building Continuous Quality Accountability in Long Term Care | <p><img src="/Articles/PublishingImages/740%20x%20740/survey.jpg" alt="survey" class="ms-rtePosition-2" style="margin:5px;width:400px;height:400px;" />Regulatory compliance surveys are essential to ensuring that health care organizations continue to provide safe, high-quality care to residents. Preparing for these surveys can be resource-intensive because it brings frontline staff, interdisciplinary professionals, and leaders together to review shared standards and priorities.</p><p>Nursing homes, assisted living communities, and post-acute care organizations can extend the benefits of this process throughout the year by embedding clear accountabilities into routine workflows. When expectations are clearly outlined for frontline teams, supported through management oversight, and reviewed through established governance processes, teams are better positioned to identify emerging concerns, address them promptly, and sustain improvements. Survey preparedness can then become a natural outcome of everyday practice rather than an intensive, episodic activity.<sup>1</sup><br></p><h3>Extending the Benefits of Survey Readiness</h3><p>Survey or audit preparation brings the team together around a common purpose: ensuring that everyone’s efforts support the best interests of residents and resident-centered care. Team members review care plans, policies, documentation practices, and other key processes to ensure they meet required standards. When these activities are incorporated into day-to-day workflows, responsibilities become clear and compliance expectations are more likely to become sustained practices throughout the year.<sup>2</sup></p><p>Organizations can gain greater value from survey preparation by carrying its most effective practices into routine operations. This can reduce last-minute pressure, improve staff confidence, support timely problem-solving, strengthen consistency, and maintain visibility of important resident-care risks. Continuous readiness does not mean constant inspection or additional paperwork. It means embedding regular quality checks into existing management routines to confirm that accountabilities are completed and to identify trends that may require improvement.<sup>4</sup><br></p><h3>Making Quality Expectations Easier to Act On</h3><p>Regulatory standards are often broad, making it difficult for frontline teams to understand how they should be applied in daily practice. Leadership therefore needs to translate these standards into clear role expectations and specific accountabilities.</p><p>One example is the workflow followed when frontline staff notice a change in a resident’s condition. A significant status change should have a clear pathway from assessment to documentation, notification of the appropriate team members and family, and escalation of unresolved clinical concerns to the appropriate interdisciplinary team member or manager.</p><p>Standards can also be organized into daily, weekly, and monthly accountabilities. Frontline actions can occur daily, care managers or unit managers can review implementation weekly and address identified gaps, and senior management can analyze broader trends monthly across care practices, nursing practices, and policy implementation. These patterns can help leaders strengthen weaker areas of the accountability model and guide quality improvement initiatives.<sup>3</sup><br></p><h3>Using Early Signals to Support Timely Improvement</h3><p>An embedded accountability approach can help organizations identify leading indicators early. Survey findings, hospitalization rates, falls with injury, and missed clinical performance targets lagging indicators because they provide information after an event or outcome has occurred. Leading indicators provide earlier signals that a process or clinical concern may require attention.<sup>1</sup></p><p>For example, repeated documentation gaps may indicate that a process is unclear, difficult to complete, or not well integrated into routine workflow. Leaders can respond with clarification, coaching, workflow adjustments, or additional resource support before the issue affects resident outcomes or regulatory performance.<br></p><h3>Closing the Loop from Identification to Improvement</h3><p>Identifying a concern is only the first step in quality improvement. Organizations need a clear accountability loop that moves from identification to action, verification, and follow-up. When a gap or emerging risk is identified, responsibility for the next step should be assigned to the appropriate team member or leader, along with an expected completion timeline.</p><p>Once action has been taken, management oversight is needed to confirm that the concern was addressed and the intended outcome achieved. This may include reviewing updated documentation, confirming communication with team members or family, reassessing the resident’s condition, or determining whether a workflow change has been implemented consistently.</p><p>Verification should not be viewed as monitoring staff for mistakes. It ensures that important concerns are not left unresolved and that staff receive the support needed to complete their accountabilities. If the same concern continues, leaders can reassess the process, identify barriers, and provide further clarification, coaching, or quality improvement support.<br></p><h3>Strengthening Quality Without Adding New Technology</h3><p>This approach does not require new technology, software integration, or expensive system add-ons. It can be implemented by creating clear workflows for each level of care delivery. Nursing assistants and other direct care staff provide day-to-day care, while licensed practical nurses and registered nurses help ensure that care reflects each resident’s needs. Care manager or unit manager workflows provide follow-up and oversight, while senior management workflows support trend identification and evaluation.</p><p>The model can be introduced gradually by focusing on a limited number of high-priority areas. A facility may begin by selecting up to three recurring quality risks, defining the frontline actions expected for each risk, establishing when concerns must be escalated, assigning weekly management review, and updating existing huddles, checklists, or audit tools. Progress can be reviewed monthly to determine whether the workflow is effective and sustainable.</p><p>Continuous accountability can be built using tools already in place, including shift reports, huddles, unit meetings, clinical rounds, quality boards, audit forms, leadership rounds, and interdisciplinary reviews.<br></p><h3>Making Continuous Readiness Part of the Culture</h3><p>Survey readiness and continuous quality improvement should complement one another. Small, consistent routines can be more sustainable than large periodic initiatives. Clear accountabilities provide staff with direction and support rather than blame. Proactive identification and timely follow-through can strengthen resident care, increase organizational confidence, and contribute positively to regulatory outcomes and resident and family satisfaction.</p><p>Long term care organizations do not need to recreate the intensity of survey preparation every day. They can preserve its strongest elements: shared priorities, clear responsibilities, visible leadership, and timely follow-through. When these practices become part of routine operations, survey readiness becomes a natural outcome of a stronger quality culture rather than a separate organizational event.<br><br class="ms-rteStyle-Normal"><span class="ms-rteStyle-Normal">References</span><br class="ms-rteStyle-Normal"><span class="ms-rteStyle-Normal">1. Centers for Medicare & Medicaid Services. QAPI at a Glance: <em>A Guide for Nursing Homes.</em> Centers for Medicare & Medicaid Services. Accessed July 18, 2026. </span><br class="ms-rteStyle-Normal"><span class="ms-rteStyle-Normal">2.  National Academies of Sciences, Engineering, and Medicine. <em>The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff.</em> The National Academies Press; 2022. doi:10.17226/26526. </span><br class="ms-rteStyle-Normal"><span class="ms-rteStyle-Normal">3. Ivers N, Yogasingam S, Lacroix M, et al. Audit and feedback: effects on professional practice. <em>Cochrane Database of Systematic Reviews.</em> 2026;(6):CD000259. doi:10.1002/14651858.CD000259.pub5.</span><br class="ms-rteStyle-Normal"><span class="ms-rteStyle-Normal">4. Zonneveld N, Pittens C, Minkman M. Appropriate leadership in nursing home care: a narrative review. <em>Leadership in Health Services.</em> 2021;34(1):16-36. doi:10.1108/LHS-04-2020-0012. </span><br><br><em><img src="/Articles/PublishingImages/2026/Prachi-Patel.jpg" alt="Prahi Patel" class="ms-rtePosition-2" style="margin:5px;width:125px;height:154px;" />Prachi Patel, RN, CHE, MHA, is director of care at a large continuing care campus in Calgary, Alberta, where she provides leadership across complex care environments and supports interdisciplinary teams in strengthening resident-centered care, accountability, and sustainable quality practices. </em></p><p><em><span style="font-family:aptos, sans-serif;font-size:14.6667px;color:#212121;">Provider<em> magazine includes information from a variety of sources, such as contributing experts. The views expressed by external contributors do not necessarily reflect the views of Provider magazine and AHCA/NCAL.<span class="Apple-converted-space"> </span></em></span><span style="font-family:aptos, sans-serif;font-size:14.6667px;color:#96607d;"><a href="/About/Pages/Submit-Article.aspx" target="_blank" title="Submit an article" data-outlook-id="badae440-b0ce-4219-9c08-f7e349a8e3d6" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" style="color:#96607d;margin-top:0px;margin-bottom:0px;"><em><span style="text-decoration:underline;">Learn how to submit an article.</span></em></a></span><br></em></p> | 2026-08-20T04:00:00Z | <img alt="survey" src="/Articles/PublishingImages/740%20x%20740/survey.jpg" style="BORDER:0px solid;" /> | Management;Survey and Certification | Prachi Patel, RN | Survey or audit preparation brings the team together around a common purpose: ensuring that everyone’s efforts support the best interests of residents and resident-centered care. |
| How Housekeeping Standardization Strengthens Survey Readiness | <p><strong class="ms-rteThemeForeColor-2-0">ADVERTORIAL</strong></p><p style="text-align:center;"><img src="/Articles/PublishingImages/2026/staples_Healthcare_SupplyCloset_3882.jpg" alt="" style="margin:5px;width:500px;height:333px;" /> </p><p>For long term care and senior living providers, regulatory expectations continue to intensify. Infection prevention standards are more prescriptive, environmental services practices receive heightened scrutiny, and surveyors increasingly assess whether processes are executed consistently across units, shifts, and facilities.</p><p>Amid staffing shortages and rising costs, many organizations struggle to maintain that consistency. One often overlooked factor is how housekeeping and environmental services (EVS) supplies are selected, managed, and used.</p><p>Housekeeping standardization offers a practical way to strengthen survey readiness. By aligning products, purchasing, and workflows across facilities, operators can reduce variation, support staff training, and create more defensible, repeatable practices during survey.</p><h3>Why Variation Creates Compliance Risk</h3><p>Surveyors not only assess whether appropriate supplies are available, but whether staff consistently understand how and when to use them. When multiple brands, formats, or SKUs are in circulation, training becomes more complicated and execution less reliable.</p><p>“When staff know exactly what to use and how to use it, execution becomes more consistent and errors decline,” says Greg Hemmer, a health care facilities solutions expert with Staples Business.</p><p>From a regulatory perspective, standardization reduces the likelihood of improper product use, dilution errors, or substitution during supply shortages. It also supports clearer documentation and consistent protocols, both of which can be critical during survey review.<br></p><h3>Gaining Visibility Across Facilities</h3><p>Another regulatory challenge for multi-site operators is limited visibility into purchasing practices. Without centralized oversight, leadership may struggle to confirm whether approved products are being used or if individual facilities are introducing unapproved alternatives.</p><p>That was the case for Claiborne Senior Living, which owns and operates 17 senior living communities across the Southeast. Each property had historically purchased its own housekeeping and environmental services supplies from various vendors.</p><p>“We needed a clearer picture of what each community was spending and what they were actually buying,” says Molly Crawford, asset manager for Claiborne Senior Living. “Not just from a cost standpoint, but for consistency.”</p><p>Working through its group purchasing organization, HPSI Purchasing Services, Claiborne explored opportunities to standardize purchasing across facilities. Certain vendor partners, including Staples, were identified as resources that could support consistent product selection, site-level quantities, and consolidated reporting.<br></p><h3>Aligning Supplies with Regulatory Expectations</h3><p>Like many long term care leaders, Crawford initially associated Staples primarily with office supplies. What she learned was that Staples supports health care providers across categories including housekeeping, dispensers, furniture, technology, and print, and maintains relationships with major GPOs serving the sector.</p><p>Staples analyzed Claiborne’s historical purchasing data and identified opportunities to reduce variation, consolidate SKUs, and align products across communities. The immediate financial impact was clear.</p><p>“It was an automatic 17 percent savings,” Crawford says. “Across 17 buildings, that’s significant. Small costs really do add up.”</p><p>Equally important, leadership gained confidence that every community had access to the same approved products, helping reduce compliance risk when surveyors assess practices across locations or revisit findings.<br></p><h3>Ensuring Availability Without Disruption</h3><p>Standardization must be paired with reliable access to supplies. Delays or substitutions can disrupt care and undermine compliance, particularly during peak demand or severe weather events.</p><p>“Timing is critical,” Crawford says. “Our business doesn’t stop. We can’t wait days for critical supplies.”</p><p>To minimize risk, Claiborne piloted standardized products at one community before expanding systemwide. The gradual rollout gave teams time to validate product performance, confirm staff adoption, and ensure delivery timelines aligned with operational needs.</p><p>Over time, Claiborne standardized key environmental services components, including towel, tissue, and soap dispensers, as well as gloves, trash liners, wipes, microfiber cloths, and other housekeeping essentials. Using fewer brands and consistent SKUs reduced substitution risk and simplified oversight.<br></p><h3>Simplifying Training and Reinforcing Execution</h3><p>One of the most tangible compliance benefits of standardization has been its effect on staff training. When products are consistent, onboarding becomes less complex, and procedures can be reinforced uniformly across communities.</p><p>“When we implement change, we focus on sustainability,” Crawford says. “Success isn’t tied to any one person. Standardization creates consistency and makes training easier across our communities.”</p><p>This consistency helps staff confidently explain processes during survey, supports more uniform execution across shifts, and reduces variation that could otherwise prompt surveyor concern.<br></p><h3>Reducing Administrative Burden on On-Site Leaders</h3><p>Before standardization, on-site leaders spent time researching products, comparing prices, managing vendors, and reconciling invoices, time that could be spent supporting staff or maintaining regulatory readiness.</p><p>“That’s the hidden labor cost,” Hemmer explains. “Time spent scouring the internet for products instead of focusing on the community.”</p><p>By consolidating purchasing on a single platform, Claiborne reduced administrative tasks for department heads and simplified budgeting. Managers no longer needed to make product decisions or manage multiple suppliers.</p><p>“All they have to worry about is staying within their budget,” Crawford says.<br></p><h3>Building a More Survey-Resilient Organization</h3><p>Today, Claiborne has clearer visibility into spending, product usage, and cash flow across all 17 communities. That visibility helps leadership identify risks, reinforce standard practices, and plan with greater confidence.</p><p>“Because we know our average spend and manage it consistently,” Crawford says, “we’re better able to spot inefficiencies, reduce risk, and make informed decisions as we grow.”</p><p>For long term care providers navigating evolving regulatory expectations, housekeeping standardization is not simply an efficiency initiative. It is a foundational strategy that supports infection prevention, staff execution, training, and survey readiness, while also reducing complexity and controlling costs.<br><br>To learn more about how standardized purchasing supports regulatory readiness and operational consistency in senior living and long term care, contact Greg Hemmer at <a href="mailto:Gregory.Hemmer@Staples.com" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="email Greg">Gregory.Hemmer@Staples.com</a> or visit <a href="https://www.staplesadvantage.com/learn/industries-served/healthcare/senior-living?cid=bnr:tp:tp:sb:mf:t:sl:cc:na:sl:na:na:ahca:ca&utc=LFKYXG" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">staplesbusiness.com/seniorliving</a>.<br><br></p><p><span style="font-family:aptos, sans-serif;font-size:14.6667px;color:#212121;">Provider<span class="Apple-converted-space"> </span><em>magazine includes information from a variety of sources, such as contributing experts. The views expressed by external contributors do not necessarily reflect the views of<span class="Apple-converted-space"> </span></em>Provider<em> magazine and AHCA/NCAL.<span class="Apple-converted-space"> </span></em></span><span style="font-family:aptos, sans-serif;font-size:14.6667px;color:#96607d;"><a href="/About/Pages/Submit-Article.aspx" title="Submit an article" data-outlook-id="badae440-b0ce-4219-9c08-f7e349a8e3d6" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" style="color:#96607d;margin-top:0px;margin-bottom:0px;"><em><span style="text-decoration:underline;">Learn how to submit an article.</span></em></a></span><br></p> | 2026-05-12T04:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/staples_supply.jpg" style="BORDER:0px solid;" /> | Management;Survey and Certification | | Housekeeping standardization offers a practical way to strengthen survey readiness. By aligning products, purchasing, and workflows across facilities, operators can reduce variation, support staff training, and create more defensible, repeatable practices during survey. |
| Top 10 Provider Resources of 2024 | <p>A roundup of all the top 2024 resources featured in <em>Provider Magazine</em> and on the website. <img src="/Articles/PublishingImages/740%20x%20740/nurses.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:250px;" /><br></p><p>1.      
<a href="/Articles/Pages/Deficiencies-at-F699-Emerging-Trends-in-the-Enforcement-of-New-Regulations.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>Deficiencies at F699: Emerging Trends in the Enforcement of New Regulations</strong></a> (article--2/13/2024)</p><p>One of the major changes in the revised regulations included tags for which many skilled nursing facilities were not adequately prepared to address, specifically F699, which addresses the provision of “trauma-informed care."</p><p>
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</p><p>2.      
<a href="/Video-Resources/Podcasts/Pages/Government-Relations-and-Advocacy-in-Long-Term-Care.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>Government Relations and Advocacy in Long Term Care</strong></a> (podcast--12/19/2024)</p><p>Bassett shares insights on key issues, including the impact of Trump's administration on the long term care industry, staffing mandates, and quality improvement initiatives. </p><p>
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</p><p>3.      
<a href="/Video-Resources/ProviderTV/Pages/A-Playbook-on-Succeeding-in-Long-Term-Care-with-Mark-Parkinson.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>A Playbook on Succeeding in Long Term Care with Mark Parkinson</strong></a> (video--12/19/2024)</p><p>A new book offers long term care professionals a blueprint on how to thrive in every facet of caring for our nation's seniors.</p><p>
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</p><p>4.      
<a href="/Video-Resources/ProviderTV/Pages/Purpose-built-Technology-Supports-Care-Outcomes-with-Viventium.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>Purpose-built Technology Supports Care Outcomes with Viventium</strong></a><strong> </strong>(video--12/12/2024)</p><p>Technology should support care providers delivering the highest quality of care, not take up valuable time. Gupta and Glauber from Viventium explain how software purpose-built for long term care can make a big difference. <br></p><p>
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</p><p>5.      
<a href="/Articles/Pages/Delving-into-Data-Steps-to-Make-Sense-of-It-All.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>Delving into Data: Steps to Make Sense of It All</strong></a> (article--12/17/2024)</p><p>Data can support decisions about the nursing department by revealing current situations, trends, and predictions, along with potential risks. Data can also offer insight into the cause of an issue.</p><p>
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</p><p>6.      
<a href="/Articles/Pages/4-Tips-to-Improve-Section-GG-Coding-Accuracy.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>4 Tips to Improve Section GG Coding Accuracy</strong></a> (article--1/09/2024)</p><p>The four tips described here will help facility teams develop a process to ensure the accuracy of section GG items.</p><p>
<strong><br></strong></p><p>7.      
<a href="/Issues/2024/Summer/Pages/Top-High-Tech-Trends-in-Long-Term-Care.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>Top High-Tech Trends in Long Term Care</strong></a> (article--6/1/2024)</p><p>New technology in long term care is exciting and promises to deliver many new functionalities as long as the purchase and implementation work for the facility, providers, and residents.</p><p>
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</p><p>8.      
<a href="/Marketplace/Pages/Using-Technology-for-Improved-Outcomes-in-Senior-Living%20Medication-Management.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>Using Technology for Improved Outcomes in Senior Living</strong><strong>
</strong><strong>Medication Management</strong></a> (article--11/07/2024)</p><p>Learn how effective medication management technology reduces risks, improves resident outcomes, and prevents staff burnout in senior living communities.</p><p>
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</p><p>9.      
<a href="/Articles/Pages/Why-Directors-of-Nursing-Need-a-Mentor.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>Why Directors of Nursing Need a Mentor</strong></a> (article--6/11/2024)</p><p>When a nurse reaches the level of director of nursing (DON), the perspective changes, and sometimes not in the most comfortable of ways. You are being looked at as the person with the answers, but who is there to help you when you have a question? </p><p>
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</p><p>10. 
<a href="/Articles/Pages/Deficiencies-at-F742-Emerging-Trends-in-the-Enforcement-of-New-Regulations.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">
<strong>Deficiencies at F742: Emerging Trends in the Enforcement of New Regulations</strong></a> (article--2/15/2024)</p><p>Vicarious learning is useful when it comes to survey deficiencies—that is, learning about the reasons for deficiencies in other facilities enables us to examine the practices, polices, and procedures in our own facility.<br></p><p></p> | 2024-12-23T05:00:00Z | <img alt="" src="/Articles/PublishingImages/740%20x%20740/nurses.jpg" style="BORDER:0px solid;" /> | Management;Survey and Certification | | A roundup of all the top 2024 resources featured in Provider Magazine and on the website. |
| Deficiency-Free Complaint Surveys | <p>State agencies survey skilled nursing centers to ensure they are meeting state and federal standards for quality and staffing set by the Centers for Medicare & Medicaid Services (CMS). These survey agencies respond to all reported complaints by residents, families, and facilities (i.e., self-reported incidents) through complaint surveys. </p><p><a href="/Issues/2024/Documents/By%20The%20Numbers.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><img class="ms-asset-icon ms-rtePosition-4" src="/_layouts/images/icpdf.png" alt="" />By The Numbers.pdf</a><br></p> | 2024-03-11T04:00:00Z | <img alt="" src="/Issues/2024/Spring/PublishingImages/PrvSpr24_BTN.jpg" style="BORDER:0px solid;" /> | Survey and Certification | | A deficiency-free complaint survey means that a facility is being operated in absolute compliance with state and federal regulations. |