State surveys are one of the most critical events for any skilled nursing facility. A successful survey reflects more than regulatory compliance, it demonstrates a facility's commitment to providing safe, high-quality care to its residents. Unfortunately, many deficiencies cited during surveys are preventable with the right systems, leadership, and continuous quality improvement efforts (Centers for Medicare & Medicaid Services [CMS], 2024).
At Kay Consulting Group, we believe that survey readiness is not a seasonal project, it is a daily commitment. Below are ten of the most common survey deficiencies and practical strategies your facility can implement to remain survey-ready throughout the year.
1. Inadequate Infection Prevention and Control
Infection prevention continues to be one of the most frequently cited areas in long-term care (CMS, 2024).
How to Prevent It
- Conduct routine infection control audits.
- Observe staff practices daily.
- Provide ongoing education and competency validation.
- Review infection surveillance data during QAPI meetings.
2. Medication Administration Errors
Medication errors place residents at risk and often result in survey citations.
How to Prevent It
- Perform regular medication pass observations.
- Audit Medication Administration Records (MARs).
- Ensure physician orders are updated promptly.
- Provide medication administration competency training.
3. Resident Rights Violations
Federal regulations require nursing facilities to protect residents' dignity, privacy, autonomy, and right to participate in care decisions (42 CFR §483.10).
How to Prevent It
- Educate staff on resident rights.
- Encourage person-centered care.
- Investigate grievances promptly.
- Communicate openly with residents and families.
4. Accident Prevention and Fall Management
Falls remain one of the leading causes of injury among nursing home residents and are closely evaluated during surveys (CMS, F689).
How to Prevent It
- Conduct comprehensive fall investigations.
- Complete root cause analyses.
- Update care plans immediately.
- Review fall trends during QAPI meetings.
5. Pressure Injury Prevention
Pressure injuries are largely preventable when facilities perform timely assessments and implement individualized interventions (CMS, F686).
How to Prevent It
- Complete regular skin assessments.
- Follow repositioning schedules.
- Monitor nutritional status.
- Audit wound documentation routinely.
6. Insufficient Staffing and Supervision
Adequate staffing is essential for maintaining quality care and regulatory compliance. Staff competency and supervision are also key survey focus areas.
How to Prevent It
- Monitor staffing based on resident acuity.
- Reduce turnover through staff engagement.
- Provide leadership coaching.
- Conduct competency evaluations.
7. Poor Documentation
Surveyors rely heavily on documentation to verify that required care has been provided.
How to Prevent It
- Conduct weekly documentation audits.
- Educate staff on documentation standards.
- Monitor completion rates.
- Provide immediate coaching when deficiencies are identified.
8. Failure to Follow Care Plans
Federal regulations require facilities to develop and implement person-centered care plans that reflect each resident's needs (42 CFR §483.21).
How to Prevent It
- Review care plans during shift reports.
- Update care plans after significant changes.
- Audit compliance regularly.
- Involve the interdisciplinary team.
9. Emergency Preparedness Deficiencies
CMS requires participating facilities to maintain comprehensive emergency preparedness programs that include planning, training, testing, and communication.
How to Prevent It
- Conduct regular emergency drills.
- Review emergency plans annually.
- Educate new employees.
- Evaluate and improve after each drill.
10. Weak Quality Assurance and Performance Improvement (QAPI) Programs
An effective QAPI program helps facilities identify risks early and implement sustainable performance improvements (CMS, QAPI at a Glance).
How to Prevent It
- Hold consistent QAPI meetings.
- Monitor quality measures monthly.
- Track corrective actions.
- Assign accountability for follow-up.
Conclusion
Survey readiness is not about preparing a few weeks before surveyors arrive it is about creating a culture of continuous compliance, accountability, and quality care. Facilities that conduct routine audits, educate staff, strengthen leadership, and embrace continuous quality improvement are more likely to achieve successful survey outcomes while improving resident satisfaction and safety.
At Kay Consulting Group, we help skilled nursing facilities build sustainable systems that support regulatory compliance, operational excellence, and exceptional resident care. Whether your organization needs survey readiness support, interim leadership, operational assessments, or QAPI development, our experienced consultants are committed to helping your team succeed.
References
- Centers for Medicare & Medicaid Services. (2024). State Operations Manual, Appendix PP, Guidance to Surveyors for Long-Term Care Facilities.
- Centers for Medicare & Medicaid Services. (2024). Quality Assurance and Performance Improvement (QAPI) at a Glance.
- Centers for Medicare & Medicaid Services. (2024). Nursing Home Quality Initiative.
- Code of Federal Regulations. (2025). 42 CFR Part 483, Requirements for States and Long-Term Care Facilities.
- Agency for Healthcare Research and Quality. (2023). Nursing Home Survey on Patient Safety Culture.
- Centers for Disease Control and Prevention. (2024). Infection Prevention and Control Assessment Tool for Nursing Homes.