• The maximum number of complaints and/or Facility Reported Incidents (FRIs) that should be brought onsite for investigation during the full survey was increased due to state complaint backlogs. This number will be used to identify the maximum number of complaints/FRIs that may be included in the initial pool since the number is indicative of the facility census size. This information can be found in Appendix A of the LTC Survey Process Procedure Guide.
• Surveyors are directed by CMS to review CDC, state/local public health information, if available, to be aware of the COVID-19 status of the facility including the COVID-19 county positivity rate.
• Where practical, one surveyor should be assigned to COVID-19 positive residents only. Additionally, a different surveyor should be assigned to the COVID-19 suspected residents, or those residents under observation. Once the surveyor that is assigned to the COVID-19 unit enters the unit, the surveyor should stay on that unit for the remainder of the day while completing the investigation and tasks specific to that unit.
• Surveyors are directed to ask the facility about their policy for entering/exiting COVID-19 units.
• Surveyors are told by CMS that the facility should complete the facility matrix within four hours (check the conference room periodically). Once the matrix is received, each surveyor will review the matrix for residents in their assigned area to identify any substantial concern that should be followed up. At least one resident who smokes, one resident who is receiving dialysis, one resident on hospice, one resident on a ventilator, and two residents who are on Transmission-Based Precautions (suspected or confirmed COVID-19 and/or non-COVID-19 TBP) should be included in the initial pool for the team if available. If one resident is on TBP for COVID-19 and TBP for a non-COVID-19 reason, it is acceptable to include just the one resident.
• Surveyors should conduct rounds until they can determine whether all observation areas should be answered with No Issues/NA, Further Investigation, or NA for hospice, ventilator, transmission-based precautions, and smoking.
• If dining rooms are not being used during the PHE, surveyors should determine whether residents are receiving assistance and ensure observation of room tray delivery.
• If a surveyor is restricted to a specific area of the building (e.g., COVID unit or cohorting), the surveyor should not be physically present with any team member. The surveyor should meet virtually or by telephone (on his/her own) with the team throughout the survey. In that case, the team will have to retrieve that surveyor’s data securely (e.g., through email).
• Surveyors should sample at least three staff, including at least one staff member who was confirmed COVID-19 positive or had signs or symptoms consistent with COVID-19 (if this has occurred in the facility), for purposes of determining compliance with infection prevention and control national standards such as exclusion from work, as well as screening, testing, and reporting.
• Sample three residents for purposes of determining compliance with infection prevention and control national standards such as transmission-based precautions (TBP), as well as resident care, screening, testing, and reporting.
• Include at least one resident who was confirmed COVID-19 positive or had signs or symptoms consistent with COVID-19 (if any).
• Include at least one resident on transmission-based precautions (if any) for a non-COVID-19 reason.
• If one resident is on TBP for COVID-19 and TBP for a non-COVID-19 reason, it is acceptable to include just the one resident.
• Sample five residents for influenza and pneumococcal immunizations.
• Surveyors are directed that during the PHE, for residents who participate in the Resident Council interview and are not on transmission-based precautions (TBP), it is important for everyone including the assigned surveyor to wear a face covering/mask as appropriate, maintain social distancing and perform hand hygiene at all times.