Nursing homes are charged with caring for our aging loved ones. They’re supposed to be safe havens, places where the elderly are honored and treated well. Sadly, that’s too often not the case. From Iowa to New Mexico to Maryland, surprise DOH inspections are finding that an immense number of nursing homes have at least one major violation. Many fail these inspections outright. How does your facility stack up? Could it pass a surprise DOH inspection?
Why Are DOH Inspections Unannounced?
In a perfect world, nursing homes wouldn’t require inspections by an outside authority. They’d self-regulate perfectly, residents would be cared for correctly, and family members would have peace of mind about their loved one’s health and care. We don’t live in that world. Inspections are critical for identifying issues and ensuring that facilities are toeing the line and living up to their responsibilities. Too often, that’s not the case. For instance, a series of unannounced nursing home inspections in 2024 found that 88% of all facilities in the state had at least one violation. In all, 91 facilities were inspected. Just 11 of them scored perfect marks, although just over half of them scored 90%. Four nursing homes failed the inspection entirely. Unannounced inspections are aimed at catching facilities “flat-footed”. That is, without an opportunity to hide problems. They’re designed to see how nursing homes are operating every day, not just when they know an inspector will be coming around. This helps provide a true measure of whether those facilities are living up to their responsibilities in terms of resident care. Passing a surprise DOH inspection is also important for other reasons. For one, failure can irreparably damage your reputation. For another, inspections influence legal compliance and quality of care outcomes.
Key Areas of Compliance: Understanding the Areas of Focus in a DOH Inspection
Nursing home inspections tend to focus on four areas where compliance is crucial:
1. Environmental Non-Compliance
Inspectors will look for things like uncleanliness, as well as improper waste disposal, and even fire safety violations. This is a very broad category, and can include things like:
- Freezers and refrigerators are not maintained at the correct temperature.
- Frozen foods not thawed correctly,
- Poor lighting and wet floors can lead to slip-and-fall accidents
- Improperly maintained wheelchairs and other equipment
Action Steps
Ensuring that your facility is not docked for environmental non-compliance issues is important. Ensure that common areas meet all required hygiene standards, that your fire safety systems are operational and maintained, that food safety protocols are followed, that you have adequate safety signage, and that staff are trained in environmental concerns.
2. Resident Care Non-Compliance:
Here, inspectors will look for signs of neglect, insufficient medical care, and a failure of your staff to meet the needs of residents. Again, this is a broad category, but it can include things such as:
- A lack of cleaning and grooming for residents.
- Improper medication dispensing.
- A lack of staffing (too few staff members for the number of residents)
- Improper care plans or a lack of care plans
Action Steps
Preventing your facility from being dinged for resident non-compliance care requires strategic, preventative steps. Make sure you have regular care plan reviews, provide ongoing staff training (initial and refresher) for medication management and administration, and create protocols and procedures to ensure that your team can respond quickly to health concerns.
3. Fire Safety Violations
Resident and staff safety in the event of a fire is a critical consideration. You must have a fire safety plan in place, but you also need the right equipment and tools to help ensure communication in an emergency. Fire drills help residents and staff understand their roles and responsibilities during a fire, operational smoke detectors and fire alarms ensure awareness and evacuation plans ensure that everyone knows where to go in the event of a fire. Violations here can include:
- Expired/lack of fire extinguishers
- Lack of a fire safety strategy
- Lack of emergency lighting
- Inoperable/lack of sprinklers
- Improper storage of flammable materials
- Lack of staff training
Action Steps
Fire is one of the most significant threats any nursing home faces. Ensuring that you’re prepared for any eventuality will help you avoid low inspection scores, but more importantly, will help you safeguard your residents and staff. Action steps here include scheduling routine fire drills; ensuring that fire extinguishers are available, inspected, and not expired; and addressing structural and operational fire hazards quickly.
A Brief Self-Assessment
Given the increase in surprise inspections thanks to the number of facilities with violations, it’s important that you know where your nursing home stands. With that information in hand, you can create a strategy to address any issues before DOH inspectors show up at your front door. Below, we’ve outlined a four-step self-assessment to help you determine where to focus your efforts.
- Inspection Readiness: Does your facility’s most recent inspection report highlight any issues related to care or compliance with state or federal standards? If so, those should be your initial priorities. It’s worth looking at the most common violations in your state and then comparing your facility, too.
- Resident & Family Engagement: Compliance and passing your DOH inspection isn’t just about your staff or your facility. It’s also about how engaged and involved both residents and their family members are in the care process. Are care plan meetings held at convenient times for both residents and family members? Do your policies ensure family involvement in care decisions?
- Access to Personal Healthcare: Providing on-site access to medical professionals is important. However, many residents may be more comfortable with their current doctors. Can residents retain access to their personal physicians? Do you provide transportation provided so they can continue seeing their doctors if needed?
- Licensing and Certification: This should go without saying, but licensing and certification are critical for passing your DOH inspection, as well as for the peace of mind of residents and their family members. Is the nursing home and its current administrator fully licensed in the state? Do you maintain Medicaid certification? How often are your credentials reviewed?
Ensuring Quality of Care Delivery
Perhaps the single most important thing for nursing home administrators to ensure is that the facility is delivering the quality of care its residents deserve. Not only does this play a major role in DOH inspections, but it also speaks to resident and family member expectations. Care Processes and Outcomes: Focus on properly managing medications, handling care routines, and monitoring health indicators for the well-being of your residents. To achieve that, you’ll need to put in place detailed care protocols, conduct audits of your staff regularly, and tap into technology that helps you track care in real time. Staffing and Training: Without adequate staffing, no amount of training or planning will help. Make sure your facility is fully staffed and that those employees are trained (and pay attention to continuing education/ongoing training). Regularly audit staffing levels and make sure that you have a robust training plan in place for all employees. Preventing Abuse and Neglect: All facilities have the potential for abuse and neglect, and those are things that DOH inspectors look for, too. To help address the risk to your facility, put into place strict protocols to protect residents. Staff members also need to be trained to recognize the signs of physical, mental, and emotional abuse, and urged to report those signs. Review your anti-abuse and neglect policies regularly, create an anonymous reporting channel so employees can provide feedback without fear of reprisal, and regularly review interactions between staff and residents. Food Storage and Hygiene: Many facilities have violations when it comes to food storage and handling. Safe food practices are critical for the well-being of your residents. Focus on food storage safety, safe food prep, and safe serving practices that align with state and federal health. standards. Important tools to help you achieve these goals include regular kitchen inspections, reviews of food storage practices, and staff training (such as ServSafe certification).
Put the Power of Checklists to Work on Your Behalf
Checklists offer a convenient way to stay on track with your compliance reviews and safety planning. You’ll find a wide range of tools out there, but one of the most effective is the Medicare Nursing Home Checklist, designed to ensure that your operational areas are inspection-ready. Why use a checklist? They offer a simple way to conduct self-audits and benefit from criteria set by Medicare itself. The checklist we linked also gives you the means to focus on cleanliness, care quality, and emergency preparedness, all of which are areas that DOH inspectors will look at.
Maintaining a Positive Facility Environment
You want to avoid violations during a surprise DOH inspection. One way to do that is to double down on creating and maintaining a positive facility environment. Here are a few proven ways to do just that.
- Focus on Hygiene: Make sure all your common areas are clean and sanitary. This includes activity rooms, dining areas, the lobby, hallways, and more. Clean, inviting facilities are essential for meeting compliance requirements. They also help you reassure residents and families of high-quality care.
- Family and Visitor Engagement: Frequent family visits and resident engagement help reduce the isolation your residents may experience and improve their overall well-being. Use tools like Advanced Entry to track the number of visitors your residents receive so staff can engage with those who have few or none.
- Emergency Preparedness: Being prepared for an emergency is a critical part of passing a surprise DOH inspection. Use tools like Advanced Entry to exceed DOH requirements. Our system delivers real-time visitor intelligence, so you know who’s in the facility at all times.
You can also create lists automatically, create and send SMS and email alerts, and keep everyone in the loop with seamless communications. In addition, you must conduct emergency drills, ensure your staff are familiar with evacuation plans, and review the results after each drill to fine-tune things.
Take a Proactive Approach to Compliance
Surprise DOH inspections happen with increasing frequency. Don’t let your facility become a statistic. A proactive approach to compliance will help ensure that you pass even the most in-depth inspection. To be proactive, conduct regular internal audits, make sure you’re fully staffed, focus on delivering a positive resident experience, implement the right emergency/disaster evacuation plans, and use the technology available to you to support those efforts. With vigilance and a solid understanding of what DOH inspectors want to see, you’ll not only pass your inspection but create a positive environment for your residents and deliver the best care possible. If you’re unsure how to use Advanced Entry’s capabilities to their fullest advantage, just get in touch. We’d be happy to discuss how we can dovetail with not just emergency preparedness, but the entire resident experience.
