Surveyor
A surveyor approaches you and asks a question, but you don’t know the answer.
What is “I’m not sure, but I know how to find out”? Staff should not guess or make up an answer.
Patients have turned the milieu lights off. What should staff do?
What is redirecting the patients and keeping the area appropriately illuminated according to program expectations?
Name three pieces of information every staff member should know about the patients they are currently supporting.
What is relevant risk level, precautions, observation status, allergies, current safety concerns, or individualized support needs?
What type of language should be used when documenting a patient interaction or incident?
What is objective, factual, respectful, and based on observable behaviors rather than assumptions or personal opinions?
Where should staff go to find instructions for responding to an emergency?
What is the organization’s emergency procedures, posted emergency information, or approved policy system?
A surveyor asks you to explain something while you are actively assisting a patient.
What is prioritizing patient safety and respectfully asking the surveyor for a moment?
You notice an unattended sharp or potentially hazardous item.
What is securing it immediately and following the reporting or escalation process?
Where should staff obtain current information about a patient’s risks and precautions?
What is the approved handoff, treatment documentation, patient record, or other established communication process?
When should documentation be completed?
What is within the timeframe established by organizational policy?
The fire alarm activates, but you do not see smoke or flames. What should you do?
What is treat the alarm as real and follow the established fire-response procedure?
Name two things you should do when speaking with a surveyor.
What are being honest, answering only the question asked, explaining your actual process, and avoiding guessing?
A refrigerator temperature is out of range. What should happen?
What is taking immediate action according to policy, documenting the variance and response, and notifying the appropriate leader?
A patient’s behavior or presentation suddenly changes. What do you do?
What is assessing immediate safety, notifying the appropriate clinical or medical team member, and documenting according to policy?
What should you do if you realize you made an error in documentation?
What is correct it using the approved amendment or late-entry process—never backdate or conceal the error?
What should staff do if a patient is missing or cannot be located?
What is immediately follow the missing-patient or elopement procedure, notify the required individuals, and provide an accurate description and relevant risk information?
A surveyor asks, “What do you do here?”
What is clearly explaining your role, your responsibilities, and how your work supports safe, individualized patient care?
You see a blocked exit, damaged furniture, exposed cord, or other environmental risk.
What is correcting it immediately when safe and reporting it through the appropriate process?
Why is it incorrect to say things like, “That patient is difficult” or “They’re attention-seeking”?
What is because care should be objective, respectful, trauma-informed, and based on assessed needs and observable behavior?
An incident occurred, but staff only completed an incident report. What could still be missing?
What is the appropriate clinical documentation, reassessment, notifications, interventions, and follow-up?
An emergency prevents staff from accessing the electronic health record. How should essential information and care be documented?
What is using the organization’s approved downtime procedures and forms?
A surveyor identifies a concern while walking through the program. What should you avoid doing?
What is becoming defensive, blaming another department, or minimizing the concern?
What is the most important response when staff identify an immediate safety concern?
What is taking action to protect patients first—not simply documenting it for someone else to address later?
A surveyor asks how treatment is individualized. Give two examples.
What are patient-specific goals, interventions based on assessed needs, accommodations, discharge planning, risk-management strategies, or evidence that patient feedback affects the plan?
Name three qualities of strong documentation.
What are timely, objective, accurate, complete, patient-specific, and consistent with the care actually provided?
After an emergency has ended, what responsibilities might still remain?
What are reassessing those involved, completing clinical and incident documentation, making required notifications, restoring supplies, debriefing, and identifying follow-up actions?