42 C.F.R. Subpart E—Survey and Certification of Long-Term Care Facilities
Title 42 - Public Health
Source: 59 FR 56238, Nov. 10, 1994, unless otherwise noted.
Sections 1819 and 1919 of the Act establish requirements for surveying SNFs and NFs to determine whether they meet the requirements for participation in the Medicare and Medicaid programs. As used in this subpart— Abbreviated standard survey means a survey other than a standard survey that gathers information primarily through resident-centered techniques on facility compliance with the requirements for participation. An abbreviated standard survey may be premised on complaints received; a change of ownership, management, or director of nursing; or other indicators of specific concern. Abuse means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Deficiency means a SNF's or NF's failure to meet a participation requirement specified in the Act or in part 483, subpart B of this chapter. Dually participating facility means a facility that has a provider agreement in both the Medicare and Medicaid programs. Extended survey means a survey that evaluates additional participation requirements subsequent to finding substandard quality of care during a standard survey. Facility means a SNF or NF, or a distinct part SNF or NF, in accordance with §483.5 of this chapter. Immediate family means husband or wife; natural or adoptive parent, child or sibling; stepparent, stepchild, stepbrother, or stepsister; father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law; grandparent or grandchild. Immediate jeopardy means a situation in which the provider's noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident. Misappropriation of resident property means the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident's belongings or money without the resident's consent. Neglect means failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness. Noncompliance means any deficiency that causes a facility to not be in substantial compliance. Nurse aide means an individual, as defined in §483.75(e)(1) of this chapter. Nursing facility (NF) means a Medicaid nursing facility. Paid feeding assistant means an individual who meets the requirements specified in §483.35(h)(2) of this chapter and who is paid to feed residents by a facility, or who is used under an arrangement with another agency or organization. Partial extended survey means a survey that evaluates additional participation requirements subsequent to finding substandard quality of care during an abbreviated standard survey. Skilled nursing facility (SNF) means a Medicare nursing facility. Standard survey means a periodic, resident-centered inspection which gathers information about the quality of service furnished in a facility to determine compliance with the requirements for participation. Substandard quality of care means one or more deficiencies related to participation requirements under §483.13, Resident behavior and facility practices, §483.15, Quality of life, or §483.25, Quality of care of this chapter, which constitute either immediate jeopardy to resident health or safety; a pattern of or widespread actual harm that is not immediate jeopardy; or a widespread potential for more than minimal harm, but less than immediate jeopardy, with no actual harm. Substantial compliance means a level of compliance with the requirements of participation such that any identified deficiencies pose no greater risk to resident health or safety than the potential for causing minimal harm. Validation survey means a survey conducted by the Secretary within 2 months following a standard survey, abbreviated standard survey, partial extended survey, or extended survey for the purpose of monitoring State survey agency performance. [59 FR 56238, Nov. 10, 1994, as amended at 68 FR 55539, Sept. 26, 2003] (a) A State plan must provide that the requirements of this subpart and subpart F of this part are met, to the extent that those requirements apply to the Medicaid program. (b) A State may establish a program to reward, through public recognition, incentive payments, or both, nursing facilities that provide the highest quality care to Medicaid residents. For purposes of section 1903(a)(7) of the Social Security Act, proper expenses incurred by a State in carrying out such a program are considered to be expenses necessary for the proper and efficient administration of the State plan. (c) A State must conduct periodic educational programs for the staff and residents (and their representatives) of NFs in order to present current regulations, procedures, and policies under this subpart and subpart F of this part. (d) Required remedies for a non-State operated NF. A State must establish, in addition to termination of the provider agreement, the following remedies or an approved alternative to the following remedies for imposition against a non-State operated NF: (1) Temporary management. (2) Denial of payment for new admissions. (3) Civil money penalties. (4) Transfer of residents. (5) Closure of the facility and transfer of residents. (6) State monitoring. (e) Optional remedies for a non-State operated NF. A State may establish the following remedies for imposition against a non-State operated NF: (1) Directed plan of correction. (2) Directed in-service training. (3) Alternative or additional State remedies. (f) Alternative or additional State remedies. If a State uses remedies that are in addition to those specified in paragraph (d) or (e) of this section, or alternative to those specified in paragraph (d) of this section (other than termination of participation), it must— (1) Specify those remedies in the State plan; and (2) Demonstrate to CMS's satisfaction that those alternative remedies are as effective in deterring noncompliance and correcting deficiencies as the remedies listed in paragraphs (d) and (e) of this section. [59 FR 56238, Nov. 10, 1994; 60 FR 50118, Sept. 28, 1995] (a) For each SNF and NF, the State survey agency must conduct standard surveys that include all of the following: (1) A case-mix stratified sample of residents; (2) A survey of the quality of care furnished, as measured by indicators of medical, nursing, and rehabilitative care, dietary and nutrition services, activities and social participation, and sanitation, infection control, and the physical environment; (3) An audit of written plans of care and residents' assessments to determine the accuracy of such assessments and the adequacy of such plans of care; and (4) A review of compliance with residents' rights requirements set forth in sections 1819(c) and 1919(c) of the Act. (b) The State survey agency's failure to follow the procedures set forth in this section will not invalidate otherwise legitimate determinations that a facility's deficiencies exist. (a) Basic rule. All standard surveys must be unannounced. (b) Review of survey agency's scheduling and surveying procedures. (1) CMS reviews on an annual basis each State survey agency's scheduling and surveying procedures and practices to ensure that survey agencies avoid giving notice of a survey through the scheduling procedures and the conduct of the surveys. (2) CMS takes corrective action in accordance with the nature and complexity of the problem when survey agencies are found to have notified a SNF or NF through their scheduling or procedural policies. Sanctions for inadequate survey performance are in accordance with §488.320. (c) Civil money penalties. An individual who notifies a SNF or NF, or causes a SNF or NF to be notified, of the time or date on which a standard survey is scheduled to be conducted is subject to a Federal civil money penalty not to exceed $2,000. (a) Basic period. The survey agency must conduct a standard survey of each SNF and NF not later than 15 months after the last day of the previous standard survey. (b) Statewide average interval. (1) The statewide average interval between standard surveys must be 12 months or less, computed in accordance with paragraph (d) of this section. (2) CMS takes corrective action in accordance with the nature of the State survey agency's failure to ensure that the 12-month statewide average interval requirement is met. CMS's corrective action is in accordance with §488.320. (c) Other surveys. The survey agency may conduct a survey as frequently as necessary to— (1) Determine whether a facility complies with the participation requirements; and (2) Confirm that the facility has corrected deficiencies previously cited. (d) Computation of statewide average interval. The statewide average interval is computed at the end of each Federal fiscal year by comparing the last day of the most recent standard survey for each participating facility to the last day of each facility's previous standard survey. (e) Special surveys. (1) The survey agency may conduct a standard or an abbreviated standard survey to determine whether certain changes have caused a decline in the quality of care furnished by a SNF or a NF, within 60 days of a change in the following: (i) Ownership; (ii) Entity responsible for management of a facility (management firm); (iii) Nursing home administrator; or (iv) Director of nursing. (2) The survey agency must review all complaint allegations and conduct a standard or an abbreviated standard survey to investigate complaints of violations of requirements by SNFs and NFs if its review of the allegation concludes that— (i) A deficiency in one or more of the requirements may have occurred; and (ii) Only a survey can determine whether a deficiency or deficiencies exist. (3) The survey agency does not conduct a survey if the complaint raises issues that are outside the purview of Federal participation requirements. (a) Purpose of survey. The purpose of an extended survey is to identify the policies and procedures that caused the facility to furnish substandard quality of care. (b) Scope of extended survey. An extended survey includes all of the following: (1) Review of a larger sample of resident assessments than the sample used in a standard survey. (2) Review of the staffing and in-service training. (3) If appropriate, examination of the contracts with consultants. (4) A review of the policies and procedures related to the requirements for which deficiencies exist. (5) Investigation of any participation requirement at the discretion of the survey agency. (c) Timing and basis for survey. The survey agency must conduct an extended survey not later than 14 calendar days after completion of a standard survey which found that the facility had furnished substandard quality of care. CMS does and the survey agency must implement programs to measure accuracy and improve consistency in the application of survey results and enforcement remedies. (a) Team composition. (1) Surveys must be conducted by an interdisciplinary team of professionals, which must include a registered nurse. (2) Examples of professionals include, but are not limited to, physicians, physician assistants, nurse practitioners, physical, speech, or occupational therapists, registered professional nurses, dieticians, sanitarians, engineers, licensed practical nurses, or social workers. (3) The State determines what constitutes a professional, subject to CMS approval. (4) Any of the following circumstances disqualifies a surveyor for surveying a particular facility: (i) The surveyor currently works, or, within the past two years, has worked as an employee, as employment agency staff at the facility, or as an officer, consultant, or agent for the facility to be surveyed. (ii) The surveyor has any financial interest or any ownership interest in the facility. (iii) The surveyor has an immediate family member who has a relationship with a facility described in paragraphs (a)(4)(i) or paragraph (a)(4)(ii) of this section. (iv) The surveyor has an immediate family member who is a resident in the facility to be surveyed. For purposes of this section, an immediate family member is defined at §488.301 of this part. (b) CMS training. CMS provides comprehensive training to surveyors, including at least the following: (1) Application and interpretation of regulations for SNFs and NFs. (2) Techniques and survey procedures for conducting standard and extended surveys. (3) Techniques for auditing resident assessments and plans of care. (c) Required surveyor training. (1) Except as specified in paragraph (c)(3) of this section, the survey agency may not permit an individual to serve as a member of a survey team unless the individual has successfully completed a training and testing program prescribed by the Secretary. (2) The survey agency must have a mechanism to identify and respond to in-service training needs of the surveyors. (3) The survey agency may permit an individual who has not completed a training program to participate in a survey as a trainee if accompanied on-site by a surveyor who has successfully completed the required training and testing program. [59 FR 56238, Nov. 10, 1994; 60 FR 50118, Sept. 28, 1995] (a) CMS considers survey performance to be inadequate if the State survey agency— (1) Indicates a pattern of failure to— (i) Identify deficiencies and the failure cannot be explained by changed conditions in the facility or other case specific factors; (ii) Cite only valid deficiencies; (iii) Conduct surveys in accordance with the requirements of this subpart; or (iv) Use Federal standards, protocols, and the forms, methods and procedures specified by CMS in manual instructions; or (2) Fails to identify an immediate jeopardy situation. (b) Inadequate survey performance does not— (1) Relieve a SNF or NF of its obligation to meet all requirements for program participation; or (2) Invalidate adequately documented deficiencies. (a) Annual assessment of survey performance. CMS assesses the performance of the State's survey and certification program annually. (b) Sanctions for inadequate survey performance. When a State demonstrates inadequate survey performance, as specified in §488.318, CMS notifies the survey agency of the inadequacy and takes action in accordance with paragraphs (c) and (d) of this section. (c) Medicaid facilities. (1) For a pattern of failure to identify deficiencies in Medicaid facilities, CMS— (i) Reduces FFP, as specified in paragraph (e) of this section, and if appropriate; (ii) Provides for training of survey teams. (2) For other survey inadequacies in Medicaid facilities, CMS provides for training of survey teams. (d) Medicare facilities. For all survey inadequacies in Medicare facilities, CMS— (1) Requires that the State survey agency submit a plan of correction; (2) Provides for training of survey teams; (3) Provides technical assistance on scheduling and procedural policies; (4) Provides CMS-directed scheduling; or (5) Initiates action to terminate the agreement between the Secretary and the State under section 1864 of the Act, either in whole or in part. (e) Reduction of FFP. In reducing FFP for inadequate survey performance, CMS uses the formula specified in section 1919(g)(3)(C) of the Act, that is 33 percent multiplied by a fraction— (1) The numerator of which is equal to the total number of residents in the NFs that CMS found to be noncompliant during validation surveys for that quarter; and (2) The denominator of which is equal to the total number of residents in the NFs in which CMS conducted validation surveys during that quarter. (f) Appeal of FFP reduction. When a State is dissatisfied with CMS's determination to reduce FFP, the State may appeal the determination to the Departmental Appeals Board, using the procedures specified in 45 CFR part 16. (a) Information which must be provided to public. As provided in sections 1819(g)(5) and 1919(g)(5) of the Act, the following information must be made available to the public, upon the public's request, by the State or CMS for all surveys and certifications of SNFs and NFs: (1) Statements of deficiencies and providers' comments. (2) A list of isolated deficiencies that constitute no actual harm, with the potential for minimal harm. (3) Approved plans of correction. (4) Statements that the facility did not submit an acceptable plan of correction or failed to comply with the conditions of imposed remedies. (5) Final appeal results. (6) Notice of termination of a facility. (7) Medicare and Medicaid cost reports. (8) Names of individuals with direct or indirect ownership interest in a SNF or NF, as defined in §420.201 of this chapter. (9) Names of individuals with direct or indirect ownership interest in a SNF or NF, as defined in §420.201 of this chapter, who have been found guilty by a court of law of a criminal offense in violation of Medicare or Medicaid law. (b) Charge to public for information. CMS and the State may charge the public for specified services with respect to requests for information in accordance with— (1) Section 401.140 of this chapter, for Medicare; or (2) State procedures, for Medicaid. (c) How public can request information. The public may request information in accordance with disclosure procedures specified in 45 CFR part 5. (d) When information must be disclosed. The disclosing agency must make available to the public, upon the public's request, information concerning all surveys and certifications of SNFs and NFs, including statements of deficiencies, separate listings of any isolated deficiencies that constitute no actual harm, with the potential for minimal harm, and plans of correction (which contain any provider response to the deficiency statement) within 14 calendar days after each item is made available to the facility. (e) Procedures for responding to requests. The procedures and time periods for responding to requests are in accordance with— (1) Section 401.136 of this chapter for documents maintained by CMS; and (2) State procedures for documents maintained by the State. (f) Information that must be provided to the State's long-term care ombudsman. The State must provide the State's long-term care ombudsman with the following: (1) A statement of deficiencies reflecting facility noncompliance, including a separate list of isolated deficiencies that constitute no harm with the potential for minimal harm. (2) Reports of adverse actions specified at §488.406 imposed on a facility. (3) Written response by the provider. (4) A provider's request for an appeal and the results of any appeal. (g) Information which must be provided to State by a facility with substandard quality of care. (1) To provide for the notice to physicians required under sections 1819(g)(5)(C) and 1919(g)(5)(C) of the Act, not later than 10 working days after receiving a notice of substandard quality of care, a SNF or NF must provide the State with a list of— (i) Each resident in the facility with respect to which such finding was made; and (ii) The name and address of his or her attending physician. (2) Failure to disclose the information timely will result in termination of participation or imposition of alternative remedies. (h) Information the State must provide to attending physician and State board. Not later than 20 calendar days after a SNF or NF complies with paragraph (g) of this section, the State must provide written notice of the noncompliance to— (1) The attending physician of each resident in the facility with respect to which a finding of substandard quality of care was made; and (2) The State board responsible for licensing the facility's administrator. (i) Access to information by State Medicaid fraud control unit. The State must provide access to any survey and certification information incidental to a SNF's or NF's participation in Medicare or Medicaid upon written request by the State Medicaid fraud control unit established under part 1007, of this title, consistent with current State laws. [59 FR 56238, Nov. 10, 1994; 60 FR 50118, Sept. 28, 1995] (a) General rules—(1) Responsibility for certification. (i) The State survey agency surveys all facilities for compliance or noncompliance with requirements for long term care facilities. The survey by the State survey agency may be followed by a Federal validation survey. (A) The State certifies the compliance or noncompliance of non-State operated NFs. Regardless of the State entity doing the certification, it is final, except in the case of a complaint or validation survey conducted by CMS, or CMS review of the State's findings. (B) CMS certifies the compliance or noncompliance of all State-operated facilities. (C) The State survey agency certifies the compliance or noncompliance of a non-State operated SNF, subject to the approval of CMS. (D) The State survey agency certifies compliance or noncompliance for a dually participating SNF/NF. In the case of a disagreement between CMS and the State survey agency, a finding of noncompliance takes precedence over that of compliance. (ii) In the case of a validation survey, the Secretary's determination as to the facility's noncompliance is binding, and takes precedence over a certification of compliance resulting from the State survey. (2) Basis for certification. (i) Certification by the State is based on the survey agency findings. (ii) Certification by CMS is based on either the survey agency findings (in the case of State-operated facilities), or, in the case of a validation survey, on CMS's own survey findings. (b) Effect of certification—(1) Certification of compliance. A certification of compliance constitutes a determination that the facility is in substantial compliance and is eligible to participate in Medicaid as a NF, or in Medicare as a SNF, or in Medicare and Medicaid as a dually participating facility. (2) Certification of noncompliance. A certification of noncompliance requires denial of participation for prospective providers and enforcement action for current providers in accordance with subpart F of this part. Enforcement action must include one of the following: (i) Termination of any Medicare or Medicaid provider agreements that are in effect. (ii) Application of alternative remedies instead of, or in addition to, termination procedures. (c) Notice of certification of noncompliance and resulting action. The notice of certification of noncompliance is sent in accordance with the timeframes specified in §488.402(f), and resulting action is issued by CMS, except when the State is taking the action for a non-State operated NF. (d) Content of notice of certification of noncompliance. The notice of certification of noncompliance is sent in accordance with the timeframes specified in §488.402(f) and includes information on all of the following: (1) Nature of noncompliance. (2) Any alternative remedies to be imposed under subpart F of this part. (3) Any termination or denial of participation action to be taken under this part. (4) The appeal rights available to the facility under this part. (5) Timeframes to be met by the provider and certifying agency with regard to each of the enforcement actions or appeal procedures addressed in the notice. (e) Appeals. (1) Notwithstanding any provision of State law, the State must impose remedies promptly on any provider of services participating in the Medicaid program— (i) After promptly notifying the facility of the deficiencies and impending remedy or remedies; and (ii) Except for civil money penalties, during any pending hearing that may be requested by the provider of services. (2) CMS imposes remedies promptly on any provider of services participating in the Medicare or Medicaid program or any provider of services participating in both the Medicare and Medicaid programs— (i) After promptly notifying the facility of the deficiencies and impending remedy or remedies; and (ii) Except for civil money penalties, during any pending hearing that may be requested by the provider of services. (3) The provisions of part 498 of this chapter apply when the following providers request a hearing on a denial of participation, or certification of noncompliance leading to an enforcement remedy (including termination of the provider agreement), except State monitoring: (i) All State-operated facilities; (ii) SNFs and dually participating SNF/NFs; and (iii) Any other facilities subject to a CMS validation survey or CMS review of the State's findings. (4) The provisions of part 431 of this chapter apply when a non-State operated Medicaid NF, which has not received a CMS validation survey or CMS review of the State's findings, requests a hearing on the State's denial of participation, termination of provider agreement, or certification of noncompliance leading to an alternative remedy, except State monitoring. (f) Provider agreements. CMS or the Medicaid agency may execute a provider agreement when a prospective provider is in substantial compliance with all the requirements for participation for a SNF or NF, respectively. (g) Special rules for Federal validation surveys. (1) CMS may make independent certifications of a NF's, SNF's, or dually participating facility's noncompliance based on a CMS validation survey. (2) CMS issues the notice of actions affecting facilities for which CMS did validation surveys. (3) For non-State-operated NFs and non-State-operated dually participating facilities, any disagreement between CMS and the State regarding the timing and choice of remedies is resolved in accordance with §488.452. (4) Either CMS or the survey agency, at CMS's option, may revisit the facility to ensure that corrections are made. [59 FR 56238, Nov. 10, 1994; 60 FR 50118, Sept. 28, 1995] (a) Opportunity to refute survey findings. (1) For non-Federal surveys, the State must offer a facility an informal opportunity, at the facility's request, to dispute survey findings upon the facility's receipt of the official statement of deficiencies. (2) For Federal surveys, CMS offers a facility an informal opportunity, at the facility's request, to dispute survey findings upon the facility's receipt of the official statement of deficiencies. (b)(1) Failure of the State or CMS, as appropriate, to complete informal dispute resolution timely cannot delay the effective date of any enforcement action against the facility. (2) A facility may not seek a delay of any enforcement action against it on the grounds that informal dispute resolution has not been completed before the effective date of the enforcement action. (c) If a provider is subsequently successful, during the informal dispute resolution process, at demonstrating that deficiencies should not have been cited, the deficiencies are removed from the statement of deficiencies and any enforcement actions imposed solely as a result of those cited deficiencies are rescinded. (d) Notification. Upon request, CMS does and the State must provide the facility with written notification of the informal dispute resolution process. (a) Investigation of complaints. (1) The State survey agency must establish procedures and maintain adequate staff to investigate complaints of violations of participation requirements. (2) The State survey agency takes appropriate precautions to protect a complainant's anonymity and privacy, if possible. (3) If arrangements have been made with other State components for investigation of complaints, the State must have a means of communicating information among appropriate entities, and the State survey agency retains responsibility for the investigation process. (4) If, after investigating a complaint, the State has reason to believe that an identifiable individual neglected or abused a resident, or misappropriated a resident's property, the State survey agency must act on the complaint in accordance with §488.335. (b) On-site monitoring. The State survey agency conducts on-site monitoring on an as necessary basis when— (1) A facility is not in substantial compliance with the requirements and is in the process of correcting deficiencies; (2) A facility has corrected deficiencies and verification of continued substantial compliance is needed; or (3) The survey agency has reason to question the substantial compliance of the facility with a requirement of participation. (c) Composition of the investigative team. A State may use a specialized team, which may include an attorney, auditor and appropriate health professionals, to identify, survey, gather and preserve evidence, and administer remedies to noncompliant facilities. A State must conduct periodic educational programs for the staff and residents (and their representatives) of SNFs and NFs in order to present current regulations, procedures, and policies on the survey, certification and enforcement process under this subpart and subpart F of this part. (a) Investigation. (1) The State must review all allegations of resident neglect and abuse, and misappropriation of resident property and follow procedures specified in §488.332. (2) If there is reason to believe, either through oral or written evidence that an individual used by a facility to provide services to residents could have abused or neglected a resident or misappropriated a resident's property, the State must investigate the allegation. (3) The State must have written procedures for the timely review and investigation of allegations of resident abuse and neglect, and misappropriation of resident property. (b) Source of complaints. The State must review all allegations regardless of the source. (c) Notification—(1) Individuals to be notified. If the State makes a preliminary determination, based on oral or written evidence and its investigation, that the abuse, neglect or misappropriation of property occurred, it must notify in writing— (i) The individuals implicated in the investigation; and (ii) The current administrator of the facility in which the incident occurred. (2) Timing of the notice. The State must notify the individuals specified in paragraph (c)(1) of this section in writing within 10 working days of the State's investigation. (3) Contents of the notice. The notice must include the— (i) Nature of the allegation(s); (ii) Date and time of the occurrence; (iii) Right to a hearing; (iv) Intent to report the substantiated findings in writing, once the individual has had the opportunity for a hearing, to the nurse aide registry or appropriate licensure authority; (v) Fact that the individual's failure to request a hearing in writing within 30 days from the date of the notice will result in reporting the substantiated findings to the nurse aide registry or appropriate licensure authority. (vi) Consequences of waiving the right to a hearing; (vii) Consequences of a finding through the hearing process that the alleged resident abuse or neglect, or misappropriation of resident property did occur; and (viii) Fact that the individual has the right to be represented by an attorney at the individual's own expense. (d) Conduct of hearing. (1) The State must complete the hearing and the hearing record within 120 days from the day it receives the request for a hearing. (2) The State must hold the hearing at a reasonable place and time convenient for the individual. (e) Factors beyond the individual's control. A State must not make a finding that an individual has neglected a resident if the individual demonstrates that such neglect was caused by factors beyond the control of the individual. (f) Report of findings. If the finding is that the individual has neglected or abused a resident or misappropriated resident property or if the individual waives the right to a hearing, the State must report the findings in writing within 10 working days to— (1) The individual; (2) The current administrator of the facility in which the incident occurred; and (3) The administrator of the facility that currently employs the individual, if different than the facility in which the incident occurred; (4) The licensing authority for individuals used by the facility other than nurse aides, if applicable; and (5) The nurse aide registry for nurse aides. Only the State survey agency may report the findings to the nurse aide registry, and this must be done within 10 working days of the findings, in accordance with §483.156(c) of this chapter. The State survey agency may not delegate this responsibility. (g) Contents and retention of report of finding to the nurse aide registry. (1) The report of finding must include information in accordance with §483.156(c) of this chapter. (2) The survey agency must retain the information as specified in paragraph (g)(1) of this section, in accordance with the procedures specified in §483.156(c) of this chapter. (h) Survey agency responsibility. (1) The survey agency must promptly review the results of all complaint investigations and determine whether or not a facility has violated any requirements in part 483, subpart B of this chapter. (2) If a facility is not in substantial compliance with the requirements in part 483, subpart B of this chapter, the survey agency initiates appropriate actions, as specified in subpart F of this part. [59 FR 56238, Nov. 10, 1994; 60 FR 50118, Sept. 28, 1995]
Title 42: Public Health
PART 488—SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES
Subpart E—Survey and Certification of Long-Term Care Facilities
§ 488.300 Statutory basis.
§ 488.301 Definitions.
§ 488.303 State plan requirement.
§ 488.305 Standard surveys.
§ 488.307 Unannounced surveys.
§ 488.308 Survey frequency.
§ 488.310 Extended survey.
§ 488.312 Consistency of survey results.
§ 488.314 Survey teams.
§ 488.318 Inadequate survey performance.
§ 488.320 Sanctions for inadequate survey performance.
§ 488.325 Disclosure of results of surveys and activities.
§ 488.330 Certification of compliance or noncompliance.
§ 488.331 Informal dispute resolution.
§ 488.332 Investigation of complaints of violations and monitoring of compliance.
§ 488.334 Educational programs.
§ 488.335 Action on complaints of resident neglect and abuse, and misappropriation of resident property.
