CMS Nursing Home Survey Guide — What to Expect

A CMS "survey" is the official on-site inspection that determines whether a skilled nursing facility meets the federal Requirements of Participation for Medicare and Medicaid. Surveys are conducted by state survey agencies on behalf of the Centers for Medicare & Medicaid Services using the procedures in the State Operations Manual (SOM), Chapter 7. The results directly shape a facility's Health Inspection score in the Five-Star Quality Rating System and are published on Care Compare, the CMS site that replaced Nursing Home Compare. This guide walks through every survey type, the software surveyors use, what happens in each phase, the documents and interviews to prepare for, and how a hallway observation becomes a formal citation.

Types of Nursing Home Surveys

Not all surveys are the same, and knowing which one you face determines how to prepare.

Standard (Recertification) Survey — the comprehensive, unannounced survey every certified facility must undergo every 9–15 months, with a statewide average interval that cannot exceed 12.9 months. It drives the Health Inspection domain of the Five-Star rating and typically lasts 3–5 days on site.
Life Safety Code (LSC) Survey — a separate survey of the physical environment and fire safety (alarms, sprinklers, egress, generators, Emergency Preparedness) cited with K-tags rather than F-tags.
Complaint & Facility-Reported Incident Survey — triggered by a complaint or a self-reported incident; scope is focused on the allegation but can expand. High-priority Immediate Jeopardy allegations are investigated on an expedited timeline.
Revisit (Follow-Up) Survey — verifies that cited deficiencies were actually corrected as promised in the accepted Plan of Correction.
Focused Infection Control (FIC) Survey — a targeted review of hand hygiene, PPE, isolation, and the Infection Preventionist program, citing tags such as F880.
Special Focus Facility (SFF) Survey — persistently poor performers are surveyed roughly every 6 months and must show sustained improvement to graduate.

The LTCSP: The Software Surveyors Use

Since 2017 all states use the tablet-based Long-Term Care Survey Process (LTCSP). Surveyors download prior surveys, complaints, Quality Measures, ownership, and staffing data before arrival; enter the full resident census (the CMS-802 Matrix) so the software builds a largely computer-generated sample; assign "care areas" (falls, pressure injuries, unnecessary medications, catheters, dialysis, behavioral health) to each sampled resident; and follow guided observation, interview, and record-review probes for every triggered area. Because roughly 70% of the sample is computer-generated, you cannot predict which residents are reviewed — the only reliable strategy is consistent, defensible care for every resident.

The Survey Process: Phase by Phase

The survey moves through predictable phases. At the entrance conference, surveyors arrive unannounced (federal law prohibits advance notice) and request the resident census, staffing schedules, floor plan, and lists of residents on dialysis, hospice, IV, and ventilator care. During the brief facility tour they observe the environment, resident dignity, infection control, dining, and medication cart security. In resident sampling the LTCSP builds the sample and assigns care areas. The core of the survey is parallel observations, staff interviews, and record review, where surveyors triangulate what the chart says, what staff describe, and what is actually observed — any mismatch is the most common route to a deficiency. The team meets daily to analyze findings and assign scope and severity (A–L), evaluating whether any situation rises to Immediate Jeopardy (J, K, L). At the exit conference surveyors present preliminary findings; the formal CMS-2567 is issued within about 10 working days.

Documents and Interviews to Prepare

Surveyors request the resident census and matrix, staffing schedules, MDS 3.0 assessments, person-centered care plans, physician orders, MARs and TARs, incident and grievance logs, QAPI/QAA minutes, staff training and competency files, abuse investigation records, and infection surveillance logs. They interview CNAs, licensed nurses, the Infection Preventionist, dietary, social services, activities, the Medical Director, DON, and Administrator. Train staff to answer honestly and specifically about their own residents, and ensure the chart, staff statements, and observed care all agree.

Frequently Asked Questions

How often are nursing homes surveyed? A standard survey occurs every 9–15 months (statewide average under 12.9 months); SFF facilities every 6 months; complaint, revisit, and focused surveys any time.

Do facilities get advance notice? No — federal law strictly prohibits any advance notice of a standard or complaint survey.

How long does a survey take? A standard health survey typically lasts 3–5 days on site, and the CMS-2567 is issued within about 10 working days of the exit.

Explore POCDesk — Free Nursing Home Compliance Tools

Official Sources

POCDesk analyzes official government data. Verify any facility's record or read the underlying regulations at these primary sources:

Medicare.gov Care Compare — CMS's official nursing home comparison tool
CMS Provider Data Catalog — the raw nursing home inspection & deficiency datasets
CMS Nursing Home Certification & Compliance — enforcement policy and the Special Focus Facility program
42 CFR Part 483 (eCFR) — the federal requirements of participation behind every F-Tag
National Long-Term Care Ombudsman Resource Center — free advocacy help for residents and families