Surveyor Minimum Qualifications Test (SMQT) — Questions and Answers

Question 1: What is the significance of the 'kitchen sink' approach in surveying, and why is it discouraged?

It means citing every minor issue observed, which dilutes focus on serious deficiencies (Correct answer)
It is the CMS-recommended method for large facilities
It refers to thorough documentation, which is encouraged
It describes the food safety inspection portion of the survey

Correct answer: It means citing every minor issue observed, which dilutes focus on serious deficiencies

Citing trivial deficiencies alongside serious ones reduces the impact of significant findings and misallocates enforcement resources.

Question 2: A surveyor is reviewing a facility's advance directive policies. Which finding would indicate a deficiency in honoring resident rights?

The facility refuses to honor a resident's DNR order because it conflicts with staff values (Correct answer)
The facility provides information about advance directives to all residents
The facility documents the resident's advance directive status in the medical record
The facility asks about advance directives at admission

Correct answer: The facility refuses to honor a resident's DNR order because it conflicts with staff values

Facilities must honor valid advance directives including DNR orders; staff personal beliefs cannot override a resident's legally executed directive.

Question 3: A PASRR Level I screen must be completed before an individual is admitted to a NF on a:

Medicaid-certified basis (Correct answer)
Skilled nursing basis only
Private-pay basis only
Voluntary basis only

Correct answer: Medicaid-certified basis

PASRR Level I screening is required prior to admission to any Medicaid-certified nursing facility.

Question 4: During a medical survey, a respondent's professional caregiver insists they must remain in the room. How should the interviewer handle this?

Refuse to conduct the interview until the caregiver leaves the room entirely
Consult supervisor guidelines and project protocols, as caregiver presence may be allowable under specific documented conditions (Correct answer)
Proceed without addressing the caregiver's presence and note nothing in the record
Allow the caregiver to stay since they are a professional bound by confidentiality

Correct answer: Consult supervisor guidelines and project protocols, as caregiver presence may be allowable under specific documented conditions

Some survey protocols have special provisions for medically necessary third parties; the interviewer must follow project-specific guidance rather than applying a blanket rule.

Question 5: Which of the following environmental conditions should an interviewer prioritize FIRST when setting up an in-person interview?

Checking that there is a flat surface for writing if a paper questionnaire is used
Confirming there is adequate lighting for reading survey materials
Ensuring the space provides visual and auditory privacy from all non-participants (Correct answer)
Verifying the room temperature is comfortable for both parties

Correct answer: Ensuring the space provides visual and auditory privacy from all non-participants

Privacy is the foundational environmental requirement in SMQT standards because it directly determines the validity and reliability of responses to all survey items.

Question 6: Under SMQT Quality of Life criteria, which situation demonstrates appropriate 'person-centered' practice?

A care manager tells the enrollee which activities they should participate in based on the manager's judgment
A care manager assigns the enrollee to the highest-available service level as a default
A care manager asks the enrollee about their interests and builds service options around those preferences (Correct answer)
A care manager copies last year's service plan without review because no changes were reported

Correct answer: A care manager asks the enrollee about their interests and builds service options around those preferences

Person-centered practice requires starting from the enrollee's own interests and goals when designing services, not imposing the care manager's own judgments.

Question 7: Which of the following is NOT a permissible reason for an involuntary discharge or transfer under federal nursing home regulations?

The resident's health has improved and nursing home care is no longer needed
The resident filed a complaint with the State Survey Agency (Correct answer)
The resident's presence endangers the health or safety of others
The facility is closing

Correct answer: The resident filed a complaint with the State Survey Agency

Filing a complaint with a regulatory agency is protected activity; discharging a resident for this reason is retaliatory and prohibited.

Question 8: A surveyor assesses a facility's sharps disposal practices. Which observation indicates FULL compliance?

Sharps containers are placed in a central hallway location only
Used syringes are placed in regular waste bins lined with red biohazard bags
Sharps containers are located at the point of care and replaced when three-quarters full (Correct answer)
Needles are recapped after use before disposal to prevent needlesticks

Correct answer: Sharps containers are located at the point of care and replaced when three-quarters full

Sharps containers must be at point of care for immediate disposal and replaced before reaching capacity to prevent overfilling and injury.

Question 9: Under Quality of Life requirements, employment and vocational activities for LTSS enrollees who want to work should be:

Limited to plan-sponsored sheltered workshop programs only
Discouraged since employment may affect Medicaid eligibility
Addressed only after all medical treatment goals are fully achieved
Supported and included in care planning for enrollees who express interest (Correct answer)

Correct answer: Supported and included in care planning for enrollees who express interest

Quality of Life standards support competitive integrated employment as a meaningful life goal, and plans must include employment supports for enrollees who want them.

Question 10: When surveying medication reconciliation practices at a hospital, which patient transition is most associated with high-risk medication errors?

Admission from home to the hospital (Correct answer)
Discharge from the hospital to home
Transfer between rooms on the same unit
Transfer from ICU to a step-down unit

Correct answer: Admission from home to the hospital

Admission from home is a high-risk transition because complete and accurate home medication lists are often unavailable, leading to omissions or duplications.

Question 11: Under SMQT Quality of Life standards, what is the significance of 'informed choice' for LTSS enrollees?

Informed choice applies only to enrollees with no cognitive impairments
Plans may withhold information about alternatives to manage utilization
Enrollees must accept the plan's recommended care options without question
Enrollees must receive complete information about options so they can make voluntary decisions (Correct answer)

Correct answer: Enrollees must receive complete information about options so they can make voluntary decisions

Informed choice requires that enrollees receive full, understandable information about their options so decisions are voluntary and truly autonomous.

Question 12: A facility's food safety log shows that a steam table was holding mashed potatoes at 130°F during lunch service. The required minimum hot holding temperature for cooked foods is:

145°F
135°F (Correct answer)
150°F
130°F

Correct answer: 135°F

The FDA Food Code requires hot foods to be held at 135°F or above to prevent bacterial growth in the temperature danger zone.

Question 13: When a respondent's spouse insists on remaining in the room during a sensitive health survey, what should the interviewer do?

Politely explain that the survey requires a private setting and request the spouse wait in another area (Correct answer)
Skip all sensitive questions and complete only non-sensitive items
Reschedule the interview for a later date without explanation
Allow the spouse to stay since refusing could jeopardize the interview

Correct answer: Politely explain that the survey requires a private setting and request the spouse wait in another area

SMQT standards require interviewers to politely but firmly request a private setting because third-party presence compromises respondent honesty and data validity.

Question 14: Creating a cadastral map that displays the borders of homes, farms, and other assets. (Alternative/True)

FALSE
TRUE (Correct answer)

Correct answer: TRUE

TRUE. A cadastral map's specific purpose is to document property boundaries and land ownership, showing the borders of homes, farms, and other assets. This is exactly what the statement describes, so it is correct.

Question 15: A surveyor notes that a facility serves its evening meal at 5:00 p.m. and breakfast the next day at 8:00 a.m. The facility does not offer a routine bedtime snack. According to federal regulations regarding the frequency of meals, how should this practice be cited?

Deficient, because meals are not served at traditional times.
Deficient, because the time between the evening meal and breakfast exceeds 14 hours. (Correct answer)
Compliant, as long as a resident group has agreed to the meal span.
Compliant, as the time span is less than 16 hours.

Correct answer: Deficient, because the time between the evening meal and breakfast exceeds 14 hours.

Federal regulation 42 CFR §483.60(f)(2) states there must be no more than 14 hours between a substantial evening meal and breakfast the following day. The time between 5:00 p.m. and 8:00 a.m. is 15 hours. The exception of up to 16 hours is only permitted if a nourishing snack is provided at bedtime. Since no snack is offered, the facility is non-compliant.

Question 16: A surveyor measures a distance of 500.00 feet with a steel tape. The tape is actually 500.25 feet long. What is the corrected distance?

500.50 feet
499.75 feet
500.00 feet
500.25 feet (Correct answer)

Correct answer: 500.25 feet

If the tape is longer than its nominal length, the measured distance must be increased by the same proportion.

Question 17: A facility fails to transmit MDS data to the CMS national repository within the required timeframe. Which consequence can a surveyor cite?

Mandatory reduction in certified beds
Immediate termination from Medicaid only
A deficiency citation under F-tag regulations governing assessments and care planning (Correct answer)
Automatic license suspension

Correct answer: A deficiency citation under F-tag regulations governing assessments and care planning

Failure to submit MDS data within required timeframes is citable as a deficiency under the F-tag regulatory framework.

Question 18: A surveyor notes that a resident's prescribed eye drops are being stored in a medication refrigerator alongside staff food items. The eye drops are in their original, labeled container. This practice fails to comply with which aspect of medication services?

Administration by licensed personnel only.
Procedures for medication disposal.
Sanitary storage and prevention of contamination. (Correct answer)
Proper temperature control.

Correct answer: Sanitary storage and prevention of contamination.

While the medication is refrigerated (addressing temperature), storing it with food items creates a significant risk of contamination for both the food and the medication. Pharmacy standards and survey guidance require that refrigerators used for medication storage be dedicated to that purpose only, ensuring sanitary conditions and preventing cross-contamination.

Question 19: During a SMQT survey, which finding would indicate a plan is NOT meeting Quality of Life privacy requirements?

Personal health information is shared only with treating providers
Enrollees have private rooms available upon request
Enrollees can lock personal belongings
Care staff discuss enrollee conditions in public hallways (Correct answer)

Correct answer: Care staff discuss enrollee conditions in public hallways

Discussing enrollee health conditions in public spaces violates privacy protections that are a fundamental component of Quality of Life requirements.

Question 20: If an interview must be conducted in an outdoor setting due to the absence of any available private indoor space, the interviewer should PRIMARILY ensure:

That the respondent signs a waiver acknowledging the non-standard interview conditions
That the chosen outdoor spot is far enough from others to prevent the conversation from being overheard (Correct answer)
That the interview is shortened to reduce the time spent in a non-ideal setting
That the outdoor location has shade to prevent sun exposure for both parties

Correct answer: That the chosen outdoor spot is far enough from others to prevent the conversation from being overheard

Even in outdoor settings, auditory privacy must be maintained as much as possible by selecting a location sufficiently isolated from passersby.

Question 21: A surveyor reviews a care plan and notes that psychosocial needs are not addressed despite the resident's documented history of depression. This deficiency falls under which regulatory tag area?

F-tag 758 (Unnecessary Medications)
F-tag 600 (Abuse Prohibition)
F-tag 684 (Quality of Care)
F-tag 656 (Comprehensive Care Plans) (Correct answer)

Correct answer: F-tag 656 (Comprehensive Care Plans)

Failure to address identified needs in the care plan is cited under F-tag 656, which governs comprehensive care plan requirements.

Question 22: A skilled nursing facility stores its Schedule II controlled substances in a locked tackle box inside a locked medication cart. How does this practice align with federal storage requirements for controlled substances?

It is non-compliant because Schedule II drugs must be stored in a hospital-grade safe.
It is non-compliant unless the cart is kept in a separately locked medication room.
It is compliant because the drugs are double-locked, meeting the storage standard. (Correct answer)
It is compliant only if the state board of pharmacy has specifically approved this method.

Correct answer: It is compliant because the drugs are double-locked, meeting the storage standard.

Federal regulation 42 CFR §483.45(h)(2) requires that Schedule II drugs be stored in separately locked, permanently affixed compartments. The common and accepted practice that meets this standard is a 'double lock' system, such as a locked box within a locked cart or cabinet. This ensures a higher level of security for substances with a high potential for abuse.

Question 23: A resident asks to use the telephone in private. The facility's only phone is in the nurses' station where staff work. The facility should:

Deny the request since the phone is a staff tool
Allow the call only if a staff member is present for safety
Provide reasonable accommodations for private telephone access (Correct answer)
Restrict calls to scheduled visiting hours

Correct answer: Provide reasonable accommodations for private telephone access

Residents have the right to private telephone communication, and facilities must make reasonable accommodations to facilitate this.

Question 24: What does PRN (pro re nata) medication monitoring require in a long-term care survey context?

PRN orders must have a documented indication, and use must be monitored for effectiveness and appropriateness (Correct answer)
PRN medications cannot be psychotropic drugs
PRN medications may be given freely without documentation
PRN orders expire after 30 days automatically

Correct answer: PRN orders must have a documented indication, and use must be monitored for effectiveness and appropriateness

Surveyors verify that PRN medications have a clear indication in the order, are documented each time given, and are reviewed for efficacy and ongoing appropriateness.

Question 25: A nursing facility uses a single shared medication cart key kept at the nurses' station accessible to all staff. What survey deficiency does this most likely represent?

Fire safety violation
Staffing ratio violation
Dietary services deficiency
Inadequate controlled substance security, as medications must be accessible only to authorized personnel (Correct answer)

Correct answer: Inadequate controlled substance security, as medications must be accessible only to authorized personnel

Federal regulations require that medications, especially controlled substances, be stored securely with access limited to authorized licensed personnel.

Question 26: Which of the following is a required component of a nursing facility's comprehensive abuse prevention program under federal regulations?

Installation of mandatory video surveillance cameras in all resident care and common areas
Monthly coordination meetings with the local law enforcement agency
Annual review of the program by a State-appointed independent abuse prevention coordinator
Screening of staff, training on prevention and identification, investigation of allegations, and required reporting (Correct answer)

Correct answer: Screening of staff, training on prevention and identification, investigation of allegations, and required reporting

Federal regulations require a comprehensive program covering staff screening, abuse prevention training, identification of indicators, investigation of allegations, and timely reporting to appropriate authorities.

Question 27: A surveyor is reviewing whether a facility properly conducted a PASRR screen. Which individual is exempt from PASRR requirements?

A resident with a dual diagnosis of SMI and intellectual disability
A resident admitted from an acute care hospital for Medicaid-covered skilled care
A resident who previously lived in a psychiatric hospital
A resident admitted for respite care of 30 days or less (Correct answer)

Correct answer: A resident admitted for respite care of 30 days or less

Federal regulations exempt individuals admitted for a short-term stay of 30 days or fewer for respite care from full PASRR requirements.

Question 28: Under Medicaid managed care Quality of Life standards, which principle ensures that enrollees retain the right to make personal decisions about their daily lives?

Care coordination
Utilization management
Self-determination (Correct answer)
Clinical oversight

Correct answer: Self-determination

Self-determination is a core Quality of Life principle that allows enrollees to make their own choices about daily activities, routines, and life decisions.

Question 29: A Plan of Correction (PoC) submitted by a facility must include which of the following elements?

How the deficiency will be corrected, a completion date, and how compliance will be maintained (Correct answer)
Surveyor approval signatures on each corrective action
Payment of assessed civil monetary penalties before submission
A signed admission of negligence by the administrator

Correct answer: How the deficiency will be corrected, a completion date, and how compliance will be maintained

A valid PoC must address correction of the specific deficiency, the completion date, and ongoing monitoring to maintain compliance.

Question 30: A facility experienced a bloodborne pathogen exposure incident involving a staff member. Which action is REQUIRED under OSHA's Bloodborne Pathogen Standard?

Providing the exposed employee with post-exposure evaluation and follow-up at no cost (Correct answer)
Reporting the incident to CMS within 24 hours
Replacing all needles in the facility with new brand products
Immediately terminating the employee for unsafe practice

Correct answer: Providing the exposed employee with post-exposure evaluation and follow-up at no cost

OSHA's Bloodborne Pathogen Standard requires employers to provide free post-exposure evaluation, testing, and follow-up to exposed employees.

Question 31: Under the Medicare Conditions of Participation for long-term care, how often must pharmacists conduct drug regimen reviews for residents?

At least monthly (Correct answer)
Weekly
Quarterly
Every 60 days

Correct answer: At least monthly

42 CFR §483.45(c) requires a licensed pharmacist to review each resident's drug regimen at least once a month.

Question 32: Under 42 CFR §483.12(c), within what timeframe must a nursing facility report an allegation of abuse to the State agency?

72 hours of the alleged occurrence
48 hours of the alleged occurrence
24 hours of the alleged occurrence (Correct answer)
5 working days of the alleged occurrence

Correct answer: 24 hours of the alleged occurrence

Federal regulations require facilities to report allegations of abuse, neglect, or exploitation to the State agency within 24 hours to enable prompt protective action.

Question 33: A resident experiences a major decline in their cognitive and functional abilities after a stroke. The facility determines this is a 'significant change in status.' According to federal regulations, within how many days must the facility complete a comprehensive resident assessment?

At the next scheduled quarterly review.
Within 14 days of determining the change is significant. (Correct answer)
Within 7 days of the stroke.
Within 48 hours of the physician's order.

Correct answer: Within 14 days of determining the change is significant.

According to 42 CFR §483.20, a comprehensive assessment must be completed within 14 calendar days after the facility determines that a significant change in the resident's physical or mental condition has occurred. This timeline is distinct from quarterly reviews and is triggered by the determination of the change, not necessarily the event itself.

Question 34: A facility's menus are planned a month in advance and offer a variety of choices. However, upon review, the surveyor cannot find any documentation that the menus have been reviewed or approved by a qualified professional. To be compliant, the menus must be reviewed for nutritional adequacy by which of the following?

A state-licensed chef.
The facility's Medical Director.
The facility's qualified dietitian or other clinically qualified nutrition professional. (Correct answer)
The Director of Nursing.

Correct answer: The facility's qualified dietitian or other clinically qualified nutrition professional.

According to 42 CFR §483.60, menus must be reviewed by the facility's dietitian or other clinically qualified nutrition professional for nutritional adequacy. While other staff members are crucial to the facility's operation, the specific responsibility for ensuring the nutritional adequacy of menus is assigned to a qualified nutrition professional.

Question 35: When a conflict exists between a family member's preferences and the LTSS enrollee's own stated preferences, Quality of Life requirements indicate that the plan should:

Average both preferences and design a compromise without further input
Prioritize the enrollee's own stated preferences unless the enrollee lacks decision-making capacity (Correct answer)
Default to the family member's preference since families know the enrollee best
Escalate all preference conflicts to the state Medicaid agency for resolution

Correct answer: Prioritize the enrollee's own stated preferences unless the enrollee lacks decision-making capacity

Quality of Life standards place the enrollee's own preferences at the center; family preferences are secondary unless the enrollee has been formally determined to lack decision-making capacity.

Question 36: A surveyor wants to evaluate whether residents are receiving adequate nutrition. Which clinical indicator is the MOST objective measure for reviewing nutritional status during a survey?

Resident satisfaction survey scores
Number of menu choices offered
Trending body weight documentation and laboratory values (Correct answer)
Staff reports of resident appetite

Correct answer: Trending body weight documentation and laboratory values

Serial weight documentation and relevant laboratory values (such as albumin, prealbumin) are objective clinical indicators of nutritional status used in survey review.

Question 37: In a household where an interpreter is needed and is also a family member, how does this affect the physical environment standard for privacy?

Physical environment standards are waived when a language barrier exists
The family-member interpreter creates a confidentiality risk; a professional or neutral interpreter should be used when possible (Correct answer)
The use of any interpreter automatically satisfies the privacy requirement since translation indicates full consent
Family interpreters are preferred because they create a more comfortable atmosphere for the respondent

Correct answer: The family-member interpreter creates a confidentiality risk; a professional or neutral interpreter should be used when possible

Family interpreters may suppress honest responses on sensitive topics, and SMQT protocols generally call for neutral interpreters to preserve both privacy and data integrity.

Question 38: A surveyor finds that a resident's care plan was not updated after a significant change in condition. This could constitute a deficiency under which regulatory area?

Comprehensive care planning (Correct answer)
Infection control
Dietary services
Staffing levels

Correct answer: Comprehensive care planning

Failure to revise care plans after a significant change in condition violates the comprehensive care planning requirements.

Question 39: Which of the following BEST describes 'actual harm' as a severity level in the CMS citation framework?

A deficiency that has resulted in a negative outcome that compromises the resident's ability to maintain or reach their highest practicable well-being (Correct answer)
Any resident complaint formally filed with the state agency
Physical injury requiring hospitalization
Harm that was narrowly avoided due to staff intervention

Correct answer: A deficiency that has resulted in a negative outcome that compromises the resident's ability to maintain or reach their highest practicable well-being

Actual harm means the deficiency caused a measurable negative outcome affecting the resident's physical, mental, or psychosocial well-being.

Question 40: A resident's family member requests that the facility not share the resident's diagnosis with the resident. Under HIPAA and CMS regulations, the facility should:

Require the family to obtain a court order before restricting information
Disclose the diagnosis only to the attending physician
Honor the family's request to protect the resident from distress
Provide the resident access to their own medical records regardless of family preference (Correct answer)

Correct answer: Provide the resident access to their own medical records regardless of family preference

Residents have the right to access their own medical records and to be fully informed of their health status; family preferences cannot override this right.

Question 41: A surveyor finds that a facility administers medications from multi-dose vials to multiple residents and reuses needles between draws from the same vial. What is the primary concern?

Increased medication waste
Violation of controlled substance regulations
Improper medication storage temperature
Risk of cross-contamination and transmission of bloodborne pathogens (Correct answer)

Correct answer: Risk of cross-contamination and transmission of bloodborne pathogens

Reusing needles with multi-dose vials can introduce contaminants into the vial and transmit bloodborne pathogens between patients, a serious infection control and pharmaceutical services deficiency.

Question 42: During a kitchen observation, a surveyor notices a food service worker handling raw chicken and then preparing a cold salad without washing hands or changing gloves. This practice PRIMARILY violates which food safety principle?

Cross-contamination prevention (Correct answer)
Temperature control
Proper thawing procedures
Pest control standards

Correct answer: Cross-contamination prevention

Moving from raw poultry to ready-to-eat foods without hand hygiene or glove change is a direct cross-contamination risk, a critical food safety violation.

Question 43: What is the primary difference between NAD83 and NAD27 horizontal datums?

NAD83 is geocentric and based on the GRS80 ellipsoid, while NAD27 uses the Clarke 1866 ellipsoid (Correct answer)
NAD83 uses feet while NAD27 uses meters
NAD27 incorporates GPS data while NAD83 is purely ground-based
NAD83 applies only to Alaska while NAD27 applies to the contiguous US

Correct answer: NAD83 is geocentric and based on the GRS80 ellipsoid, while NAD27 uses the Clarke 1866 ellipsoid

NAD83 is a geocentric datum based on the GRS80 ellipsoid and was defined using satellite data, while NAD27 is based on the Clarke 1866 ellipsoid with its origin at Meades Ranch, Kansas.

Question 44: A SMQT surveyor finds that a plan's Quality of Life assessment tool focuses exclusively on physical health deficits. What is the primary problem with this approach?

It ignores psychological, social, and environmental dimensions of well-being (Correct answer)
Physical health is irrelevant to Quality of Life assessments
It violates HIPAA because physical data is too sensitive
Physical assessments must be conducted only by physicians under federal rules

Correct answer: It ignores psychological, social, and environmental dimensions of well-being

Quality of Life encompasses psychological well-being, social relationships, and environment—not just physical health—so a deficit-only physical tool is incomplete.

Question 45: A surveyor reviews a resident's medical record and notes the attending physician has not documented a required interval visit but has signed off on all orders. What is the appropriate survey action?

Cite only if the resident experienced an adverse outcome
Cite a deficiency for failure to meet physician visit frequency requirements (Correct answer)
No deficiency because the physician remained engaged via order signatures
Request clarification from the physician before determining deficiency

Correct answer: Cite a deficiency for failure to meet physician visit frequency requirements

Order signatures do not substitute for the required face-to-face physician visits; a missing documented visit is a citable deficiency regardless of other physician activity.

Question 46: A nursing facility offers only one meal seating time for all residents, and several residents report missing meals due to therapy scheduling conflicts. The MOST relevant regulatory concern is:

F809 – Frequency of Meals (Correct answer)
F550 – Resident Rights/Exercise of Rights
F679 – Activities
F812 – Food Sanitation

Correct answer: F809 – Frequency of Meals

F809 requires that meals be offered at times that meet residents' needs; a rigid single seating that causes residents to miss meals violates this standard.

Question 47: During observation, a surveyor notices a CNA crushing a tablet that is labeled 'do not crush.' What regulation or standard is most directly implicated?

Resident rights regulations
Dietary supplement guidelines
Hand hygiene protocols
Medication administration standards requiring medications to be given in the form prescribed (Correct answer)

Correct answer: Medication administration standards requiring medications to be given in the form prescribed

Crushing a 'do not crush' medication (e.g., extended-release tablets) alters the dose form and delivery, violating medication administration standards and potentially harming the resident.

Question 48: A resident's care plan goal reads: 'Resident will express satisfaction with meal choices by next review.' This goal is problematic because:

Dietary goals require a registered dietitian co-signature
Satisfaction goals must be written in the resident's own words
It lacks a measurable baseline or criterion for success (Correct answer)
Meal satisfaction is not a valid care plan topic

Correct answer: It lacks a measurable baseline or criterion for success

Without a measurable criterion (e.g., 'rates meals ≥7/10 on satisfaction scale'), progress toward this goal cannot be objectively evaluated.

Question 49: A surveyor observes that the care plan room is locked and staff must request access from the charge nurse to review care plans. The concern with this practice is:

Only the Director of Nursing is permitted to access care plan files
Restricted access may prevent timely implementation of care plan interventions by all staff (Correct answer)
Care plans must be stored in the resident's room by regulation
Care plans should be available on the internet for family access

Correct answer: Restricted access may prevent timely implementation of care plan interventions by all staff

If care plans are not readily accessible to all direct care staff, timely and consistent implementation of interventions is compromised.

Question 50: Which kind of survey is shown in the image?

Plane
Geodetic
Topographic (Correct answer)
Dimensional

Correct answer: Topographic

A map showing contour lines plus natural and man-made features like rivers, roads, and buildings is a topographic survey. Dimensional is not a standard survey type, while geodetic (large-scale, curvature-based) and plane (flat-assumption) describe scale and method, not the feature-mapping shown in the image.

Question 51: A resident who is Muslim requests that pork products never be served to them. Under resident rights regulations, the facility must:

Offer only vegetarian meals to all residents to avoid the issue
Transfer the resident to a facility that specializes in religious diets
Explain that the standard menu cannot be altered for individual requests
Provide a pork-free alternative that is nutritionally adequate (Correct answer)

Correct answer: Provide a pork-free alternative that is nutritionally adequate

Facilities must make reasonable accommodations for residents' religious and cultural dietary preferences, providing nutritionally adequate alternatives.

Question 52: A pharmacist's monthly drug regimen review identifies that a resident is on two drugs with a clinically significant interaction but the physician has not been notified. What should the surveyor cite?

The charge nurse for administering both drugs
The facility for not ensuring the pharmacist's recommendation prompted a physician response (Correct answer)
The pharmacist for failing to document the review
The prescribing physician for an unauthorized order

Correct answer: The facility for not ensuring the pharmacist's recommendation prompted a physician response

Under 42 CFR §483.45(c)(4), the facility must ensure that the physician and director of nursing are informed of pharmacist recommendations and that there is a timely response.

Question 53: The MDS Discharge assessment must be completed within how many days after the resident leaves the facility?

1 day
7 days (Correct answer)
3 days
14 days

Correct answer: 7 days

The Discharge assessment (return not anticipated) must be completed within 7 days after the resident's discharge from the facility.

Question 54: A resident's family member informs a surveyor that the facility discovered an abuse allegation but failed to report it to the State agency. Under federal regulations, this failure to report is:

Permissible if the alleged incident occurred between two residents rather than involving a staff member
Acceptable if the facility conducted a thorough internal investigation and found the allegation unsubstantiated
A regulatory violation that can result in citation and potential civil monetary penalties regardless of investigation outcome (Correct answer)
Only a regulatory violation if the investigation ultimately substantiates that abuse occurred

Correct answer: A regulatory violation that can result in citation and potential civil monetary penalties regardless of investigation outcome

Failure to report allegations of abuse within the required timeframe is itself a regulatory violation, as the reporting requirement is triggered by the allegation, not the outcome of the investigation.

Question 55: A surveyor discovers that a facility failed to investigate and report an allegation of resident-to-resident abuse. The MOST appropriate action is to:

Issue a courtesy warning and allow 30 days for self-correction
Refer the matter solely to local law enforcement and take no survey action
Cite deficiencies under abuse prohibition and reporting requirements (Correct answer)
Document the finding but defer citation pending the facility's own investigation

Correct answer: Cite deficiencies under abuse prohibition and reporting requirements

Failure to investigate and report abuse allegations constitutes a citable deficiency independent of local law enforcement action.

Question 56: Which of the following best represents a person-centered care plan approach as emphasized in current CMS regulations?

Goals written exclusively by clinical staff using standardized templates
Goals approved only after family consent overrides resident choice
Goals reflecting the resident's own preferences, strengths, and life history (Correct answer)
Goals focused solely on reducing clinical risk regardless of resident preference

Correct answer: Goals reflecting the resident's own preferences, strengths, and life history

CMS Phase 2 and 3 rules emphasize individualized, person-centered care plans that incorporate resident preferences, values, and goals.

Question 57: A facility develops a comprehensive care plan for a new resident within 48 hours of their admission. This plan includes measurable objectives, timeframes, and addresses all identified needs from the comprehensive assessment. In this scenario, the facility:

has met the requirements for both the baseline and comprehensive care plan timelines. (Correct answer)
must still create a separate baseline care plan.
is out of compliance for completing the comprehensive plan too soon.
is required to get a physician to co-sign the plan within the first 24 hours.

Correct answer: has met the requirements for both the baseline and comprehensive care plan timelines.

According to 42 CFR §483.21(a)(2), a facility may develop a comprehensive care plan in place of a baseline care plan if it is developed within 48 hours of admission and meets all the requirements of a comprehensive care plan. By doing so, they fulfill the initial planning requirement.

Question 58: A resident with dementia is non-verbal and unable to participate in their care planning meeting. To comply with person-centered care planning requirements, which of the following is the facility's BEST course of action?

Postpone the care planning meeting until the resident is able to communicate.
Proceed with the care plan development without the resident's input, as it is not practicable.
Have the nursing staff who work closest with the resident make all care plan decisions.
Ensure the resident's legal representative or family member participates in the process, and that the plan reflects the resident's known preferences. (Correct answer)

Correct answer: Ensure the resident's legal representative or family member participates in the process, and that the plan reflects the resident's known preferences.

Person-centered care requires that the facility actively involves the resident and/or their representative in the care planning process. When a resident cannot participate, the facility must include their representative to ensure the plan reflects the resident's values, preferences, and goals to the greatest extent possible.

Question 59: Which of the following is a direct requirement of a facility regarding a resident's right to manage their own financial affairs?

The facility is required to act as the resident's representative payee for Social Security benefits.
The facility cannot require a resident to deposit their personal funds with the facility. (Correct answer)
The facility must ensure a resident's bank account never falls below the Medicaid eligibility limit.
The facility must provide free financial planning services to all residents.

Correct answer: The facility cannot require a resident to deposit their personal funds with the facility.

According to 42 CFR §483.10(c)(1), a resident has the right to manage their own financial affairs, and a facility may not require them to deposit personal funds with the facility. While a facility must hold, safeguard, and account for resident funds upon request, they cannot mandate that the resident turn over their money for management.

Question 60: When a PASRR Level II evaluation is required, which professional must conduct it?

A qualified mental health professional or intellectual disability specialist (Correct answer)
A licensed social worker
A registered nurse
The nursing facility's medical director

Correct answer: A qualified mental health professional or intellectual disability specialist

Level II evaluations must be performed by a qualified mental health professional or intellectual disability specialist as defined by the state.

Question 61: When a facility employee is accused of committing abuse, what immediate action is required by federal regulation?

Place the employee on a 30-day probationary period pending completion of the investigation
Remove the employee from direct contact with residents while the investigation is conducted (Correct answer)
Terminate the employee immediately without conducting a formal investigation
Allow the employee to continue working while documenting the allegation in the personnel file

Correct answer: Remove the employee from direct contact with residents while the investigation is conducted

Regulations require immediate removal from direct resident contact of any employee accused of abuse to protect residents during the investigation period.

Question 62: A resident who is cognitively intact asks to manage their own personal finances. Under resident rights regulations, the facility must:

Allow the resident to manage their own financial affairs (Correct answer)
Require the family to serve as financial representative
Hold all funds in a facility trust account automatically
Appoint a staff member to co-manage the resident's funds

Correct answer: Allow the resident to manage their own financial affairs

Residents have the right to manage their own financial affairs, and facilities cannot require residents to deposit funds with the facility.

Question 63: Which of the following situations would be classified as 'misappropriation of resident property'?

A nurse aide borrows $20 from a resident's personal funds account and fails to repay it (Correct answer)
A social worker assists a resident in completing a durable power of attorney document
A facility requires residents to store valuables in a secured safe at the nursing station
A resident voluntarily gives a staff member a birthday gift of modest value

Correct answer: A nurse aide borrows $20 from a resident's personal funds account and fails to repay it

Misappropriation involves deliberate misplacement, exploitation, or wrongful use — even temporary — of a resident's belongings or funds for another's benefit without authorization.

Question 64: According to infection control standards, when should a surgical or procedure mask be worn by a healthcare worker during resident care?

Only when the resident has a known respiratory illness
Whenever there is risk of splashing or spraying of blood or body fluids to the face (Correct answer)
Only during aerosol-generating procedures
At all times while inside the facility

Correct answer: Whenever there is risk of splashing or spraying of blood or body fluids to the face

Masks are required as part of standard precautions when there is risk of body fluid splash or spray to the mucous membranes of the face.

Question 65: During a hospital survey, a surveyor finds that a patient received a double dose of warfarin because the day-shift and night-shift nurses both administered the evening dose. Which system failure does this best illustrate?

Inadequate hand hygiene compliance
Failure of medication administration documentation and handoff communication (Correct answer)
Poor dietary coordination with pharmacy
Insufficient physician oversight

Correct answer: Failure of medication administration documentation and handoff communication

Double dosing due to a shift change indicates a failure in real-time medication administration documentation and structured handoff communication between nurses.

Question 66: A surveyor interviews a resident who states she has not seen a doctor in four months. The medical record shows the last documented physician visit was 62 days ago. What should the surveyor do?

Reconcile the record with the resident's account and investigate whether documentation is missing or the visit did not occur (Correct answer)
Accept the medical record as accurate since it is an official document
Cite a deficiency immediately based solely on the resident's statement
Dismiss the resident's statement as unreliable due to cognitive concerns

Correct answer: Reconcile the record with the resident's account and investigate whether documentation is missing or the visit did not occur

Surveyors must triangulate information from interviews, observations, and records; a discrepancy warrants further investigation rather than immediate citation or dismissal.

Question 67: Which type of personal protective equipment (PPE) is required for a healthcare worker performing bronchoscopy or suctioning on a resident with known or suspected influenza?

Gloves and gown only
N95 respirator, eye protection, gown, and gloves (Correct answer)
Standard precautions with no additional PPE needed
Surgical mask, gown, and gloves

Correct answer: N95 respirator, eye protection, gown, and gloves

Aerosol-generating procedures with influenza patients require airborne-level respiratory protection (N95), eye protection, gown, and gloves.

Question 68: A surveyor is at a facility with an average daily occupancy of 85 residents. The Director of Nursing (DON), an RN, is assigned as the charge nurse for a specific unit every weekday from 7 a.m. to 3 p.m. This staffing assignment is:

Not permitted, because the DON may only serve as a charge nurse in facilities with an average daily occupancy of 60 or fewer residents. (Correct answer)
Permitted, as long as the DON works full-time.
Permitted, because the DON is a qualified RN.
Not permitted, because the DON can only be a charge nurse in a facility with a daily occupancy of 120 or fewer residents.

Correct answer: Not permitted, because the DON may only serve as a charge nurse in facilities with an average daily occupancy of 60 or fewer residents.

Federal regulation 42 CFR §483.35(b)(3) specifies that the Director of Nursing may serve as a charge nurse only when the facility has an average daily occupancy of 60 or fewer residents. Since this facility's occupancy is 85, this arrangement is a violation.

Question 69: When a surveyor reviews a hospital's high-alert medication policy, which class of drugs would they most expect to see listed?

Laxatives and stool softeners
Antihistamines and topical corticosteroids
Antacids and vitamins
Anticoagulants, concentrated electrolytes, insulin, and opioids (Correct answer)

Correct answer: Anticoagulants, concentrated electrolytes, insulin, and opioids

ISMP's high-alert medication list includes anticoagulants, concentrated electrolytes, insulin, opioids, and other drugs with a high risk of causing significant patient harm if misused.

Question 70: When a surveyor observes that a nursing home posts a resident's care schedule on their room door without consent, this is most likely a violation of the resident's right to:

Privacy and confidentiality of personal and clinical records (Correct answer)
Choose their own physician
Participate in care planning
Refuse treatment

Correct answer: Privacy and confidentiality of personal and clinical records

Publicly posting personal care information without consent violates the resident's right to privacy and confidentiality of their records.

Question 71: A plan's Quality of Life monitoring system uses only unannounced on-site visits to assess enrollee experience. A SMQT surveyor would most likely recommend adding which additional method?

Direct enrollee interviews conducted independently of plan staff (Correct answer)
Analysis of encounter data completeness rates
Review of provider billing patterns
Review of provider credentialing files

Correct answer: Direct enrollee interviews conducted independently of plan staff

Enrollees may not freely express concerns in front of plan staff, so independent interviews are essential for capturing the authentic enrollee perspective on Quality of Life.

Question 72: A resident with dementia is assessed as having high fall risk but refuses to use a bed alarm or call light. The care plan should:

Contact state authorities before proceeding
Override the refusal because the resident lacks decision-making capacity
Document refusal, offer alternatives, and include all feasible interventions the resident will accept (Correct answer)
Document refusal and exclude fall interventions since the resident refused

Correct answer: Document refusal, offer alternatives, and include all feasible interventions the resident will accept

Even when a resident refuses specific interventions, the facility must document the refusal, provide education, and implement all other feasible safety measures.

Question 73: When evaluating Quality of Life for LTSS enrollees, a surveyor should check that care plans include which of the following elements?

Only the enrollee's medical diagnoses and treatment history
Enrollee's goals, preferred daily routines, and support preferences (Correct answer)
The plan's cost projections for each service
Provider performance scores for each assigned clinician

Correct answer: Enrollee's goals, preferred daily routines, and support preferences

Comprehensive Quality of Life-focused care plans must capture the enrollee's personal goals, preferred routines, and how they want to receive support.

Question 74: Under the MDS, the 'look-back period' for most clinical assessments is:

7 days (Correct answer)
14 days
5 days
3 days

Correct answer: 7 days

The standard MDS look-back period is 7 days, capturing clinical status over the week preceding the assessment reference date.

Question 75: The 'universe' in the context of a nursing home survey refers to:

All deficiencies cited in the past three surveys
The total population from which the resident sample is drawn (Correct answer)
All residents currently admitted to the facility
The full list of applicable federal regulations

Correct answer: The total population from which the resident sample is drawn

The universe is the entire eligible population used to determine the appropriate resident sample size and selection.

Question 76: A surveyor finds that a resident's care plan lists a goal of 'resident will not fall' but lacks specific interventions. This is a deficiency because:

Only physicians may write fall-prevention goals
Goals must be written in medical terminology
Care plans require measurable goals with corresponding interventions (Correct answer)
Falls goals are not required by regulation

Correct answer: Care plans require measurable goals with corresponding interventions

Regulations require care plans to include measurable objectives and specific interventions to address identified problems.

Question 77: A nursing facility serving Medicaid residents fails to conduct PASRR Level I screens on new admissions. Under OBRA 1987, which agency has enforcement authority over this violation?

The resident's managed care organization
The local health department
The state survey agency acting on behalf of CMS (Correct answer)
The Joint Commission

Correct answer: The state survey agency acting on behalf of CMS

State survey agencies, acting under CMS authority, have enforcement responsibility for PASRR compliance in Medicaid-certified nursing facilities.

Question 78: A surveyor identifies that a facility's MDRO (multidrug-resistant organism) surveillance program lacks active surveillance cultures. What is the PRIMARY concern?

Inadequate documentation of vital signs
Non-compliance with dietary requirements
Increased supply costs
Failure to identify colonized residents who can transmit the organism (Correct answer)

Correct answer: Failure to identify colonized residents who can transmit the organism

Without active surveillance cultures, colonized but asymptomatic residents may go unidentified, allowing silent transmission of MDROs.

Question 79: During a survey, you observe that staff are wearing the same gloves while moving between resident rooms. Which infection control principle is being violated?

Glove change between patients to prevent cross-contamination (Correct answer)
Isolation precaution signage
Personal protective equipment storage
Hand hygiene protocol

Correct answer: Glove change between patients to prevent cross-contamination

Gloves must be changed between patients and hand hygiene performed to prevent transferring pathogens from one resident to another.

Question 80: Surveyors use this for fixed points of reference that are known to be elevated above or below a specific datum.

A survey mark
A benchmark (Correct answer)
A reference tag
A P.O.R

Correct answer: A benchmark

A benchmark is the standard surveying term for a permanent fixed point of known elevation relative to a datum, used as a reference. 'Survey mark' and 'reference tag' are vaguer markers not tied specifically to a known elevation, and 'P.O.R' is not the established term for an elevation reference point.

Question 81: Under SMQT survey protocols, what is the significance of a 'look-alike/sound-alike' (LASA) medication error during a review?

It indicates a potential system failure in drug storage or labeling that requires facility policy review (Correct answer)
It is automatically considered a sentinel event regardless of patient outcome
It is exclusively a nursing performance issue
It only matters if the patient was harmed

Correct answer: It indicates a potential system failure in drug storage or labeling that requires facility policy review

LASA errors signal systemic vulnerabilities in labeling, storage, or verification processes; surveyors examine whether the facility has policies to reduce LASA confusion.

Question 82: While observing a housekeeping staff member cleaning a resident corridor, a surveyor notices that the floor buffing machine has a frayed electrical cord with exposed wires, which is plugged into a wall outlet. This observation points to a potential failure of the facility to:

Implement an effective pest control program.
Ensure the Life Safety Code is met for corridor width.
Maintain all mechanical equipment in safe operating condition. (Correct answer)
Provide adequate housekeeping and maintenance personnel.

Correct answer: Maintain all mechanical equipment in safe operating condition.

42 CFR §483.90 requires the facility to be equipped and maintained to protect the health and safety of residents, personnel, and the public. This includes ensuring all electrical equipment is in good repair and safe to operate. A frayed cord with exposed wires poses a significant risk of electric shock or fire.

Question 83: During a medication pass observation, a surveyor notes a nurse administering a medication that does not appear on the current Medication Administration Record. The nurse states the physician called in a change. What is the immediate concern?

The order was not properly documented before administration, creating a medication safety risk (Correct answer)
This is acceptable if the nurse documents after administration
The physician should be present for any medication change
The nurse should have refused to administer any unwritten order

Correct answer: The order was not properly documented before administration, creating a medication safety risk

Medications must not be administered before verbal orders are received, recorded, and authenticated; administering without an MAR entry represents a medication safety and documentation deficiency.

Question 84: Which scenario constitutes 'neglect' rather than 'abuse' under long-term care regulations?

A staff member removes cash from a resident's wallet while assisting with personal care
A staff member yells obscenities and makes degrading remarks to a confused resident
A resident with a documented skin care protocol develops a deep pressure ulcer because staff consistently failed to follow the protocol (Correct answer)
A staff member touches a resident in their genital area without care justification during morning care

Correct answer: A resident with a documented skin care protocol develops a deep pressure ulcer because staff consistently failed to follow the protocol

Neglect occurs when staff fail to provide required care — such as not following a skin care protocol — resulting in preventable harm, rather than through a willful harmful act.

Question 85: A physician's order reads 'continue current medications.' A surveyor would find this order problematic because:

Continuation orders must be signed by the medical director, not the attending physician
The order is acceptable as a standing order if the medications are listed in the MAR
Such orders are only valid for 30 days before reauthorization is needed
Orders must specifically identify each medication, dose, route, and frequency to be valid and safe (Correct answer)

Correct answer: Orders must specifically identify each medication, dose, route, and frequency to be valid and safe

Blanket continuation orders lacking specific medication details fail to meet standards for clear, individualized physician orders and create medication safety risks.

Question 86: A resident refuses a care plan goal. The facility's correct response is to:

Override the refusal and implement the goal anyway
Document the refusal and the risks explained, then respect the resident's right to refuse (Correct answer)
Discharge the resident for non-compliance
Remove the goal from the care plan without documentation

Correct answer: Document the refusal and the risks explained, then respect the resident's right to refuse

Residents have the right to refuse treatment; facilities must document informed refusal and any education provided about risks.

Question 87: A resident tells a surveyor that a nurse aide 'grabbed my arm and twisted it hard' when they refused to take a shower. Which type of regulatory violation does this describe?

Sexual abuse because it involved unauthorized physical contact
Neglect because the resident's right to refuse care was not respected
Physical abuse because it involved the use of physical force causing or risking bodily injury (Correct answer)
Psychological abuse because it was done to force compliance

Correct answer: Physical abuse because it involved the use of physical force causing or risking bodily injury

Physical abuse is the use of physical force that may result in bodily injury, physical pain, or impairment, including grabbing and twisting a resident's limb.

Question 88: Which interdisciplinary team member is primarily responsible for coordinating the comprehensive care plan meeting?

The Director of Nursing
The Registered Nurse or designated care coordinator (Correct answer)
The attending physician
The Social Worker

Correct answer: The Registered Nurse or designated care coordinator

A registered nurse or designated care coordinator typically organizes and leads the interdisciplinary care plan conference.

Question 89: An interviewer notices mid-interview that the respondent appears visibly tense and keeps glancing toward a partially open door. The best response is to:

Continue at a faster pace to finish before the source of the respondent's distraction returns
Tell the respondent to ignore the door and focus on the questions
Note the respondent's body language in the record but take no action during the interview
Pause, acknowledge the respondent's comfort, and offer to close the door or move to a different space (Correct answer)

Correct answer: Pause, acknowledge the respondent's comfort, and offer to close the door or move to a different space

Visible respondent discomfort signals a privacy concern that the interviewer should address immediately, as continuing without intervention compromises response quality.

Question 90: During a survey, you observe that a nurse administered a medication two hours after the scheduled time without documentation. What is the primary concern?

Failure to follow the prescribed medication schedule and lack of documentation (Correct answer)
The physician was not available to approve the delay
Staff shortage causing delays
The medication was still effective

Correct answer: Failure to follow the prescribed medication schedule and lack of documentation

Surveyors cite facilities when medications are not administered per the physician's order and when deviations are not documented in the medical record.

Question 91: When conducting interviews in a group residential facility such as a nursing home, which physical environment standard is MOST critical to enforce?

Verifying that the facility is properly licensed and in good regulatory standing
Confirming that facility administrators have approved the overall survey project
Ensuring the interview room has comfortable seating appropriate for elderly respondents
Ensuring each respondent is interviewed individually in a private space, away from other residents and staff (Correct answer)

Correct answer: Ensuring each respondent is interviewed individually in a private space, away from other residents and staff

In group settings, individual privacy is hardest to achieve and most important to enforce because residents may feel watched or judged by peers and staff.

Question 92: Which action by a surveyor best evaluates whether a facility is honoring residents' right to choose their daily schedule?

Confirm the facility has a written resident rights policy
Check if the social worker documents schedule preferences in the care plan
Review the facility's posted activity calendar
Interview residents about whether they can choose when to wake up, eat, and sleep (Correct answer)

Correct answer: Interview residents about whether they can choose when to wake up, eat, and sleep

Directly interviewing residents about their daily schedule choices is the most reliable way to assess whether the right is being honored in practice.

Question 93: A resident newly admitted for short-term rehabilitation has different care plan requirements than a long-term resident primarily because:

The initial assessment and care plan timeline may be abbreviated to 14 days for Medicare Part A stays (Correct answer)
Therapy staff are solely responsible for their care plans
Short-term residents do not require care plans under federal law
Physicians write the entire care plan for rehabilitation stays

Correct answer: The initial assessment and care plan timeline may be abbreviated to 14 days for Medicare Part A stays

For Medicare Part A short-stay residents, facilities may use an abbreviated care planning process with an initial assessment completed within 14 days.

Question 94: In GPS/GNSS surveying, what is 'dilution of precision' (DOP)?

The loss of signal caused by multipath reflections
The correction factor applied to atmospheric delays
The accuracy degradation introduced by selective availability
A dimensionless number indicating how satellite geometry affects positional accuracy (Correct answer)

Correct answer: A dimensionless number indicating how satellite geometry affects positional accuracy

DOP describes how the geometry of visible satellites amplifies or reduces ranging errors; a low DOP (close to 1) indicates favorable geometry and better positional accuracy.

Question 95: Under federal regulations, how frequently must a nursing facility review and revise a resident's comprehensive care plan?

Only when the resident requests it
Annually
Every 90 days or after a significant change (Correct answer)
Every 6 months

Correct answer: Every 90 days or after a significant change

CMS requires care plans to be reviewed and revised quarterly or following a significant change in the resident's condition.

Question 96: A resident shares information with a social worker about concerns with their care. The social worker discloses this information to other residents during a group meeting. This violates the resident's right to:

Freedom from restraint
Participate in care planning
Refuse treatment
Confidentiality of personal information (Correct answer)

Correct answer: Confidentiality of personal information

Disclosing a resident's private concerns to others without consent violates confidentiality protections under resident rights regulations.

Question 97: Under OBRA regulations, within how many days of admission must a comprehensive care plan be completed for a long-term care resident?

7 days
30 days
14 days
21 days (Correct answer)

Correct answer: 21 days

OBRA '87 requires a comprehensive care plan to be developed within 21 days of admission to a skilled nursing facility.

Question 98: A facility's infection preventionist reports a cluster of three urinary tract infections in a single unit over two weeks. What is the surveyor's FIRST step in evaluating this situation?

Review the dietary department's food handling logs
Immediately cite the facility for an infection outbreak
Determine whether the facility identified the cluster and initiated an investigation (Correct answer)
Check whether the facility purchased new urinary catheters

Correct answer: Determine whether the facility identified the cluster and initiated an investigation

Surveyors must assess whether the facility detected the cluster and responded with an appropriate investigation per its QAPI and infection control program.

Question 99: A surveyor finds that a nursing facility charges a Medicaid resident a fee for an activity that is considered a basic service under Medicaid. This finding relates to which resident right?

Right to participate in care planning
Right to refuse treatment
Right to manage personal finances
Right to be fully informed of services and charges, including the right not to be improperly charged (Correct answer)

Correct answer: Right to be fully informed of services and charges, including the right not to be improperly charged

Residents must be fully informed of services and applicable charges, and facilities cannot bill Medicaid residents for services already covered under Medicaid.

Question 100: Under resident rights regulations, a resident's right to privacy during personal care means:

Privacy applies only when visitors are present in the facility
The facility may use open-bay treatment areas if staffing is limited
Privacy is only required if the resident requests it verbally
Staff must ensure doors are closed and the resident is draped appropriately during care (Correct answer)

Correct answer: Staff must ensure doors are closed and the resident is draped appropriately during care

Residents have the right to privacy during personal care, treatment, and bathing, which requires appropriate draping and ensuring doors or curtains are closed.

Question 101: In surveying, what does the abbreviation 'NGS' stand for?

National Geographic System
Network of Ground Stations
North Grid Standard
National Geodetic Survey (Correct answer)

Correct answer: National Geodetic Survey

The National Geodetic Survey is the federal agency that defines and manages the National Spatial Reference System, including horizontal and vertical datums.

Question 102: Under the CMS infection control regulations, what is required when a resident is placed on transmission-based precautions?

Notification of the resident's family within 24 hours
Immediate transfer to a hospital
Education of the resident about their precaution status and the reason (Correct answer)
Restriction of all visitation indefinitely

Correct answer: Education of the resident about their precaution status and the reason

Residents have the right to know why precautions are being used, and education must be provided to support their understanding and cooperation.

Question 103: How do Quality of Life standards interact with an enrollee's grievance rights in Medicaid managed care?

Only clinical grievances about medical treatment are allowed under federal rules
Grievance rights are separate and do not relate to Quality of Life
Grievances about Quality of Life are handled by state courts, not the plan
Enrollees can file grievances specifically when Quality of Life standards are not met (Correct answer)

Correct answer: Enrollees can file grievances specifically when Quality of Life standards are not met

Enrollees have the right to file grievances when they believe the plan has failed to meet Quality of Life standards, and plans must have processes to address such complaints.

Question 104: Which MDS section is used to document a resident's skin condition, including pressure injuries?

Section N
Section M (Correct answer)
Section G
Section I

Correct answer: Section M

Section M (Skin Conditions) of the MDS captures pressure injuries, skin treatments, and other skin integrity data.

Question 105: What is the primary purpose of the Care Area Assessments (CAAs) within the Resident Assessment Instrument (RAI) process?

To guide the interdisciplinary team in a deeper review of specific areas triggered by MDS responses. (Correct answer)
To serve as the final, comprehensive care plan document.
To calculate the daily Medicare reimbursement rate for the resident.
To replace the need for daily nursing progress notes.

Correct answer: To guide the interdisciplinary team in a deeper review of specific areas triggered by MDS responses.

The CAA process is designed to assist the interdisciplinary team in systematically interpreting information recorded on the MDS. When specific MDS responses trigger a Care Area, the CAAs guide the team to conduct a more in-depth assessment of that potential problem, which then informs care planning decisions.

Question 106: The Quality of Life regulation at 42 CFR §483.24(a) states that a facility must provide care and services to ensure a resident's abilities in activities of daily living do not diminish. What is the exception to this requirement?

When the resident's family provides written consent for the decline.
When the facility has documented a temporary staffing shortage.
When the resident verbally refuses the care or service on three separate occasions.
When the diminution is an unavoidable consequence of the individual's clinical condition. (Correct answer)

Correct answer: When the diminution is an unavoidable consequence of the individual's clinical condition.

The regulation at 42 CFR §483.24(a) specifies that the facility's responsibility to prevent decline in ADLs holds "unless circumstances of the individual's clinical condition demonstrate that such diminution was unavoidable." This acknowledges that some decline is inevitable due to disease progression, but the facility is otherwise responsible for providing care to prevent avoidable decline.

Question 107: A respondent's young children are repeatedly running into the room and interrupting the interview. What should the interviewer do?

Reschedule the interview without offering any guidance about interview conditions
Shorten the questionnaire to reduce the number of interruptions
Ask the respondent if the children can be occupied elsewhere or if there is a quieter room available (Correct answer)
Ignore the interruptions and continue asking questions during brief breaks in activity

Correct answer: Ask the respondent if the children can be occupied elsewhere or if there is a quieter room available

Repeated interruptions compromise data quality and respondent focus, so the interviewer should proactively seek a better environment rather than simply enduring the disruption.

Question 108: During a kitchen inspection, a surveyor observes several large, unmarked containers of leftover food in the walk-in refrigerator. The kitchen manager states they were from a meal served two days ago. Which of the following food safety requirements is most likely NOT being met?

Disposing of garbage and refuse properly.
Providing special eating equipment and utensils for residents who need them.
Procuring food from sources approved by federal, state, or local authorities.
Storing, preparing, distributing, and serving food in accordance with professional standards for food service safety. (Correct answer)

Correct answer: Storing, preparing, distributing, and serving food in accordance with professional standards for food service safety.

42 CFR §483.60(i)(2) requires facilities to store, prepare, distribute, and serve food in accordance with professional standards for food service safety. Proper dating and labeling of leftover food to ensure it is used or discarded within a safe timeframe is a fundamental component of these professional standards. Unmarked, undated containers represent a failure to adhere to these standards.

Question 109: During a survey, you observe that care plan conferences are held but family members consistently report not being invited. The most likely citation would be:

F-tag 550 (Resident Rights – Dignity)
F-tag 726 (Nurse Aide Competency)
F-tag 812 (Food Safety)
F-tag 656 (Comprehensive Care Plan) for failure to ensure participation (Correct answer)

Correct answer: F-tag 656 (Comprehensive Care Plan) for failure to ensure participation

Failing to provide residents and representatives an opportunity to participate in care planning is a direct deficiency under F-tag 656.

Question 110: During a Quality of Life survey, a surveyor interviews enrollees. Which finding would be MOST concerning?

Enrollees state they are told when they must shower and at what time (Correct answer)
Enrollees report they can choose when to wake up and go to sleep
Enrollees say they selected their own personal care workers
Enrollees report they attend community events of their choosing

Correct answer: Enrollees state they are told when they must shower and at what time

Mandating specific times for personal hygiene without enrollee input removes autonomy over basic daily decisions, directly violating Quality of Life standards.

Question 111: A long-term care facility has no physician available on-site and no formal written agreement with an on-call physician. A surveyor would cite this as a deficiency under which standard?

Resident rights to choose their own physician
24-hour availability of physician services (Correct answer)
Medical director qualifications requirement
Minimum physician visit frequency

Correct answer: 24-hour availability of physician services

SNFs must ensure physician services are available 24 hours a day through an on-call arrangement to meet emergency needs of residents.

Question 112: A facility uses a computerized care plan system that auto-populates generic interventions from the MDS. A surveyor's concern with this practice would be:

Auto-populated plans may not be individualized to the specific resident (Correct answer)
Generic interventions are acceptable as long as they are reviewed annually
Only paper care plans are legally enforceable
Electronic care plans are not accepted by CMS

Correct answer: Auto-populated plans may not be individualized to the specific resident

Even when using electronic systems, care plans must be individualized; generic auto-populated content that is not customized constitutes a deficiency.

Question 113: Which finding would indicate that a facility's QAPI program is effectively integrated with its infection prevention program?

The facility purchases new PPE each year regardless of infection rates
Infection trends are analyzed at QAPI meetings and result in documented performance improvement projects (Correct answer)
Infection data is collected but reviewed only by the infection preventionist privately
Hand hygiene audits are conducted but results are never shared with staff

Correct answer: Infection trends are analyzed at QAPI meetings and result in documented performance improvement projects

Effective integration means infection data drives QAPI performance improvement projects with documented goals, interventions, and outcomes.

Question 114: Per CMS requirements, the individual designated as the facility's Infection Preventionist (IP) must meet several qualifications, including:

Being a board-certified infectious disease physician.
Holding a master's degree in public health.
Working at least part-time at the facility. (Correct answer)
Having at least 10 years of experience as a Director of Nursing.

Correct answer: Working at least part-time at the facility.

CMS regulations require that the designated Infection Preventionist (IP) must work at least part-time at the facility and have primary professional training in a relevant field (like nursing, epidemiology, etc.), and have completed specialized training in infection prevention and control. While extensive experience or specific advanced degrees are valuable, the 'part-time, on-site' requirement is a specific regulatory mandate.

Question 115: Which of the following is the correct order of steps when a surveyor identifies a potential Immediate Jeopardy situation?

Document the finding and wait until the exit conference to inform the facility
Cite the deficiency, notify the state agency, then inform the facility
Notify the team coordinator, confirm IJ criteria are met, inform facility leadership, and require immediate removal of jeopardy (Correct answer)
Exit the survey immediately and return with law enforcement

Correct answer: Notify the team coordinator, confirm IJ criteria are met, inform facility leadership, and require immediate removal of jeopardy

IJ protocol requires team consultation to confirm criteria, followed by immediate notification to facility leadership so jeopardy is removed as quickly as possible.

Question 116: The Care Area Assessment (CAA) process that follows MDS completion requires the facility to:

Automatically develop an intervention for every triggered care area
Report all triggered areas to the state survey agency
Investigate each triggered care area and document whether it will be addressed in the care plan (Correct answer)
Discharge residents who trigger more than five care areas

Correct answer: Investigate each triggered care area and document whether it will be addressed in the care plan

The CAA process requires clinical investigation of triggered areas and documentation of care planning decisions, but intervention is not automatic for every trigger.

Question 117: A state's PASRR program must include which two categories of individuals for evaluation?

Dementia and traumatic brain injury
Depression and substance use disorder
Autism and physical disability
Serious mental illness (SMI) and intellectual disability (ID) (Correct answer)

Correct answer: Serious mental illness (SMI) and intellectual disability (ID)

Federal PASRR law specifically targets individuals with serious mental illness and intellectual disability as the two populations requiring screening and evaluation.

Question 118: During a tour of a facility, a surveyor observes a medication cart in a hallway. The cart is unlocked and unattended while the nurse is in a resident's room with the door closed. This practice is a direct violation of which pharmacy service requirement?

Medication Error Prevention
Labeling of Drugs and Biologicals
Drug Regimen Review
Storage of Drugs and Biologicals (Correct answer)

Correct answer: Storage of Drugs and Biologicals

Regulation 42 CFR §483.45(h) requires that drugs and biologicals be stored in locked compartments under proper temperature controls and that access is limited to authorized personnel. Leaving a medication cart unlocked and unattended in a common area violates this security requirement.

Question 119: When must a facility notify a resident (or representative) of a scheduled care plan meeting?

Notification is optional if the facility invites them
At least 24 hours in advance so the resident can participate (Correct answer)
Only if the resident previously requested notification
At least 72 hours in advance per CMS regulation

Correct answer: At least 24 hours in advance so the resident can participate

CMS requires facilities to provide at least 24 hours advance notice of care plan meetings to enable meaningful resident participation.

Question 120: Which finding would most directly indicate a deficiency in nursing services under 42 CFR §483.35?

No licensed nurse on duty during a night shift when a resident required medication administration (Correct answer)
A delay in transcribing a non-urgent physician order
An RN who supervised more than 10 aides simultaneously
A resident preference to have family administer oral medications

Correct answer: No licensed nurse on duty during a night shift when a resident required medication administration

Facilities must have a licensed nurse on duty 24 hours a day, 7 days a week; absence during a shift requiring medication administration is a direct violation.

Question 121: During a revisit survey, the surveyor's primary goal is to:

Reassess the facility's overall quality star rating
Verify that previously cited deficiencies have been corrected (Correct answer)
Conduct a full standard survey of all care areas
Interview all residents about new complaints

Correct answer: Verify that previously cited deficiencies have been corrected

A revisit is a targeted follow-up to confirm that deficiencies cited in the prior survey have been corrected.

Question 122: During a survey, a surveyor finds a resident's care plan does not address a newly identified pressure injury documented in the MDS. This is an example of a failure in:

Comprehensive discharge planning
PASRR Level II follow-up
Care plan development based on assessment findings (Correct answer)
Minimum Data Set transmission

Correct answer: Care plan development based on assessment findings

Federal requirements mandate that care plans be developed from comprehensive assessment data, including MDS findings such as pressure injuries.

Question 123: The daughter of a competent resident, who holds no legal authority like a power of attorney, insists that the facility staff not inform her mother about a new, potentially life-sustaining medication prescribed by the physician. What is the facility's proper course of action in respecting resident rights?

Follow the daughter's instructions to avoid family conflict.
Inform the resident fully about the new medication and her right to refuse it. (Correct answer)
Administer the medication without discussion since it was prescribed by the physician.
Ask the daughter to sign a form taking responsibility for the decision.

Correct answer: Inform the resident fully about the new medication and her right to refuse it.

A competent resident has the absolute right to be fully informed about their medical condition and treatment options, and to participate in their own care, which includes the right to refuse treatment. The daughter's wishes do not override the resident's right to self-determination unless she is the legally appointed representative for a resident deemed incompetent.

Question 124: A surveyor identifies that the facility failed to implement its fall prevention plan for three different residents on the same unit, all of whom subsequently experienced falls with injury. How should the surveyor categorize the SCOPE of this deficiency?

Widespread
Substandard
Pattern (Correct answer)
Isolated

Correct answer: Pattern

'Pattern' is the correct scope because the deficient practice affected more than a limited number of residents and indicates a recurring issue within a specific area or process. 'Isolated' would be too limited, and 'Widespread' would imply the problem is pervasive throughout the facility. 'Substandard' is a severity determination, not a scope category.

Question 125: A surveyor reviews a resident's care plan and notes that hydration goals are not documented despite the MDS indicating the resident is at risk for dehydration. The MOST relevant F-tag is:

F675 – Quality of Life
F692 – Nutritional Status
F656 – Comprehensive Care Plans (Correct answer)
F636 – Comprehensive Assessments

Correct answer: F656 – Comprehensive Care Plans

F656 requires that care plans address identified needs including hydration, so an absent hydration goal for a resident at risk violates the comprehensive care plan requirement.

Question 126: Which of the following staff behaviors would be classified as 'psychological abuse' of a nursing home resident?

Failing to reposition a bedridden resident on the schedule documented in the care plan
Repeatedly threatening a resident with punishment if they do not cooperate with personal care (Correct answer)
Removing money from a resident's personal funds account without authorization
Administering an incorrect medication dosage that causes the resident discomfort

Correct answer: Repeatedly threatening a resident with punishment if they do not cooperate with personal care

Psychological abuse includes verbal threats, humiliation, intimidation, and other conduct that causes mental anguish or emotional distress to a resident.

Question 127: A respondent lives in a single-room dwelling with multiple family members always present. What is the MOST appropriate action?

Proceed with the interview and note that a private environment was unavailable
Arrange an alternative location such as a private room at a community center or library (Correct answer)
Ask family members to go outside during the interview
Convert the interview to a self-administered mail questionnaire automatically

Correct answer: Arrange an alternative location such as a private room at a community center or library

When a respondent's home cannot provide privacy, interviewers are expected to arrange mutually agreeable alternative locations that meet environmental standards.

Question 128: If a facility disputes a citation during the exit conference, the surveyor's appropriate response is to:

Allow the facility 24 hours to provide counter-evidence before the exit
Explain the basis of the finding and note the dispute for the record (Correct answer)
Remove the citation immediately to avoid conflict
Escalate the dispute to the CMS regional office on the spot

Correct answer: Explain the basis of the finding and note the dispute for the record

Surveyors explain their findings' evidentiary basis; formal dispute resolution occurs through the IDR/IIDR process after the survey.

Question 129: Which federal regulation primarily establishes Quality of Life requirements for Medicaid managed care LTSS enrollees?

45 CFR Part 164
42 CFR Part 438 (Correct answer)
42 CFR Part 483
42 CFR Part 455

Correct answer: 42 CFR Part 438

42 CFR Part 438 governs Medicaid managed care regulations, including Quality of Life standards that plans must meet for LTSS enrollees.

Question 130: A food service worker is observed using a cloth towel to wipe food contact surfaces between uses. Under food safety standards, this practice is:

Acceptable if the towel is color-coded for kitchen use
A violation because wiping cloths must be stored in sanitizer solution between uses (Correct answer)
Acceptable only for dry food surfaces
Acceptable if the cloth is laundered daily

Correct answer: A violation because wiping cloths must be stored in sanitizer solution between uses

FDA Food Code requires that wiping cloths used on food contact surfaces be kept in a sanitizer solution between uses to prevent bacterial contamination.

Question 131: A resident who practices Islam informs the dietary manager that they cannot eat the pork-based main entree served at dinner. The facility's policy is to offer a peanut butter sandwich as the only alternative meal. This practice may be deficient because the facility is failing to:

Ensure the Director of Food and Nutrition Services is properly certified.
Provide a therapeutic diet as ordered by the physician.
Serve meals at times comparable to the community.
Offer appealing options of similar nutritive value. (Correct answer)

Correct answer: Offer appealing options of similar nutritive value.

Federal regulations at 42 CFR §483.60(d)(5) require that the facility provide appealing options of similar nutritive value to residents who choose not to eat the food that is initially served. While a peanut butter sandwich provides some nutrition, it may not be of similar nutritive value to the main entree and may not be considered an appealing or sufficient alternative, especially if it is the only option offered consistently. The regulations also emphasize accommodating cultural and religious needs.

Question 132: Which infection control practice should a surveyor look for when evaluating wound care procedures in a skilled nursing facility?

Use of sterile technique for all wound dressing changes regardless of wound type
Performing hand hygiene and changing gloves between preparing and applying a dressing (Correct answer)
Nurses performing wound care without gloves to improve tactile assessment
Reusing dressing materials to reduce facility costs

Correct answer: Performing hand hygiene and changing gloves between preparing and applying a dressing

Hand hygiene and glove change between the dirty and clean phases of wound care prevents contaminating the wound and surroundings.

Question 133: A facility posts a notice on the dining room bulletin board listing which residents have been assessed as a fall risk. This practice:

Is permissible only if residents consent at the care plan meeting
Is required under CMS fall prevention guidelines
Is acceptable as a safety measure to alert all staff
Violates residents' right to confidentiality of their health information (Correct answer)

Correct answer: Violates residents' right to confidentiality of their health information

Publicly posting residents' health assessment status violates their right to confidentiality and privacy under both HIPAA and CMS resident rights regulations.

Question 134: A surveyor reviews a facility where enteral tube feeding is used for a cognitively intact resident who had not consented to this intervention. This scenario MOST directly raises concerns under:

F812 – Food Sanitation
F804 – Nutritive Value of Foods
F578 – Request/Refuse Treatment; Formulate Advance Directives (Correct answer)
F636 – Comprehensive Assessment

Correct answer: F578 – Request/Refuse Treatment; Formulate Advance Directives

A cognitively intact resident has the right to refuse any treatment including tube feeding; proceeding without consent violates F578 (right to refuse treatment).

Question 135: Which section of the MDS captures a resident's cognitive skills for daily decision-making?

Section E
Section D
Section B
Section C (Correct answer)

Correct answer: Section C

Section C (Cognitive Patterns) of the MDS assesses cognitive skills including the Brief Interview for Mental Status (BIMS).

Question 136: A surveyor observes that a facility has no written policy for disposing of unused or expired controlled substances. What is the most appropriate survey finding?

Deficiency, because DEA and state regulations require facilities to have documented procedures for controlled substance disposal (Correct answer)
Not a deficiency if the drugs are being returned to the pharmacy
Acceptable practice as long as a pharmacist witnesses all disposals
Minor finding, as verbal policies are acceptable for controlled substances

Correct answer: Deficiency, because DEA and state regulations require facilities to have documented procedures for controlled substance disposal

DEA regulations and state pharmacy laws require facilities to maintain written policies for the disposal of controlled substances, including return, destruction, or DEA Form 41 procedures.

Question 137: A surveyor reviews the record of a new resident admitted from an acute care hospital for a 21-day stay for rehabilitation. The resident has a known intellectual disability, and the PASRR Level I was positive, but no Level II evaluation was performed. This is compliant if the admission meets the criteria for a(n):

Exempted hospital discharge. (Correct answer)
Categorical determination for terminal illness.
Annual resident review.
Significant change in status.

Correct answer: Exempted hospital discharge.

Federal regulations allow for an 'exempted hospital discharge' from the PASRR Level II requirement. This applies when an individual is admitted to a nursing facility directly from a hospital for the same condition they were treated for, and the stay is not expected to exceed 30 days. The other options are not applicable exemptions in this scenario.

Question 138: A Medicaid managed care plan's Quality of Life policy states that enrollees may not decorate their living spaces. A SMQT surveyor would likely cite this as a violation of which standard?

Encounter data submission rules
Fraud and abuse prevention policies
Home and community-based settings personalization requirements (Correct answer)
Network adequacy standards

Correct answer: Home and community-based settings personalization requirements

HCBS settings rules require that individuals be able to personalize their living spaces, making restrictions on decoration a clear Quality of Life violation.

Question 139: A quarterly MDS assessment is required approximately every:

90 days (Correct answer)
30 days
180 days
60 days

Correct answer: 90 days

Quarterly MDS assessments must be completed no less frequently than every 92 days following the annual comprehensive assessment.

Question 140: Under federal regulations, what must a facility do regarding an employee for whom abuse has been substantiated?

Reassign the employee exclusively to administrative or non-resident-contact positions
Prohibit future employment and report to the appropriate nurse aide registry or applicable licensing authority (Correct answer)
Place the employee on permanent probation within the facility with enhanced supervision
Allow continued employment contingent upon successful completion of mandatory retraining

Correct answer: Prohibit future employment and report to the appropriate nurse aide registry or applicable licensing authority

Facilities must terminate employees with substantiated abuse findings and report them to the State nurse aide registry or licensing authority to prevent employment in other care settings.

Question 141: A resident's care plan was developed and signed 90 days ago but has not been reviewed since. The resident recently developed a urinary tract infection that resolved two weeks ago. Is a care plan revision required?

No, because quarterly reviews are optional for short-term clinical events
Yes if the infection caused a significant change; otherwise the quarterly review is sufficient (Correct answer)
Yes, because any new clinical event requires a care plan update regardless of resolution
No, because the infection resolved and no ongoing problem exists

Correct answer: Yes if the infection caused a significant change; otherwise the quarterly review is sufficient

A resolved, uncomplicated UTI is unlikely to constitute a significant change requiring an unscheduled revision, but it should be addressed at the next quarterly review.

Question 142: When a resident is unable to participate in care plan development due to cognitive impairment, who must the facility involve?

The State Ombudsman only
The facility administrator
Only the interdisciplinary team members
The resident's legal representative or family member if no representative exists (Correct answer)

Correct answer: The resident's legal representative or family member if no representative exists

Federal regulations require facilities to involve the resident's legal representative or, if none, a family member when the resident cannot participate.

Question 143: A facility's policy requires all residents to attend morning exercises. A resident refuses to attend, citing their right to choose their activities. The facility:

Should place the resident in a supervision room during the exercise period
Can document the refusal and bill the family for the missed session
Must honor the resident's right to choose their schedule and activities (Correct answer)
May require attendance since group activities support clinical goals

Correct answer: Must honor the resident's right to choose their schedule and activities

Residents have the right to choose their activities and daily schedule, and mandatory participation in activities violates this right.

Question 144: Which type of survey establishes the exact boundaries of a parcel of land?

Topographic survey
Cadastral survey (Correct answer)
Geodetic survey
Hydrographic survey

Correct answer: Cadastral survey

A cadastral survey defines and documents land boundaries for legal ownership and taxation purposes.

Question 145: A care plan correctly identifies a pressure injury but the interventions listed have not been updated despite documented wound progression. A surveyor would cite this as:

Not a deficiency unless the wound reaches Stage 3
Acceptable because the problem was identified
Acceptable if the physician has not ordered new treatment
A deficiency because the care plan must be revised when conditions change (Correct answer)

Correct answer: A deficiency because the care plan must be revised when conditions change

Care plans must be updated to reflect current status; failing to revise interventions when a wound progresses constitutes a care planning deficiency.

Question 146: When a resident's representative (not the resident) is the primary decision-maker, the surveyor should verify that:

A representative's authority supersedes all resident preferences without exception
The resident is still involved in care decisions to the extent of their ability and desire (Correct answer)
The representative's decisions are reviewed monthly by the medical director
The facility communicates only with the representative and not the resident

Correct answer: The resident is still involved in care decisions to the extent of their ability and desire

Even when a representative is involved, residents must be included in care decisions to the extent they are able and wish to participate.

Question 147: A surveyor reviews a facility's emergency generator testing logs. The logs indicate that the generator is started and tested for 15 minutes every month under the available building load. This practice is:

Non-compliant, as the generator must be tested for a minimum of 30 minutes monthly. (Correct answer)
Compliant, as long as a full load test is performed annually.
Compliant, because monthly testing is the required frequency.
Non-compliant, as weekly load testing for 30 minutes is required.

Correct answer: Non-compliant, as the generator must be tested for a minimum of 30 minutes monthly.

Federal regulations, which incorporate standards from the National Fire Protection Association (NFPA 110), require that emergency generators be exercised under load for at least 30 minutes monthly. A 15-minute test is insufficient to meet this standard for ensuring the generator's reliability during an actual power outage.

Question 148: A resident with moderate dementia is observed by a surveyor to be wearing soiled clothing at midday, with staff walking past without intervening. This most directly suggests a deficiency in:

Resident dignity and personal hygiene care (Correct answer)
Infection control practices
Staffing ratios
Restraint use policies

Correct answer: Resident dignity and personal hygiene care

Allowing a resident to remain in soiled clothing indicates a failure to provide care that maintains dignity and basic hygiene, a direct violation of resident rights.

Question 149: A facility has a policy stating that all residents must be bathed between 6:00 AM and 8:00 AM, regardless of their personal preferences. A resident who has always been a 'night owl' expresses a strong desire to bathe in the evenings. Which of the following principles is the facility failing to uphold?

The right to be informed of their medical condition.
The right to be free from abuse and neglect.
The right to make independent choices. (Correct answer)
The right to choose an attending physician.

Correct answer: The right to make independent choices.

The Nursing Home Reform Law emphasizes self-determination and accommodating individual needs. Forcing all residents onto a rigid bathing schedule without regard for their lifelong habits and preferences violates their right to make personal decisions and receive reasonable accommodation of their needs, as supported by 42 CFR §483.10.

Question 150: During the survey exit conference, the facility's administrator presents new documentation that directly refutes a preliminary finding discussed by the survey team. What is the surveyor's most appropriate action?

Tell the administrator to submit it with the Plan of Correction after the survey.
Immediately remove the finding and apologize for the error.
Reevaluate the finding based on the new evidence before finalizing the report. (Correct answer)
Ignore the new information as it was presented too late in the process.

Correct answer: Reevaluate the finding based on the new evidence before finalizing the report.

The exit conference provides an opportunity for an exchange of information. If a provider presents new information that could negate a finding, surveyors should be receptive and willing to reevaluate the finding before leaving the facility and finalizing the Form CMS-2567. This ensures the final report is accurate and based on all available evidence.

Surveyor Minimum Qualifications Test (SMQT)

The SMQT is administered by CMS through PSI Services LLC to certify that state agency surveyors possess the minimum knowledge needed to conduct federal compliance surveys of long-term care facilities.

150

Questions

270 min

Time Limit

75%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds