Attachment D_Table of Surveyor Component Guide.pdf

This document is a Table of Surveyor Component Guide that establishes staffing and time requirements for conducting facility surveys across two facility types: Nursing Homes and Domiciliaries.

For Nursing Home surveys, the guide specifies surveyor requirements across three components—Clinical, Life Safety, and Administrative & Fiscal—based on facility census size. Clinical Surveyor Component staffing ranges from 2 surveyors for facilities with 1-50 residents (3 days virtual/onsite) to 5 surveyors for facilities with 251+ residents (4 days virtual/onsite). The Life Safety Surveyor Component consistently requires 1 surveyor for 2 days virtual/onsite across all census sizes. The Administrative & Fiscal Surveyor Component requires 1 surveyor for 2-3 days virtual/onsite, with 3 days required for facilities with 51+ residents. For Domiciliary surveys, Clinical Surveyor Component staffing ranges from 2 surveyors (2 days) for 1-50 residents to 3 surveyors (4 days) for 251+ residents. Life Safety Surveyor Component requires 1 surveyor for 1-2 days across all census sizes. The Administrative & Fiscal Surveyor Component consistently requires 1 surveyor; however, a notation indicates that 2 days are needed if the domiciliary is a standalone facility, whereas the standard allocation is 1 day for facilities with 151+ residents.