Attachment E Table of Surveyor Component Guide_updated.pdf

44 KB Posted

Attached to
R499--Community Living Centers (CLC) Long Term Care
Solicitation number
36C10G24R0017
Issued by

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This is an appendix document providing a staffing guide for surveyor resources required for Community Living Center inspections.

The table specifies surveyor component requirements based on facility census size, with two distinct surveyor categories: Clinical Surveyor Component and Life Safety Surveyor Component. For the Clinical Surveyor Component, facilities with 1-100 residents require 2 surveyors for 3 days (virtual/onsite), while facilities with 101-150 and 151-200 residents require 3 surveyors for 3 days. Facilities with 201-250 residents require 4 surveyors for 4 days, and those with 251 or more residents require 5 surveyors for 4 days. The Life Safety Surveyor Component maintains consistent staffing across all facility sizes, requiring 1 surveyor for 2 days (virtual/onsite) regardless of census. This guide establishes the minimum staffing levels and time allocation necessary to conduct comprehensive surveys of Community Living Center facilities of varying sizes.

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Attachment I Scope and Severity Ratings.pdf PDF
Attachment H VA-Joint Commission LSC Clarifications Document.pdf PDF
36C10G24R0017.docx DOCX document
Attachment M -Business Associate Agreement.docx DOCX document
Attachment G Survey Due By Dates.pdf PDF
Attachment C Corrective Action Request Procedure and Form.pdf PDF
Attachment K CLC Survey Report Template.pdf PDF
Attachment J Immediate Jeaporday Template.pdf PDF
Attachment O Detailed Price Cost Sheet.xlsx XLSX spreadsheet
Attachment N Estimated Quantities and Pricing Sheet.xlsx XLSX spreadsheet
Attachment L CLC Deidentifed Survey Report Template.pdf PDF
Attachment F Updated VA F-Tag-Crosswalk 8.2023.pdf PDF
Attachment D Survey Observation Record.xlsx XLSX spreadsheet
Attachment B List of VA CLCs and SCI-D.pdf PDF
Attachment A HATCh Intro VA CLCs.pdf PDF
36C10G24R0017.pdf PDF
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Attachment B

Table of Surveyor Component Guide

Community Living Center Clinical Surveyor Component

Life Safety Surveyor Component

Facility Census # of Surveyors

# Days virtual/onsite

# of Surveyors

# Days virtual/onsite

1-50 2 3 1 2 51-100 2 3 1 2

101-150 3 3 1 2 151-200 3 3 1 2 201-250 4 4 1 2

251+ 5 4 1 2

File details come from the government source that posted it. Updated .