Nursing home recertification survey: what happens and what to have ready
Short answer
A nursing home's standard recertification survey is unannounced and runs at least two days in a row on site. It must happen no later than 15 months after the last one. Surveyors sample residents, observe care, and ask for incident, abuse-policy and QAPI records. Since September 8, 2026, higher-performing homes may get a shorter risk-based survey.
- Frequency
- Within 15 months of the last standard survey; statewide average at most 12 months
- Notice
- Unannounced; at least 10 percent are off-hours (weekend, before 6 a.m., after 5 p.m.)
- On-site time
- At least 5 hours in a row after entry, and at least 2 calendar days in a row
- Team
- Multidisciplinary, with at least one registered nurse
- Offsite review
- Last survey, repeat deficiencies, closed complaints, facility-reported incidents, staffing data
- Four-hour request
- QAPI plan, QAA committee information, abuse prohibition policy, facility assessment, infection control program
- Risk-based survey
- Nationwide from September 8, 2026 for eligible homes; CMS estimates about 12 percent qualify
- After the survey
- Form CMS-2567 by the 10th working day. Plan of correction within 10 calendar days of receipt.
Applies to: Medicare-certified skilled nursing facilities · Medicaid-certified nursing facilities
How does the standard health survey work?
The standard survey is a periodic, resident-centered inspection. It checks whether a home meets the federal requirements for participation in 42 CFR Part 483. It uses a sample of residents that reflects the home's case mix. Surveyors observe, interview and review records. They follow the Long-Term Care Survey Process (LTCSP) and Appendix PP of the State Operations Manual.
A state must survey each home within 15 months of the last standard survey. Surveys are unannounced. The team stays on site at least two calendar days in a row, and includes a registered nurse.
What happens during the survey?
- Offsite preparationThe team coordinator reviews your last survey, repeat deficiencies and closed complaints. They also review incidents you reported since then and payroll-based journal staffing data.
- EntranceThe team asks for the census, resident lists and other items on CMS's entrance conference worksheet. Then it screens residents.
- Initial poolSurveyors observe, interview and review limited records for residents in the initial pool.
- Sample selectionAfter the first-day team meeting, the team picks closed records. It sets the resident sample and assigns investigations.
- Investigations and facility tasksSurveyors investigate sampled residents. They also complete facility tasks: dining, infection control, kitchen, medication administration and storage, resident council, staffing, environment and QAPI/QAA.
- Decisions and exitThe team decides on potential citations and holds the exit conference with preliminary findings. The state issues Form CMS-2567 after supervisory review.
What do you hand over, and how fast?
CMS's Entrance Conference Worksheet (LTCSP, September 2026) sets the timing. These are selected items; the worksheet has more.
| Due | Selected items |
|---|---|
| Immediately | Census. Matrix for residents admitted in the last 30 days. Alphabetical resident list. List of residents who smoke. |
| Within 1 hour | Mealtimes and menus. Medication pass times. Number and location of medication carts and storage rooms. Actual staff schedules by department. Key personnel and contract staff contacts. Infection preventionist name and training. |
| Within 4 hours | Matrix for all other residents. Admission packet. Infection prevention and control policies and surveillance plan. QAA committee information. QAPI plan. Abuse prohibition policy and procedures. Facility assessment. Nurse staffing waivers. |
| By the end of day 1 | Read-only electronic health record access for each surveyor. Include a guide to where pressure ulcers, falls, hospitalization, elopement and change of condition are found. |
| Within 24 hours | Completed Medicare/Medicaid application (CMS-671). List of residents discharged from a Medicare Part A stay in the last six months. |
What incident and QAPI evidence do surveyors look for?
Surveyors read your incident history before they arrive and test your systems on site. If a complaint is linked to the survey, they investigate abuse at the facility level. That includes your policies and your QAA system for monitoring reported allegations. The QAPI and QAA review comes late, so there is time to investigate concerns.
| Evidence | Tag | What surveyors look for |
|---|---|---|
| Abuse prevention policies | F607 | Written policies, including training and coordination with QAPI |
| Reports of alleged violations, annual notice to covered individuals, results reports | F609 | First report within 2 or 24 hours. Results within 5 working days. Date and time sent. Proof of annual notice. |
| Investigations and protection | F610 | A thorough investigation, protection while it was open, corrective action if verified |
| QAPI program and plan | F865 | Systems that identify, report, investigate, analyze and prevent adverse events, and the corrective actions taken |
| Adverse event monitoring and QAA activities | F867 | Data and feedback systems, including adverse event monitoring, used to find high-risk, high-volume or problem-prone areas |
| QAA committee | F868 | Committee composition, meeting frequency and the action it takes |
If a surveyor cites F600, the QAPI step checks whether the QAA committee had already found the issue. It also checks whether the committee made a good faith attempt to correct it.
What is the risk-based survey?
CMS began a nationwide risk-based survey (RBS) on September 8, 2026 for eligible homes. The source is memo QSO-26-14-NH (revised September 29, 2026). The RBS is a modified standard recertification survey. It reviews all required areas in a more focused way. It takes roughly half the time and uses fewer surveyors. CMS estimates about 12 percent of homes will qualify. It plans an icon on Nursing Home Care Compare for them starting October 8, 2026.
A home does not qualify if it has any of these, among other listed criteria:
- an overall rating below 5 stars or a staffing rating below 3 stars;
- a citation for actual harm, immediate jeopardy or substandard quality of care in the last survey cycle;
- more than 18 months without a standard survey, or a change in ownership since the last one;
- a nurse staffing waiver, or a failed payroll-based journal or MDS audit.
States can still use the full process in a qualified home, and CMS may require it. Ask your state agency which process applies to you.
What happens after the exit conference?
Citations are not final at the exit conference. After supervisory review, the state sends Form CMS-2567 by the 10th working day after the last day of the survey. An acceptable plan of correction is due within 10 calendar days of your receipt of the 2567. A request for informal dispute resolution is due in the same 10 days. See plan of correction.
How do you stay ready between surveys?
This list is our practical advice, drawn from what CMS asks for:
- Practice the four-hour document pull. Gather the QAPI plan, QAA roster, abuse prohibition policy, facility assessment and infection control program.
- Match your incident log to what you reported to the state.
- Keep QAA minutes that show an issue, an action and a follow-up measure.
- Keep proof of the annual notice to covered individuals.
- Run the survey readiness check and review abuse and neglect reporting.
How IncidentKit supports this requirement
| What the rule asks for | Where it lives in IncidentKit |
|---|---|
| Four-hour document request: QAPI plan, QAA information, abuse prohibition policy | Compliance packets assemble QAPI summaries and survey packets. Your policies stay in your own document system. |
| Facility-reported incidents match your own records | The incident record keeps timestamps, your logged reporting steps and the investigation. The audit trail records every change. |
| Abuse allegations reported, investigated and corrected (F609, F610) | Investigations and corrective actions give the evidence F610 asks for. Staff report by text, QR code, email or web form, and routing alerts the administrator. |
| QAA monitors reporting and investigations, and shows a good faith attempt to fix issues (F600, F867) | Analytics cluster incidents by location, shift and cause. Corrective actions with effectiveness checks give the committee follow-up items. |
| Electronic health record access, resident matrix and staffing schedules | Not an IncidentKit function. IncidentKit runs alongside your EHR and HRIS and does not replace them. |
Product parts involved: Incident reporting, Investigations and RCA, Corrective actions (CAPA), Compliance packets, Analytics, Audit trail. Capabilities marked “rolling out” are being released in stages; see the changelog.
Frequently asked questions
How often are nursing homes surveyed?
No later than 15 months after the last standard survey. The statewide average interval must not exceed 12 months. Homes with excellent compliance histories may be surveyed less often, but never less often than every 15 months. Complaint surveys can happen at any time.
Can a survey start at night or on a weekend?
Yes. At least 10 percent of standard surveys must be off-hour surveys. They start on a weekend, or before 6 a.m. or after 5 p.m. on a weekday. At least half of those must start on a weekend day.
Do surveyors review facility-reported incidents?
Yes. The team coordinator reviews closed complaints and facility-reported incidents since the last survey. They look for repeated issues. A linked complaint also triggers a review of your abuse policies and QAA monitoring of reported allegations.
How long will the survey team be in the building?
At least five hours in a row after entry. At least two calendar days in a row on site, weekends and holidays included. Total time varies with the home's size, layout and concerns to investigate.
What is the risk-based survey, and will my home get one?
A shorter, more focused standard survey for higher-performing homes, begun nationwide on September 8, 2026. CMS gives each state a quarterly list of qualified homes. A home stays eligible for six months after the state gets the list. A disqualifying event ends that. A state may still use the full process.
Sources
- CMS State Operations Manual, Chapter 7: survey and enforcement process for skilled nursing facilities and nursing facilities (Rev. 244)
- CMS State Operations Manual, Appendix PP, guidance to surveyors for long-term care facilities
- CMS LTCSP Procedure Guide and Entrance Conference Worksheet, September 2026 (Survey Resources package)
- CMS memo QSO-26-14-NH (revised September 29, 2026): Nursing home risk-based survey national implementation
- CMS, Nursing homes: regulations and guidance
Reviewed against the sources above on Oct 5, 2026. Rules change: confirm current requirements with the issuing body or your counsel before relying on any summary.
Map this requirement to your records.
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