Every mock survey checklist on the internet is the same: a flat bullet list of things to check, organized by someone who has never watched a surveyor work. They cover the obvious stuff and miss everything else.
This one is different. Each checklist item maps to the F-tag surveyors cite for it. Each department section includes the actual questions surveyors ask staff, residents, and family members. And at the end, there’s a 90/60/30-day timeline that tells you when to do what so you’re not scrambling the week before.
Under QSO-26-03-NH effective April 30, 2026, surveyors are required to spend 5 consecutive hours on Day 1. That is enough time to observe a full medication pass, watch an entire meal service, do a complete environment walk, and review a dozen records. Your mock survey should take at least as long. If it doesn’t, you’re not simulating the real thing.
How to Use This Checklist 📄
Run this mock survey in conditions that actually resemble a real survey. That means:
- Do it on a Friday afternoon or Saturday morning — not a Tuesday when the DON is on the floor and the binders are freshly organized
- Give department heads 48 hours notice, not two weeks — that’s about what real advance notice feels like
- Assign a charge nurse or ADON to lead it — the DON should not be the one running their own mock survey
- Run it as a continuous 5-hour block — environment walk first, then nursing, dietary, activities, and finish with documentation review
- Document every finding specifically — not “call light slow,” but “call light Room 214 activated at 2:14pm, answered 2:27pm (13 minutes)”
Each checklist item below has an F-tag badge showing which CMS regulatory citation applies. These are the actual tags surveyors write when they find a deficiency in that area. When your mock survey finds a gap, you’ll know exactly what tag is at risk — and you can look up the full guidance at the complete SNF F-tag list to understand the severity threshold and remediation requirements.
The surveyor question boxes show you what staff, residents, and family members get asked in that department. Practice these answers. A charge nurse who hesitates on a basic care plan question is a signal to a surveyor that something is worth investigating deeper.
Nursing Department Checklist 💉
Nursing is where most surveys are decided. Care plans, medication administration, fall documentation, and pressure injury management are the four domains surveyors spend the most time on — and they are interconnected. A care plan gap leads to a medication pass gap leads to an incident documentation gap. Run this section during an actual shift, not during a quiet prep window.
- F655 Spot-check 5 care plans: each has a current problem list, measurable goals, and resident-specific interventions (not copy-pasted template language)
- F657 Care plan reflects the most recent MDS findings; any significant change in condition in the past 30 days has triggered a care plan update
- F689 Fall care plans include specific post-fall interventions — not just “fall risk precautions” or “non-skid footwear”
- F641 MDS assessments are completed within required timeframes; coding reflects current clinical status and matches care plan interventions
- F656 Resident and/or family involvement in care plan development is documented within the past 90 days
- F758 Residents on psychotropic medications have a documented clinical indication, gradual dose reduction attempts where applicable, and behavior monitoring
- F759 Observe a full medication pass: nurse verifies resident identity before each administration (name band, photo, verbal confirmation)
- F758 Medications are crushed or modified appropriately for residents with dysphagia; crushing order is in place, current, and on the MAR
- F760 PRN medications have documented effectiveness notation within 1 hour of administration
- F756 Medication cart is locked when not in direct use; controlled substances are counted at shift change with both nurses present and documented
- F761 No medications are prepared in advance and left unattended; expired medications are not in the cart or on the unit
- F755 Medication error log is current; errors in the past 30 days have documented follow-up and pharmacist review
- F689 All falls in the past 90 days have a completed root cause analysis on file; post-fall assessments documented within 24 hours
- F689 High-fall-risk residents have individualized intervention plans at the bedside and in the care plan (not identical across residents)
- F610 Incident reports are completed within required timeframes; reports involving potential abuse or neglect have required notifications documented
- F867 QAPI has trended fall data from at least the past 3 months with documented root cause analysis and corrective actions (see QAPI program requirements template guide)
- F686 Residents with current pressure injuries have consistent wound measurements, staging, and treatment documentation in every nursing note
- F686 Pressure injury prevention care plans are specific: repositioning schedules, specialty mattress orders, nutritional supplementation where indicated
- F684 Residents who developed pressure injuries while at the facility have documented clinical rationale showing unavoidability, or a corrective action plan
- F692 Residents with documented weight loss have dietary intervention orders, supplement administration records, and care plan updates within 30 days of first weight loss
What staff get asked in nursing
- Tell me about this resident’s care plan. What are the main goals and what are you doing to address them?
- This resident had a fall last month. What changed in their care plan as a result?
- Walk me through how you do a medication pass. What do you do to confirm you have the right resident?
- Who do you call if you notice a significant change in a resident’s condition at 2am?
- How do you document a PRN medication after you give it? Can you show me an example?
- This resident is on a fall prevention protocol. Can you describe the specific interventions in their plan?
10 Printable Self-Audit Documents. Every Department.
The FacilityKit Mock Survey Kit gives your ADON a complete set of department-by-department audit tools — F-tag mapped, formatted for real use during an active shift, not just a binder review. Includes medication pass observation forms, dietary temperature log audits, care plan spot-check worksheets, and more. Built for the 5-hour Day 1 standard.
Free: SNF Survey Readiness Checklist
9-page CMS Appendix PP guide — F-tags, binder audit, staff interview prep, and morning-of-survey walkthrough protocol. Free, instant delivery.
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Dietary Department Checklist 🍳
An experienced surveyor can walk a dietary area in 20 minutes and document six citations. The most common: food temperatures out of range, missing or outdated HACCP logs, therapeutic diet labeling errors, and staff without current food safety training. Run this section during meal service and kitchen prep — not at 10am when the kitchen is quiet and clean.
- F800 Hot foods arrive to residents at or above 140°F; cold foods at or below 41°F — spot-check with probe thermometer at tray line and at resident bedside
- F803 Therapeutic diet trays are correctly labeled and match the current diet orders in the resident’s medical record
- F803 Texture-modified diets (mechanical soft, pureed, minced) are distinguishable and properly prepared — not combined into unidentifiable mash
- F693 Residents requiring meal assistance are receiving it during the observation window; no resident is left with a tray they cannot access independently
- F800 Dining room environment is appropriate: no competing odors, adequate lighting, residents seated comfortably and safely
- F804 Meal substitutes are available and offered when residents refuse a meal item — menus are posted and accessible
- F812 HACCP temperature logs are current: refrigerator temps logged at least twice daily, freezer temps daily, within required ranges
- F812 Dishwasher final rinse temperature logs are current and within range (180°F for high-temp machines; 50–200 ppm chlorine for chemical sanitizing machines)
- F812 All refrigerated food items are labeled with contents and date; no unlabeled, undated, or expired items in any refrigerator or dry storage
- F812 Raw meats are stored below ready-to-eat foods; proper FIFO rotation is visible in refrigerator organization
- F812 Chemical storage is clearly separated from food storage, labeled, and locked or secured against unauthorized access
- F812 Staff observed using gloves and hair coverings during food prep; no bare-hand contact with ready-to-eat foods; no jewelry on hands or wrists during food prep
- F812 No evidence of pest activity: no droppings, gnaw marks, or live insects in kitchen, dry storage, or dining area
- F803 Current diet orders are on file for every resident; dietary and nursing diet orders match exactly — any discrepancy is a direct citation pathway
- F692 Residents with calorie or protein supplement orders have documented evidence of supplement administration in the past 30 days
- F692 Weight monitoring is current; residents with significant weight loss (5% in 30 days or 10% in 180 days) have documented dietary assessment and intervention
- F801 Qualified Dietary Manager or Registered Dietitian credentials are current and on file; coverage is documented when the primary is absent
- F812 Food safety training documentation is current for all dietary staff; certificates or training records are accessible during survey
What dietary staff get asked
- This resident is on a 1,800 calorie, no-concentrated-sweets diet. What does that mean for their tray today?
- Where are your temperature logs? When was the last time temperatures were out of range and what did you do?
- This resident has a swallowing disorder. How do you make sure their texture-modified diet is prepared correctly?
- What do you do when a resident refuses to eat their meal?
- Can you show me your HACCP plan and where you document dishwasher sanitizing temperatures?
Activities & Social Services Checklist 🎮
Activities is the department most facilities under-prepare for. The citations here are rarely dramatic, but they accumulate: generic programming that doesn’t reflect resident interests, activity assessments that look identical across 40 residents, and notes that say “resident participated in bingo” without any specifics about outcomes or engagement. Social services gets cited for documentation gaps around psychosocial needs, advance directives, and discharge planning. See the full guide on Activities Director Compliance Guide compliance in SNFs for department-specific surveyor protocols.
- F679 Activity calendar for the current month is posted in a visible location; programming listed matches what is actually occurring on the floor (surveyors verify this in real time)
- F679 Activity assessments are current (within 14 days of admission, quarterly thereafter) and reflect resident-specific interests — not identical check-box forms across residents
- F679 Residents who prefer individual activities (rather than group) have documented individualized programming and notes reflecting those sessions
- F679 Evening and weekend programming exists and is documented — not just weekday group activities during business hours
- F679 Bed-bound or room-confined residents have documented evidence of in-room activity interventions with specific outcomes noted
- F675 Activity notes document resident response and engagement — not just participation (“resident engaged with music therapy; demonstrated increased affect and verbalized enjoyment” vs. “attended music”)
- F740 Social services notes are substantive and in every resident file; notes reflect actual psychosocial assessment rather than “resident stable, no concerns”
- F550 Advance directive discussions are documented for all residents; current advance directive or POLST is on file, or resident’s declination to complete one is documented
- F622 Discharge planning documentation is current for all residents identified as potential discharges; family involvement is documented
- F740 Residents with identified psychosocial needs (depression, anxiety, grief, family conflict) have care plan entries with specific social services interventions
- F740 Social services quarterly reviews are current and reflect changes in resident status, goals, or psychosocial condition since the previous review
What residents and activities staff get asked
- (To resident) What kinds of activities do you enjoy here? Do you feel like they have things you like to do?
- (To resident) Has anyone talked to you about your wishes if you got very sick? Do you have paperwork for that here?
- (To activities staff) This resident is on your low-engagement list. What individualized programming have you done with them this month?
- (To activities staff) This resident can’t leave their room. How do you make sure they have meaningful activity engagement?
- (To social services) When did you last meet with this resident about their psychosocial needs? What did you find?
Environmental & Maintenance Checklist 🏠
Environmental citations require no chart review — surveyors see them instantly. A propped fire door, an outdated temperature log, a broken call light, a cluttered hallway. These take seconds to find and seconds to write up. They also signal to surveyors that the facility’s oversight processes are weak, which encourages deeper review everywhere else. Do the environment walkthrough first in your mock survey, start at the front entrance, and treat every hallway like a stranger who has never been there before.
- F689 Call light response times: observe 5 call light activations; document time from activation to response (CMS identifies patterns over 5 minutes as a potential deficiency)
- F689 All call lights in resident rooms and bathrooms are functional — test by activation, not visual check; document any non-functional units
- F689 Emergency pull cords in bathrooms reach to the floor or within resident reach when lying on the floor
- F584 Fire exits are clearly marked, unobstructed, and door hardware functions without a key or special knowledge; no blocked fire exits
- F584 Fire doors and smoke barrier doors close completely when released; no propped open fire doors anywhere in the building
- F584 Oxygen tanks in use or storage are properly secured upright; not lying on their sides
- F584 Emergency evacuation maps are posted in each corridor and are current (match actual room assignments and exit routes)
- F584 Room temperature logs are current and within range (68–74°F for resident care areas); no gaps in daily log entries
- F584 Hot water temperature at resident-accessible sinks is within the anti-scald range (verify at 2–3 locations with a thermometer, not just from maintenance records)
- F756 Medication refrigerator temperature logs are current (daily entries, within 36–46°F); any out-of-range entries have documented corrective action
- F584 Emergency generator testing log is current; last test date, duration, and outcome are documented
- F584 No visible water damage, peeling paint, or mold in resident rooms, bathrooms, or common areas
- F584 Utility rooms and soiled linen rooms are locked and secured from unsupervised resident access
Common environmental observation patterns
- Surveyors will test 3–5 call lights themselves and time the response; they document the exact minutes
- Fire doors are checked systematically on every corridor walk — a propped door is an automatic finding
- Temperature logs are pulled and reviewed for gaps — missing entries are as problematic as out-of-range entries
- Surveyors will ask maintenance: “When did you last test your emergency generator and what’s the result?”
- Hallway width and clutter are measured against fire code clearance requirements; equipment stored against walls narrows the pathway
Emergency preparedness is surveyed under its own E-tag series (E0001–E0042) and is a CMS Condition of Participation. For the complete checklist covering risk assessments, communication plans, training requirements, and annual testing, see the SNF Emergency Preparedness Plan guide.
Administration & Compliance Checklist 💼
Administrative deficiencies frequently multiply during survey because they reveal systemic oversight failures. A missing policy, an expired license, a required posting that’s outdated — these are easy to find and easy to write. More importantly, they signal to surveyors that the administrative infrastructure supporting clinical care may be equally weak. Run this section as a separate document audit, not during the floor observation.
- F550 Resident Rights are posted in a conspicuous location accessible to all residents; the posting is current and legible
- F563 Ombudsman contact information is posted and current (verify actual phone number against state ombudsman directory)
- F838 State survey agency contact information is posted and current
- F842 Staffing information is posted daily with actual hours worked per licensed nurse and CNA per resident — not projected or scheduled hours
- F550 Grievance process is explained in writing in the admission packet and posted in the facility in a location visible to residents and family members
- F838 Facility license and administrator license are current, posted, and accessible during survey
- F726 Staff licenses and certifications are current for all licensed nurses; CNA certification verification is on file for all nursing assistants
- F726 Background checks and Nurse Aide Registry clearances are on file for all clinical staff; no staff with substantiated abuse findings
- F838 Policies and procedures are current; policy revision dates align with current CMS guidance and QSO updates
- F867 QAPI program is active with documented quarterly meetings, performance improvement projects, and corrective action tracking (see the SNF QAPI program requirements guide)
- F838 Facility assessment is current (annual review documented) and reflects current resident acuity, staffing levels, and resources
- F600 Abuse prohibition policy is current and reflects QSO-26-03-NH requirements; includes updated mandatory law enforcement reporting timelines for serious-harm allegations
- F609 All reportable incidents in the past 12 months have documentation showing the required notifications were made within the required timeframes (see SNF abuse investigation protocol)
- F602 Staff Training Tracker records show annual abuse prevention training completion for all staff with resident contact; training content reflects current QSO guidance
- F606 Pre-employment screening documentation (OIG exclusion check, state registry) is on file and current for all staff
What administrators and DONs get asked
- Walk me through your abuse reporting process. If a CNA reported suspected abuse to a charge nurse at 2am, what happens next?
- When did you last update your policies to reflect QSO-26-03-NH? Can you show me the updated abuse investigation policy?
- What does your QAPI committee look like? Who attends, how often do you meet, and what are your current PIPs?
- Tell me about your staffing. How do you calculate and post the daily staffing hours?
- How do you handle a grievance from start to finish? Can you walk me through a recent example?
Infection Control Checklist 🧠
F880 (Infection Prevention & Control) has been the most-cited tag in skilled nursing facilities for years. Surveyors know exactly what to look for, and they document in real time during observation. Hand hygiene compliance alone accounts for a significant portion of F880 citations — and it’s easy to observe during a 5-hour Day 1. See the full infection control checklist for nursing homes for department-by-department specifics on F880 through F886.
Infection Control Checklist- F880 Observe 10 hand hygiene opportunities during mock survey; document compliance rate and which staff were non-compliant
- F880 Hand sanitizer dispensers are present at every room entrance and in hallways; dispensers are not empty (check 5 randomly)
- F880 Gloves are worn for contact with bodily fluids, mucous membranes, or non-intact skin; gloves are removed after care and not worn into the hallway between residents
- F880 PPE is donned and doffed correctly; staff remove and replace gloves between residents and between tasks on the same resident
- F883 Annual flu vaccination status is on file for all residents; declinations are documented; staff vaccination rates are tracked and recorded
- F880 Residents on contact, droplet, or airborne precautions have appropriate signage at the room entrance; adequate PPE is stocked outside the door
- F880 Infection surveillance log is current; any HAI trends in the past 90 days have documented QAPI follow-up and corrective action
- F881 Antibiotic stewardship program is active; antibiotic starts in the past 30 days have documented clinical rationale, culture data where applicable, and prescriber review
- F880 Single-use items are not reused across residents; BP cuffs have covers, glucometer lancets are resident-specific, shared equipment is wiped between uses per protocol
- F880 Soiled linen is handled without contact with the uniform; linen bags are not overfilled; clean and soiled linen are stored and transported separately
What infection control staff and nurses get asked
- What is your current hand hygiene compliance rate? How do you measure it and what do you do with the data?
- This resident is on contact precautions. Walk me through what happens when a nurse enters that room.
- Tell me about your antibiotic stewardship program. Who reviews antibiotic starts and what triggers a review?
- What infections did you track in the past 90 days? Were there any clusters and what did QAPI do with that data?
- How do you handle a situation where you suspect MRSA in a resident who doesn’t have a confirmed diagnosis yet?
Resident Rights Checklist ✍️
Resident rights citations (F550–F585) tell a story about culture, not just procedure. A surveyor who observes staff discussing a resident’s diagnosis in a crowded hallway, or finds that a grievance was “resolved” with no documented outcome, isn’t just writing a tag — they’re building a narrative about how your facility treats the people living there. Under QSO-26-03-NH, certain resident rights violations related to serious harm are now subject to mandatory IJ treatment.
- F550 Observe 5 care interactions: resident privacy is maintained during personal care (curtains, closed doors); staff knock before entering
- F550 Residents are addressed by their preferred name; staff do not use infantilizing language unless the resident has stated a preference
- F550 Resident care discussions and clinical information are not shared in public areas where other residents, visitors, or staff can overhear
- F550 Personal care is not conducted with room door open unless the resident has expressly stated a preference for this and it is documented
- F676 Residents are able to make choices about their daily schedule: wake time, meal preferences, activity participation — and these preferences are reflected in care plans
- F585 Grievance log is current; every grievance has a documented acknowledgment date, investigation summary, outcome, and communication back to the resident or family
- F585 Grievances are not resolved with one-line entries like “resident satisfied after discussion” — outcomes are specific, documented, and signed
- F585 No patterns suggesting retaliation: residents who filed grievances are receiving the same level and quality of care as other residents
- F585 The grievance process is explained in writing at admission and posted in a visible location; residents and families know how to file and to whom
- F572 Residents have access to their personal funds; no resident accounts are overdrawn or improperly managed; quarterly statements are provided
- F623 Notice of discharge rights and transfer policies are documented and provided to residents and families at admission
- F623 Medicare/Medicaid coverage termination notices (SNF ABN, MOON forms) are issued correctly within required timeframes and acknowledged by signature
What residents and families get asked
- (To resident) Do you feel like you have a say in your care? Do the nurses ask you before doing things to you?
- (To resident) If you had a complaint about something here, do you know how to make it? Has anyone ever told you what to do if you have a problem?
- (To resident) Do you have any money kept here for you? Can you get to it when you need it?
- (To family) Have you ever raised a concern with the facility? What happened when you did?
- (To resident) Do the staff knock before coming in your room? Do they close the curtain when they’re helping you?
Documentation Red Flags That Trigger Deeper Review 🚨
Surveyors are pattern-recognition professionals. They look at documentation not just for what it says, but for what it reveals about operational habits. Certain patterns are reliable signals that something deeper is wrong — and when surveyors see these signals, they expand their review. Run this section as a separate chart audit, pulling 5–8 records at random. When deficiencies surface, you’ll need a corrective response — the SNF plan of correction examples and template guide and how to fix a CMS plan of correction cover the language and structure reviewers require.
These patterns trigger expanded surveyor review
- Templated nursing notes: Notes that are obviously copy-pasted from previous entries with only the date changed, or that use identical language across multiple residents — signals staff are documenting for compliance, not for care
- Late entries without notation: Entries added significantly after the event with no “late entry” notation and no explanation for the delay
- Incident reports with no follow-up: An incident report filed with no subsequent nursing assessment, no care plan update, and no QAPI notation — signals incidents are being documented but not learned from
- Care plans not updated after condition changes: A resident was hospitalized, had a significant fall, or had a major change in condition and the care plan hasn’t been updated within 30 days
- PRN medications with no effectiveness documentation: PRN pain, anxiety, or sleep medications with no outcome notation after administration — surveyors will count these
- Weight loss without dietary intervention: Significant weight loss with no corresponding dietary assessment, no supplement order, no care plan update — direct pathway to F692 and F800
- Grievances resolved without specifics: Grievance log says “addressed and resolved” with no documentation of what was found, what was done, or how the resident was notified
- Missing signatures or incomplete physician orders: Telephone orders not countersigned within required timeframes; treatment records with missed entries and no explanation
- Identical shift notes across multiple days: Narrative nursing notes that read the same across consecutive shifts — a signal of inadequate assessment, sometimes evidence of falsified documentation
1. Your highest-fall-risk resident: review 90 days of nursing notes, incident reports, and care plan entries for consistency.
2. A resident recently discharged or hospitalized: check discharge planning documentation and care plan updates post-discharge.
3. A resident with a chronic wound: verify consistent wound measurements, staging, and treatment order currency across every nursing note.
4. A resident who filed a grievance in the past 90 days: review the grievance log entry and compare it to their clinical documentation.
5. A resident on multiple PRN medications: count effectiveness notations for the past 30 days; expect surveyors to do the same math.
Free Plan of Correction Template
When your mock survey finds something — and it will — you need a Plan of Correction that holds up to CMS review. The free template covers the four required elements with the specific language surveyors and state reviewers want to see: identification, corrective action, systemic fix, and monitoring. Use it before you need it on a real deficiency.
Plan of Correction Examples 📋 Get Free PoC Template →90/60/30-Day Survey Preparation Timeline 📅
A mock survey run the week before a state visit is not preparation — it’s a fire drill. Actual survey readiness is built over months: systematic audits, corrective actions, re-auditing to confirm fixes held, and staff training on the areas that keep showing deficiencies. This timeline gives you a structured approach. Adapt it to your survey window if you know when you’re due.
📅 Preparation Timeline
Baseline Assessment — Find Out Where You Actually Are
- Run a full mock survey using this checklist; document every finding specifically with room numbers, times, and staff identifiers
- Pull the past 12 months of survey deficiencies (your own and comparable facilities from CMS deficiency data); identify your highest-risk F-tag categories
- Audit the past 6 months of incident reports: identify fall trends, HAI trends, and grievance patterns; bring findings to QAPI
- Verify all staff licenses and certifications are current; identify any expirations in the next 90 days and schedule renewals
- Check all required postings; confirm ombudsman and state agency contact information is current
Targeted Corrections — Fix What the Baseline Found
- Implement corrective actions for all findings from the 90-day mock survey; assign owners and target dates for each action item
- Conduct department-specific in-services on your top 3 deficiency areas (usually medication administration, infection control, and care plan documentation)
- Run a focused dietary audit during meal service; test food temperatures at 3 points in the tray line and at resident bedsides
- Audit infection control compliance: observe 20 hand hygiene opportunities, document compliance rate, and address non-compliant staff individually
- Update care plans for the 10 highest-complexity residents: verify MDS accuracy, fall risk documentation, and behavioral health plans
- Review and update abuse prevention policy to reflect QSO-26-03-NH; confirm all staff have signed updated training acknowledgment
Re-Audit & Final Prep — Confirm the Fixes Held
- Run a second full mock survey (off-hours, different person leading) to verify that 60-day corrections are holding under real operational conditions
- Do a focused documentation audit: pull 8 charts at random and check for every red flag listed in Section 9 above
- Verify grievance log is current; review every open or recently closed grievance for documentation completeness
- Confirm all QAPI PIPs from the past 6 months are documented with measurable outcomes; prepare to show surveyors this data
- Brief all department heads on surveyor question patterns (use the surveyor question boxes in this guide); conduct a tabletop exercise on abuse reporting protocol
- Walk the building as a stranger: use the main entrance, check the lobby, test 3 call lights, look at every required posting, check 5 refrigerators
Run it at 3pm on a Friday or on a Saturday morning. Give department heads 48 hours notice. Do not brief floor staff directly — the ADON leading the mock should observe what the building actually looks like without a warning announcement. That’s what the real survey looks like.
Schedule a debrief within 24 hours. Every finding gets an owner, a corrective action, and a re-audit date. Document all of this. If surveyors find the same thing your mock survey found and you have documented corrective action already underway, that is a materially different situation than discovering it for the first time during the survey.
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