SMQT Practice Study Guide Exam 2026

SMQT Practice Study Guide Exam 2026 Used to guide facility task investigations Facility task CE Pathways & Appendix PP A Regulatory Reference includes WHAT 4 following components: 1. A survey data tag number, 2. The CFR (or LSC reference), 3. The language from that reference which specifies the aspect(s) of requirement with which entity was noncompliant. 4. An explicit statement that requirement was “NOT MET.” What is an F-tag ? * "F" federal tag # corresponds to a specific FEDERAL regulation within the CFR (Code of Federal Regulations) - ("F" for "federal") * federal system through which areas of dp's /compliance (standards & guidelines) are assessed/identified based on performance within CMS (CMS Survey) * Each tag is related to one area of the CFR Nursing homes are less likely to be accredited because they are not given "deemed status" When can a provider/supplier have their services covered ? When compliance with all CoP (conditions of participation) are met - substantial compliance with the requirements for SNFs & NFs are met - compliance with applicable CoC (conditions for coverage) for suppliers. When can a standard survey be broaden or expanded ? If SQC (Substandard quality of care) suspected SMQT SMQT When should timing of an abbreviated standard survey take place ? At discretion of SA (An exception is made for complaints that allege IJ to resident health & safety) What happens when an extended or partial extended survey is conducted ? A facility loses it's ability to train nurse aides. Your team is conducting a complaint survey concerning the quality of care at a nursing home. During the complaint survey, your team expands the survey & determines that the facility is providing substandard quality of care that was not previously identified. Is an additional survey required in this situation? If so, what type of survey is needed? A partial extended survey is conducted after SQC is found during an abbreviated standard survey or during a revisit, when SQC was not previously identified. What is Reasonable-Person concept? Used when a resident's psychosocial outcome may not be readily determined through the investigative process: * determine the severity of psychosocial outcome that dp on a Reasonable Person in a SIMILAR Situation * degree of care that a RP would exercise under ALL circumstances An abbreviated standard survey is also known as a A complaint investigation B standard survey C state monitoring visit D particle extended survey A Complaint Investigation Which survey may a surveyor investigate any area of concern and make compliance decisions regarding any regulatory requirement , whether or not it is related to the original purpose of the visit ? A Complaint Survey B State Monitoring Survey SMQT SMQT C Resurvey D Initial Certification Survey A Complaint Survey The administrator was successful during an informal dispute review in reversing an IJ during the survey . For it to be removed from the 2567 , the administrator must A Draw a line through the deficiency on the 2567 . B do nothing, CMS will remove it C notify the corporate office . D submit a written allegation of removal . D submit a written allegation of removal Which form must be completed and given to surveyors within 24 hours ? A CMS - 673 and CMS - 674 B CMS - 674 and CMS - 675 C CMS - 671 and CMS - 672 D CMS - 672 and CMS - 673 C - CMS - 671 and CMS - 672 Which piece of information is provided to surveyors during the entrance conference? A CMS - 671 form B Name of the Resident Council President C Immunization policies and procedures D Grievance information B. Name of the Resident Council President Who conducts the Life Safety Code inspection ? A State Fire Marshall's office and State Surveyors B State Surveyors SMQT SMQT C The Governors office D State Fire Marshall's office D State Fire Marshall's office A facility received a deficiency for infection control due to a nurse aide not washing her hands between residents' care. Part of their POC is to monitor nursing assistants for hand washing . The frequency of the monitoring must specify A the time interval is unnecessary B it will be random . C it will be unannounced D daily , weekly , monthly , etc. D daily , weekly , monthly , etc. On a deficiency statement , SS - G would represent A deficient practice . B scary stuff . C severity and scope . D scope and severity . D scope and severity Which of the following contains the compliance history of the facility over the past 4 years ? A CASPER 1 B CASPER 3 C Facility Profile D CASPER 4 B CASPER 3 Once the survey team introduces themselves to the administrator the team coordinator will finish the entrance conference while the other surveyors SMQT SMQT A introduce themselves to facility staff B observe resident cares C listen to all the information D go to their designated area / task D go to their designated area / task To determine if a facility is in compliance with resident rights and quality of life requirements, surveyors should assess whether or not residents are given the opportunity to choose activities and schedules that are consistent with their: A) Resident Behavior & Facility Practice B) Quality of Life C) Quality of Care D) interests, assessments, & CP D) interests, assessments, & CP During an interview with Resident #4 , an 80-year-old female, she voiced a complaint that her hearing aid was broken and that even before it broke, she was not hearing very well with it. The most recent Minimum Data Set (MDS) assessment indicated the Resident had moderate hearing deficits. Based on this information, the surveyor should determine if the facility A. made arrangements to have an audiology exam and the hearing aid repaired. B. made arrangements to have a hearing specialist come to the facility to evaluate Resident #4's hearing. C. asked Resident #4's family to arrange for her audiological examination and hearing aid repair D. was aware of Resident #4's missing hearing aid and, if so, what interventions the facility took to address or correct the problem. SMQT SMQT The correct answer is "A." Resident #4 indicates that her hearing was impaired before her hearing aid broke. Although an audiological examination is needed to determine the status of Resident #4's hearing ability, it is not required that this examination be conducted at the facility At a particular long term care facility, 98% of all organized resident activities are held between the hours of 11 a.m. and 6 p.m. Monday through Friday. The survey team should A. recognize that activity therapy staff only works Monday-Friday: 8 a.m. to 6 p.m B. interview residents to determine satisfaction with activities schedule C. suggest that activity department provide structured, volunteer- run activities at night & weekends D. suggest facility offer transportation to local churches, theaters & malls on weekends The correct answer is "B." Given the limited amount of information, the survey team should investigate further to gather additional information from residents, to learn about the impact on residents. "A" is incorrect because it reflects surveyor behavior that accepts facility practice without evaluating its appropriateness in relation to the needs of the residents. "C" and "D" are incorrect because they reflect surveyor behavior that presupposes the correct answer and provides "consultation" or suggestions based on limited information. T/F. Med errors occurring with residents who self-administer should not be counted in facility's medication error rate. TRUE (However, this may call into question the judgment of facility staff in allowing self administration of medication for that resident.) SMQT SMQT T/F. Additional fees for locating the records or typing forms/envelopes are included in requests for records. FALSE (FA may charge a reasonable, cost-based fee for providing copy of requested records (paper or electronic form) May only include: cost of labor for copying the records supplies for creating the paper copy or electronic media, and postage, if applicable Additional fees for locating the records or typing forms/envelopes may not be assessed) What is avoidable decline? FA failed to do 1 or more of following: 1. Evaluate clinical condition & risk factors 2. Develop/implement INTERVENTIONS (consistent with resident needs, goals & standards of practice) 3. Monitor/evaluate impact of interventions 4. Revise interventions (as appropriate) What must you do prior to observing resident care? Have consent from the resident or resident rep., and facility nurse staff must be available during the observation. What do you do if an interviewee says you cannot use the information they reveal? You cannot use the revelation but you can investigate the issue with other residents Can an interviewee's identity be revealed if the facility appeals a cited deficiency and the deficiency is based on information from the interview? Yes What factors should you consider in determining severity when harm has occured ? Is the harm at the level of serious injury, impairment or death? Does the deficient practice require immediate correction? did the resident experience a negative psychosocial outcome? How did FA practice in question cause, contribute, or perpetuate the harm? SMQT SMQT Could the noncompliance have an impact on many residents? (Use the psychosocial outcome grid & the Reasonable-Person concept) What factors should you consider in determining severity when the is NO actual harm? how likely is it that a resident could suffer harm, impairment, death or compromise/deterioration Could the noncompliance have an impact on many residents? Did the resident experience a negative psychosocial outcome? During a formal appeal, does CMS have the responsibility of showing why the provider should have enforcement? Yes When should you contact the RAI coordinator? If the number of residents is unreasonable after exporting the survey shell What should you do if a resident halts the interview midway? Attempt to complete later, if you can't, leave the rest blank, complete RO/RR then mark the resident as complete. “Court of "competent jurisdiction“ means any court with the authority to hear & determine a case/suit with matter in question What does a significant change status mean in MDS * Major decline or improvement in resident's status that will not normally resolve itself without further interventions OR * has impact on more than one area of resident's health status & requires interdisciplinary review or revision of care plan/both What pathway is used to investigate QOC concerns that have no pathway? General CE pathway How should you determine who to interview? SMQT SMQT Use the CEP What do you do if an interviewee says you cannot use info they reveal? You cannot use the revelation but you can investigate the issue with other residents Can an interviewee's identity be revealed if FA appeals a cited deficiency & deficiency is baed on info from interview? Yes How should privacy curtains be hung? Must be hung from the ceiling and extend around the bed to provide total visual privacy What are Problem-prone areas Refers to care or service areas that have historically had repeated problems, e.g., call bell response times; staff turnover; lost laundry. T/F: All CE Pathways provide investigative probes TRUE T/F: Tags CAN be cited for the same noncompliance. FALSE Tags shall NOT be cited for same noncompliance What areas are reviewed for non-interviewable residents ? Pressure Ulcers dialysis infections nutrition falls in (last 120 days) ADL decline low risk B&B unplanned hospitalization elopement Change of CONDITION (in last 120 days) What are the types of interview status? 1. Interviewable SMQT SMQT 2. Non-Interviewable 3. Refused 4. Unavailable 5. Out of facility Can the sample size exceed the sample size grid? Yes What should you use when selecting the sample size? Use the sample size grid, and system calculated minimum. What should you ask for if Abuse is being investigated (based on a history of abuse as noted on offsite prep screen)? Ask FA for all allegations of abuse since last survey. What is the definition of abuse? the WILLFUL infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish What is the definition of neglect? failure to provide goods / services necessary to avoid physical harm, mental anguish, or mental illness What should you consider when adding residents when the sample size is not met? Residents with: * most concerns * with r/t QOL & RR * selected for unnecessary med review * prior survey & complaint results * underrepresented areas of facility. What is the psychosocial outcome grid? guide designed to ID each residents psychosocial response to noncompliance as basis for determining psychosocial SEVERITY of a deficiency What factors drive decisions on SEVERITY? residents condition SMQT SMQT whether staff followed P&P duration of event facility and staff response to the problem impact on the resident (condition after the event) How do you classify the severity when the evidence includes incidents of varying severity and cope? Classify the deficiency at highest LEVEL of severity. (Ex. 1 resident severity level 3, there were widespread finding of same deficiency at severity level 2-classify as severity level 3-scope isolated) How do you determine SQC Deficiency designated under CoP 1 or more def. that poses IJ A pattern of, or widespread def. at severity level 3 A widespread deficiency a severity level 2 (F,H,I,J,K, or L) What is a Formal Appeal? An appeal heard with Administrative Law Judge. Both sides use lawyers, it is adversarial. (CMS and provider are subject to cross-examination. If either side is unsatisfied with results it can be appealed to the DAB- Departmental Appeals Board) What is Judicial Review A provider may request (CMS may not) if unsatisfied with DAB. What action must be taken after a complaint alleging resident neglect, abuse, or misappropriation of resident property is received? Review of allegation T/F - If the facility is in compliance, no enforcement action is required. TRUE SMQT SMQT Why is investigation & resolution of complaints a critical certification activity? To insure FAs continually meet Federal participation requirements Effectiveness of physical environment to: - Empower residents - Accommodate resident needs - Maintain resident safety Sections of Environmental Pathway? accommodation of need call system sound temp lighting clean equipment/good repair water temp bed/bath linens clean pest control ventilation handrails other concerns Who does Medicaid provide services for? low income, needy elders, blind, disabled getting SSI, certain infants and low income pregnant women. To determine if a facility is in compliance with resident rights and quality of life requirements, surveyors should assess whether or not residents are given the opportunity to choose activities and schedules that are consistent with their: A. likes, disabilities, and diagnoses B. medical histories, physician orders, and treatments SMQT SMQT C. mobility, medication regimens, and ability to pay for treatment D. interests, assessments, and plans of care. The correct answer is "D." interests, assessments, and plans of care. During an interview with Resident #4 , an 80-year-old female, she voiced a complaint that her hearing aid was broken and that even before it broke, she was not hearing very well with it. The most recent Minimum Data Set (MDS) assessment indicated the Resident had moderate hearing deficits. Based on this information, the surveyor should determine if the facility A. made arrangements to have an audiology exam and the hearing aid repaired. B. made arrangements to have a hearing specialist come to the facility to evaluate Resident #4's hearing. C. asked Resident #4's family to arrange for her audiological examination and hearing aid repair. D. was aware of Resident #4's missing hearing aid and, if so, what interventions the facility took to address or correct the problem. The correct answer is "A." (Resident #4 indicates that her hearing was impaired before her hearing aid broke. Although an audiological examination is needed to determine the status of Resident #4's hearing ability, it is not required that this examination be conducted at the facility.) At a particular long term care facility, 98% of all organized resident activities are held between the hours of 11 a.m. and 6 p.m. Monday through Friday. The survey team should A. recognize that the activity therapy staff only works Monday through Friday: 8 a.m. to 6 p.m. B. interview residents to determine their satisfaction with the activities schedule. SMQT SMQT C. suggest that the activity department provide structured, volunteer- run activities at night and on the weekends. D. suggest that the facility offer transportation to local churches, theaters, and malls on weekends. The correct answer is "B." (Given the limited amount of information, the survey team should investigate further to gather additional information from residents, to learn about the impact on residents. "A" is incorrect because it reflects surveyor behavior that accepts facility practice without evaluating its appropriateness in relation to the needs of the residents. "C" and "D" are incorrect because they reflect surveyor behavior that presupposes the correct answer and provides "consultation" or suggestions based on limited information.) SURVEY Process Standard SURVEY = SQC = Extended SURVEY What is the survey PROCESS based on? * Person-centered care (QOC) And * RESident-centered outcomes (QOL) When is QAA/QAPI done & by whom? complete of end of survey by TC only What ARE IMMEDIATE items required upon Entrance 1. Census (excluding bed holds) 2. Matrix for new admits (last 30 days) 3. Alphabetized list of residents 4. List of smokers/location/times Clinical purpose of a psychotropic medication GDR: (select all that apply)? a. Find an optimal dose SMQT SMQT b. Determine whether continued use of the medication is benefiting the resident c. To eliminate the need for nonpharmacological behavior interventions d. All of the above e. A and B above e. A and B above Nursing home psychotropic Gradual Dose Reductions are (select all that apply): a. Required by CMS regulation (Appendix PP) b. Optional if the resident is not exhibiting adverse psychotropic medication effects c. To be implemented in accordance with accepted standards of practice while continuing non-pharmacological behavior interventions d. A and C above e. All of the above d. A and C above What documents are printed by TC during offsite prep? (1) Matrix (with instructions) (1) Entrance Conference Worksheet (3) Beneficiary worksheets AND depending on # of surveyors on team: UPdated FA floor map if possible - do EARLY! When should you share data? At the end of each day & SMQT SMQT when the team composition changes. Using a steam table to reheat food is ________ since it does not bring the food to the proper temperature within acceptable timeframes. unacceptable Paid Feeding Assistants INFO (from FA) Needed within 1 hour What does the Beneficiary Protection Notice Review verify? * verify notification to resident when Med A ends- SNF-ABN & NOMNC * verify FA billed medicare within required time frame after resident requested a demand bill (verify that FA did not bill the resident while a decision was pending.) What does a med observation assess for? * MD orders - reconcile observed meds with orders * manufacturers specifications * professional standards * verify med expiration date According to F882, SNFs must have a Full-Time dedicated Infection Preventionist A. True B. False B. False What is reviewed for compliance with Antibiotic Stewardship program? 1. AB use protocol on prescribing 2. Protocols to determine if AB is indicated 3. A process for review of AB use by prescribers 4. Protocols to ensure resident are prescribed the appropriate AB 5. A system for feedback reports What is a significant medication error? error which causes the resident discomfort or jeopardizes health/safety When are pharmaceutical INTERVENTIONS used? USED only when SMQT SMQT Clinically Indicated AND Closely Monitored Pharmacy Services Issues unnecessary medications & psychotropic medications T/F: Pharmacy Services has ONE set of interpretive guidance and is cited WHEN COMBINED with other citations FALSE Pharmacy has only One set of guidelines but is cited SEPARATELY ALL RESidents are reviewed for which areas? * Advanced Directives * confirm specific info based on RI/RO * other concerns What is the importance of a (limited) Record Review • Conduct after interviews & observations are completed prior to sample selection. • All IP residents: ADs & confirm specific info • If interview not conducted: review certain care areas in record • Confirm insulin, anticoagulant, & antipsychotic with a diagnosis of Alzheimer’s or dementia, & PASaRR • New admissions – broad range of high-risk medications • Extenuating circumstances, interview staff What 9 things should be DISCUSSED at END of Day 1 team meeting? 1. Any NEWLy ID’d harm/IJ concerns validated? 2. were offsite concerns VALIDATED? Any that were offsite selected who were then dc'd? 3. Was each newly admitted resident listed on the MATRIX screened by a team member? SMQT SMQT 4. Need to EXPAND sample to r/o any harm, SQC, IJ or other concerns to discuss? 5. PERTINENT findings (has more than 1 surveyor identified & validated same concern? Make a list of concerns that FA should be aware of) 6. STATUS of complaint/FRI info? 7. Work left to complete/ Need to ADJUST workload? 8. (3) resident rep INTERVIEWs completed? 9. Any SYSTEM failure concerns? what does "Highest practicable physical, mental, and psychosocial well-being" mean? * defined as highest possible level of functioning & well-being (limited by individual's recognized pathology & NL aging process) * determined (through comprehensive RAI) by recognizing & competently/ thoroughly addressing physical/ mental/psychosocial needs When are Activities are supposed to be provided -daily basis -evenings and weekends -at least 30 min of staff time shall be provided per resident per week for activities duties -encourage participation What is reviewed during the INFECTION Control task? (REM! ** ALL surveyors observe for breaks in infection control throughout survey): * reviews IPCP&P * AB Stewardship * influenza/pneumococal vaccination (5 residents) * sample 3 staff including at least 1 that was COVID positive * 3 residents for TBP (1 covid/ suspected w/ screening, testing & reporting of COVID) What are conflict of laws ? When between state & federal laws, use the most stringent or higher standard When is a Recapitulation (of resident's stay) done? SMQT SMQT containing all required components done during DISCHARGE What does "Prompt efforts to resolve" mean? include facility acknowledgment of a complaint/grievance and actively working toward resolution of that complaint/grievance. "Hold, safeguard, manage, and account for" means: that the facility must act as fiduciary of the resident's funds & report EVERY quarter on status of these funds in a clear & understandable manne “Court of "competent jurisdiction“ means any court with the authority to hear & determine a case/suit with matter in question What are the clinical quality measures used by CMS? Electronic Clinical Quality Measures Basics (via CASPaR/PBJ report) (* Patient & Family * Engagement * Patient Safety * Care Coordination * Population/Public Health * Efficient Use of Healthcare Resources. * Clinical Process/Effectiveness) The 4 providers that may be deemed as meeting Medicare CoPs based on accreditation include: Home Health Agencies (HHAs) Ambulatory Surgical Centers (ASCs) Hospices Critical Access Hospitals (CAHs) If a State finds that either have provided SQC the State shall notify (i) the attending physician of each resident with respect to which such finding is made, and SMQT SMQT (ii) any State board responsible for licensing of nursing facility (iii) DOA of facility. T/F The POLST governs detailed medical wishes in near future desired by patient & signed by MD. It is a form equal to an Advanced Directive. FALSE Physician Orders for Life-Sustaining Treatment - form designed to improve patient care - portable medical order form records treatment wishes so emergency personnel know what patient wants in event of a medical emergency - taking patient's current medical condition into consideration. A POLST paradigm form is NOT an Advance Directive What is a K-tag ? (Requirements pertaining to the adopted codes & related standards ensuring compliance w/) Life Safety and Health Care Facilities codes (Appendix I) What is Scope & Severity A system of rating the seriousness of deficiencies: citations get assigned a letter (A-L: severity levels 1-4) J, K, L = Immediate Jeopardy In contrast, Medicare is a federal health insurance program primarily for individuals aged 65 and older, as well as certain younger individuals with disabilities. What is another name for Medicare supplement policies? Major Medical Medigap Medicaid Original Medicare Major Medical (Medical expense insurance) Medigap SMQT SMQT Medicaid (separate program, distinct from Medicare, which provides health care and health-related services to people with low incomes) Original Medicare (Medicare Parts A and B) ALL facilities MUST be licensed by the state Why is CMS accreditation important? * it is the process by which an organization is authorized & credentialed * to ensure industry standards are met & * maintain highest levels of excellence in service & supplies What does "Prompt efforts to resolve" include? facility acknowledgment of a complaint/grievance and actively working toward resolution of that complaint/grievance (3) Deficiency categories that would be SQC, if scope/severity met 1) RESident Behavior & FACility Practice 2) Quality of Life 3) Quality of Care 27) Which of the following statements concerning facility practices & resident restraints is true? a) any device that the resident cannot remove easily b) Any drug designed only to restrain control certain behaviors is prohibited at all times as a restraint c) Physical restraint may be used with a physicians order without putting the facility at risk of being out of compliance with the restraint requirements SMQT SMQT d) Bed rails are always considered to be restraints, but may be justified or not justified a) any device that the resident cannot remove easily (which restricts freedom of movement, or normal access to one’s body, is considered a physical restraint) T/F: Majority of time spent observing and interviewing with relevant review of record to complete investigation True Signs and Symptoms of substance abuse include: 1. Changes in behavior 2. Unexplained drowsiness 3. Lack of coordination 4. Slurred speech 5. Mood changes 6. Loss of consciousness 7. All of above Under what tag can guidance be found regarding Accidental Overdose? A. F582 B. F563 C. F661 D. F689 D. F689 Operating Organizations with Five or more Facilities Must designate a compliance officer for whom the compliance and ethics program is a major responsibility A. True B. False A. True What is a "Surety bond" ? SMQT SMQT an agreement between the principal (the facility), the surety (the insurance company), and the obligee (depending on State law, either the resident or the State acting on behalf of the resident), wherein the facility and the insurance company agree to compensate the resident (or the State on behalf of the resident) for any loss of residents' funds that the facility holds, safeguards, manages, and accounts for. For newly admitted residents, the Comprehensive Care PLAN must be completed within 7 days of the completion of the comprehensive assessment and no more than 21 days after admission. What are the 3 components of an IJ? - NONcompliance - serious harm as a result of NONcompliance - need for immediate action SMQT