FblI.pwing

.U p:on:.:Lea— :H_:z:—,. Consideration

of facts as ‘leads’ could be based on: • professional experience • intuition • ‘gut instinct’ • ‘chance’ Valid conclusions about activities
or performance
will not be able to be drawn unless the surveyor has
a clear understanding

of what

it means for the entity to perform the condition

or task correctly.= Circumstance commonly triggering more detailed examination;
i.e., evidence from record reviews, interviews and observations could have begun to reveal: • emerging pattern of deficient performance

of some extent and/or frequency • episode(s)

of a resident/patient/client experiencing serious harm • complaints
on file may trigger more in-depth inquiry • several residents/patients/clients complaints about

a particular staff, situation
or environmental issue = Look first to the regulations and survey protocols

to see if there
is definition
of the facts that must be shown
to prove

a deficiency

or incident.=‘ If Official guidance.

is unclear, than consult further with superiors

to determine theforms

of investigative information that are needed
to support

a deficient practice.=‘ Critically review the ‘lead’, the known facts, ultimately, should be able to answer
all the who, what, when, where, how and why. Locate and review each applicable requirement(s)
and other official policy directives,

if any. Use observation, interview and documentary sources
to obtain the additional relevant facts that describe the practice, condition
or portion of the environment under scrutiny.= List the precise minimum criteria necessary for the entity to demonstrate

its compliance with the requirement.=‘ bevelop

a corresponding
line of inquiry, that when answered

to completion, provides clear. and convincing evidence relative
to compliance with the requirements._ Analyze and correlate the available information. Avoid arriving
at conclusions based on observations and record reviews without asking related follow-up questionsto staff or residents,

if possibie. Develop one or more likely working hypotheses that explain

in a comprehensive fashion how the entity’s practices
or conditions could be consistent with the available survey findings.. NEC— Principles
f Investigation—_Use observation, interview and documentary sources
to subject these hypotheses

to more in- depth scrutiny. Systematically eliminate various possibilities

as the analysis cntinues. On the basis of consistency with known facts arid
a high degree of probability, select and focus on the best hypothesis, Objectively test this ‘best’ hypothesis and modify or reject

it when contrary evidence

is uncovered from record reviews, observations

or interviews. Do not allow personal feelings about the issue to substitute for a decisFon that has otherwise been properly made. Do not permit your observations and interpretations

to be biased
in favor of the hypothesis. Seek information from others (surveyors/investigators).V NEC — Principles

of Investigation 3/2000CASE STUDY INSTRUCTIONS A key part of Investigative

Skills Training

is the practical application
of investigative techniques through participation

in various activities. On of these activities

is the Case Study, which every person will work on throughout the three day course. Participants will be broken into groups. These groups will remain consistent throughout the

3 days. Day One Each group will receive

a case study and an Investigative Planning Form. Within your group, assign

a recorder and
a reporter. One person can serve as both. Using the preliminary information from the case study, your group will complete the Investigative Planning Form. As a group, you will determine: • What you will need to look at, • Who you will want to interview, • What observations you will need to make, • What resources you will need to consult. After completing the form, the designated reporter will present the group’s plan to the rest of the class. Day Two On day two, you will receive additional information regarding your case study. Using this information, along with the information from the Investigative Planning Form you completed
on day one, you will decide as a group the two primary persons you wish to interview. The group will identify questions

to ask of each of the persons chosen to be interviewed.

It is recommended that the recorder write these questions on the, “Inter-view Notes” handout. Copies will then be made for everyone

in their case study group to use when taking notes during the interviews. Next, each group will determine two people who will be conducting the interviews. Arrangements

have been made for persons from the case studies
to be available for the interviews. Each interviewer will be allowed
10 minutes per interview. After the interview has been conducted, time will be allowed for a group critique. Interview notes will need to be taken during the iizterviewpertainiizg

to your case study. Each group will decide bow notes will be taken. Options include: Having

a note taker present during the interview Each member, including the interviewer takes notes *Each member of the group, except the interviewer, takes notes.Page

2 Case Study Instructions You will use yourinterview noteson day

3 for the Report Writing activity.
If youdo not take notes, youwill need to rely solely on your memory
of the interview forthe Report Writing activity. *For groupsthat do not have the interviewer take notes, copies will be made of theother groupmembers notesto share with the interviewer for the report writing activity. If youhave any questions regarding this, please ask aninstructor! Day Three From the interview notes taken on day 2, each personwill write an Investigative Summary. After your report has been completed youwill pair yourself with another class member, exchange reports and provide constructive feedback

toeach other. The personyou pair yourself with should preferably
be a personwho shares yoursame discipline, butnot from yourcase study group. (Example: nursing home surveyor critiques another nursing home surveyor’s report, children’s program licensing specialist critiques another children’s program licensing specialist’s report.) After all reports have been reviewed byaclass member, volunteers will be asked toshare their report and have it critiqued by theclass. Formats of reports may vary,but all reports will be critiqued on: •Details • Sequence • Clarity • Relevancy • Accuracy • Objectivity •Use of quotes •Closure 4/09INVESTIGATIVE PLAN Interviews

to be conducted. Why? What information

do they have or may have? Documents and records

to be gathered (including photos, diagrams, charts). Why? What information will or should they contain? What to observe? Why? What do.you expect
to see or learn? 7)OG