If you run a home health or hospice agency, a Focus Survey is just one of many surveys you’ll undergo. While you receive notice that the survey is coming, you will never know the exact date and time. This leaves many agency owners anxious and scrambling for last-minute checks.
You may be asking: What are they looking for? How serious is this? Are we at risk of failing?
At The Home Health Consultant, we’ve helped guide hundreds of agencies through surveys—initial, renewal, complaint, focus, and more. We understand the stakes. And we know how to prepare you for success.
In this article, we’ll break down:
- exactly what a Focus Survey is
- when and why it happens
- what the surveyor is checking
- how to stay prepared
We’ll also explain what to do if something goes wrong, so you don’t panic if the unexpected happens. Let’s help you feel confident, even when the door swings open unannounced.
What is a Focus Survey?
A Focus Survey is a short, targeted visit from a surveyor to check specific things. It’s not a full accreditation survey, and it’s not about every aspect of your agency. Instead, it happens after certain big changes. This could be a change in ownership (CHOW) or location (CHOL). This survey is designed to make sure you’re still meeting the Medicare Conditions of Participation (CoPs).
In most cases, the visit is quick—just a few hours. But even though it’s short, it still matters. What they find can affect your compliance standing.
Who conducts a Home Health or Hospice Focus Survey?
Who conducts your focus survey will depend on where your agency is located. In most of California, the California Department of Public Health (CDPH) is the one who shows up. But in Los Angeles County, there’s a twist. CDPH often lets your accreditor (like ACHC) do the survey instead. That’s likely because LA has so many agencies, and the state can’t get to them all fast enough.
So, if you're in LA County, expect your accreditor. Everywhere else? Probably your local health department.
When is a Focus Survey Triggered?
There are a few common triggers:
- A change of ownership (CHOW)
- A change of location (CHOL) more than 20 miles away
- Moving to a new county
- A combination of any of the above
The purpose is to make sure everything still checks out during transitions. Medicare wants to see that quality care and compliance continue, even if your business is evolving.
Are Focus Surveys Announced?
Nope. They’re unannounced. Once your change application is approved, the surveyor can show up any time during your normal business hours. If you’re working with an accreditor, there’s an application process and a fee for the survey. Once the fee is paid and application completed, the surveyor can show up unannounced at any point. That’s why it’s critical to always stay survey-ready, especially right after any major reportable change.
What Actually Happens During A Focus Survey?
Let’s walk through a typical example, using ACHC since they provide clear guidance.
First, the surveyor introduces themselves and explains why they’re there. Then they’ll ask for your current patient census so they can select charts to review. From that list, they’ll choose up to five patient records—only those admitted after your CHOW or CHOL date.
If your Administrator, DPCS, or alternates were hired after the change, they’ll check those personnel files too. They’re only interested in leadership staff hired post-change.
They’ll also ask to see your CDPH and CMS approval letters or any correspondence showing that your change was officially approved.
Here’s what they won’t review:
- emergency preparedness
- governing body meeting notes
- QAPI plans
- anything else administrative.
There are no patient visits either. The only instance a surveyor would review any of these things, is if they notice something is wrong.
We’ve seen instances where a focus survey is called for a change of location (CHOL). The surveyor notices an issue, and through investigation, asks for administrative paperwork. This paperwork then contains deficiencies. Then the surveyor ends up giving the agency a deficiency over something typically unrelated to focus surveys.
Even if a topic isn't usually covered at survey, the surveyor has the right to investigate and cite any issues they encounter. However, this is a rare occurrence, and again highlights the importance of staying survey-ready at all times.
All in all, the visit is focused, brief, and specific to your change.
What Are Surveyors Looking for During a Focus Survey?
The surveyor wants to verify that your agency stayed compliant through the change. That includes checking that:
- Patient care continued and was documented appropriately
- Leadership positions are filled by qualified people
- CMS approvals are on file
- Records are accurate and up-to-date post-change
They’re not digging into your entire operation. They’re just checking that the transition didn’t cause any lapses in care or compliance.
What Happens If You Fail Your Agency’s Focus Survey?
Here’s the good news: we haven’t seen many agencies “fail” a Focus Survey outright. But it’s definitely possible to have deficiencies.
Some common issues include:
- Not having any patients admitted after the CHOW/CHOL date
- Missing or incomplete patient records
- No CMS approval letter on file
- Leadership team not fully documented or not meeting qualifications
If the surveyor finds issues, you’ll be required to submit a Plan of Correction (POC). That doesn’t always mean you failed the survey—it just means you need to fix what’s not in compliance.
Failing to submit a POC or correct the issues? That’s where real problems can start. To read more about how to respond to a POC and stay prepared for any survey outcome, read our article below.
What’s the Best Way to Prepare for a Home Health or Hospice Focus Survey?
Even though the survey is unannounced, there’s a lot you can do now to get ready.
Start with these five key steps:
- Update all company forms and documents with the changed information
- Admit at least one patient after your CHOW/CHOL
- Keep patient records clean and complete, especially post-change
- Update personnel files for leadership hired after the change
- Have your CMS approval letter ready and easy to find
- Double-check that your charting reflects your new location or ownership
Pro Tip: Even though they’ll review no more than five charts, make sure every single one is solid. You don’t know which ones they’ll pick, so assume any could be reviewed.
What Home Health & Hospice Agencies Need to Know About Focus Surveys
A Focus Survey is a quick, targeted review that follows big agency changes.
Reminder: It’s unannounced and specific—usually focused on ownership, location, or GSA changes. Make sure your patient records, leadership files, and CMS docs are in order. If you stay prepared and know what to expect, you’ll handle it with confidence.
Need help preventing deficiencies or prepping your team? That’s what we do. We’ve helped plenty of agencies stay ready and pass Focus Surveys without stress.
Let’s talk. We’ll make sure your next survey is one less thing to worry about.
*This article was written in consultation with Mariam Treystman.
*Disclaimer: The content provided in this article is not intended to be, nor should it be construed as, legal, financial, or professional advice. No consultant-client relationship is established by engaging with this content. You should seek the advice of a qualified attorney, financial advisor, or other professional regarding any legal or business matters. The consultant assumes no liability for any actions taken based on the information provided.
