Section 4000, Quality Monitoring Visits

Revision 16-1; Effective February 3, 2016


Quality monitoring visits are conducted by individual quality monitors (QMs), and are coordinated by a scheduling system that uses the early warning system (EWS) to ensure facilities that are identified as medium risk, or those that have a history of resident care deficiencies, are given priority for visits. A follow-up visit will be scheduled within 45 calendar days of the initial QM visit. The initial QM visit is the first time a nursing facility is scheduled for and receives a QM visit after being identified as medium risk through the EWS. The process of identifying a QM visit as an initial visit will start again once 12 months have passed with no QM visits to the facility. Nursing facilities may also request a quality monitoring visit by contacting QM staff.

Before conducting a quality monitoring visit, the QM reviews the facility's data, including the quality measure reports in the Certification and Survey Provider Enhanced Reports (CASPER) system, and identifies areas that may represent opportunities for improvement.

After reviewing the available data, the QM will contact a facility representative to provide the date of the visit and the QM's anticipated time of arrival. The QM gives advance notice so the nursing facility can plan to involve key staff related to the specific focus areas that will be evaluated during the visit, and to invite the facility's medical director to participate, if possible. The QMs are aware that, at times, there may be other events that prevent key staff from participating in the visit. In those situations, the QMs will work with available staff members, providing technical assistance to the extent possible.


Entrance Conference


Each visit begins with an entrance conference. This is the QM's opportunity to inform facility staff of the focus areas that will be addressed during the visit and give staff an opportunity to describe the progress the facility has made in implementing best practices since the last visit. The entrance conference is also an opportunity for the facility to mention other issues about which the QM should be aware. The QM will request a copy of the current resident roster to assist in the selection of the resident sample, and will provide facility staff with an estimated time for the exit conference time.


QM Visit Activity


During the monitoring visit, the QM will assess the overall quality of life in the facility, as well as specific conditions that are directly related to resident care.

Each QM visit consists of:

  • Touring the facility to locate the residents who the QM will assess that day.
  • Observing the delivery of care and identifying areas where facility staff could benefit from technical assistance, as well as observing systems staff may already have implemented.
  • Interviewing residents and staff to get their perspectives regarding the issues about which technical assistance can be provided.
  • Reviewing records and policies with attention to the focus areas being reviewed.
  • Providing technical assistance based on the QM's findings.
  • Demonstrating the program's Texas Quality Matters website and online educational presentations.

Visit Wrap-up


Each QM visit ends with a wrap-up meeting. During the wrap-up meeting, the QM will provide information regarding the focus areas that were reviewed. Findings will include identified best practices, as well as opportunities for improvement.

The QM will encourage facility staff to develop a plan for implementing evidence-based best practice systems to improve resident care. The purpose of this step is to help facilities determine how to make improvements; however, the QMs do not direct facilities to use any specific best practice. QMs will offer resources that can be used by facility staff to decide what may work best in their facility.

During the exit conference, the QM will also remind facility staff to expect a report summarizing the findings made during the visit and the technical assistance provided. The report will also include any steps the facility plans to take toward specific improvements in the areas identified by the QM. If the facility was not able to develop a specific plan for improvement at the time of the exit conference, that will be reflected in the report.

The report is sent by email within 15 working days of the visit. If the facility does not have internet access, a copy of the report will be mailed via the U.S. Postal Service. The QM who conducted the visit will request confirmation that the report was received by a facility representative.


Report Review


When the facility receives the report, the facility representative should read it to note those areas identified as needing improvement, and to review the plans that were decided upon at the time of the exit conference. If anything in the report is unclear or if additional information is needed, the facility representative should contact the QM who conducted the visit.

Note: This report is not shared with the Texas Department of Aging and Disability Services (DADS) Regulatory Services Division.


After the visit, the QM encourages facility staff to visit the Quality Monitoring Program website at for additional resources. The web address can also be found on the QM’s business card.

Anonymous Feedback Survey


Along with the report, the facility representative will receive a link to an anonymous feedback survey. The survey asks questions about the QM visit and conduct. This short survey is part of the Quality Monitoring Program's own quality improvement process, and facilities are encouraged to respond.