Getting ready for an ACHC survey can feel like a big job, but it doesn’t have to be scary. The accreditation commission for health care (ACHC) helps organizations prove they meet strong quality and safety standards. Think of it as a quality check that shows you’re giving safe, dependable care to every patient.
Here’s an interesting fact: ACHC notes that in home care organizations, more than half of survey citations stem from services that did not match the written plan of care. That means aligning what you do with what you’ve documented makes a real difference.
When your team knows what to expect, the survey becomes much easier. You can focus on what matters most—helping people and keeping your workplace running smoothly.
Let’s begin by understanding what an ACHC survey is and why it’s such an important part of your success.
What Is an ACHC Survey and Why Does It Matter?
An ACHC survey is a formal visit where trained surveyors review your organization’s policies, procedures, and day-to-day work. They look to see if you meet ACHC standards for quality care and safety. These standards are part of the accreditation process that all healthcare providers must follow to earn or keep their ACHC approval.
Surveyors usually arrive without warning, especially if you have “deemed status” through Medicare or Medicaid. They want to see how your organization runs on an ordinary day. During the healthcare survey, they check patient records, observe care, and talk with staff. They make sure your work matches your written policies and that patients are receiving the right services.
The ACHC survey isn’t only for hospitals. It also includes durable medical equipment suppliers, pharmacies, hospices, and home health agencies. For example, surveyors might review how DME companies track equipment safety or verify that oxygen tanks are stored properly.
Here’s what surveyors usually review:
- Policies and procedures: Are they up-to-date and followed?
- Staff files: Do they show licenses, training, and background checks?
- Patient care: Are records clear and complete?
- Safety: Are equipment and environments well-maintained?
Passing the survey means your organization has met ACHC’s high standards. It shows patients, families, and payers that they can trust your care. It also helps your team stay sharp and confident, knowing you’re doing things the right way every day.
Once you understand the purpose, the next question becomes: why does it feel so hard to prepare for something that’s meant to help?
What Makes the Survey Feel So Hard?
It’s normal to feel nervous about your ACHC survey. Many people worry because the process can seem complex, especially when it involves rules, paperwork, and tight deadlines. Sometimes, teams feel unsure where to begin or how to keep everything in order.
Here are some common reasons the survey feels challenging:
- Too many details: Keeping track of forms, policies, and checklists takes time.
- Busy schedules: Staff members already have full workloads, so finding time to review files can be tough.
- Fear of missing something: No one wants to fail or get cited for small mistakes.
- Changing rules: ACHC updates standards to match new federal guidelines, and it can be hard to stay current.
You can make the process smoother by starting early and working step by step. Using an ACHC accreditation checklist can help keep you on track. It breaks large tasks into smaller ones, like reviewing staff files, checking training records, and confirming your emergency plans are complete.
Remember, surveyors aren’t there to catch you doing something wrong. They want to see that you care about safety and quality. When you treat the survey as a team effort instead of a test, the stress level drops.
Another reason surveys feel hard is that people wait too long to start. ACHC accreditation preparation should be ongoing, not something you do right before the visit. By building a habit of regular reviews, you’ll always be close to survey-ready.
And don’t forget the paperwork! Many organizations struggle with DME compliance administration, especially if they serve both patients and suppliers. Keeping your records clear and organized helps you avoid mistakes and saves time when the survey begins.
It may feel like a lot, but it becomes manageable when you make readiness a part of your routine. The next section shows how to turn everyday actions into lasting readiness.
How to Build Everyday Readiness
Staying ready for your ACHC survey doesn’t have to be complicated. The key is to make readiness part of your daily work, not something you rush to finish later.
Here’s a step-by-step approach that works:
1. Keep policies up to date
Set time each month to review your policies. If your daily work has changed, your paperwork should match. For example, if you started using new cleaning products, make sure your infection control policy mentions them.
2. Check staff files often
Each employee’s file should show licenses, training, health checks, and performance reviews. Create a simple tracking sheet that reminds you when something is due.
3. Review patient or client records
Look for missing signatures, dates, or care notes. Fix small errors right away before they become big problems.
4. Hold short team check-ins
Ask staff what parts of the process confuse them. Use these meetings to share updates and review common questions surveyors ask.
5. Use your tools
ACHC offers resources to help, such as their mock survey guides and readiness checklists. Use them often to see how your organization measures up.
6. Focus on quality improvement
Use your quality meetings to talk about what’s working and what needs fixing. Keep records of your improvements. Surveyors look for ongoing progress, not perfection.
Here’s a helpful mindset: every task that makes your agency stronger also makes you survey-ready. When you build good habits, you’ll feel calm when the survey team arrives.
Keeping your ACHC accreditation preparation organized can even improve teamwork. People understand their roles better, communicate more clearly, and take pride in doing things right.
Consistency and teamwork lead to confidence. When you keep small things in order daily, you build a strong foundation that helps your whole organization shine.
Step-by-Step Plan to Get Ready for Your ACHC Survey
Preparing for an ACHC survey takes time and structure. But with the right plan, you can handle it smoothly and confidently. Think of this as your roadmap—a series of clear, doable steps that help you show your best work when the surveyors arrive. Each part connects to the next, building steady progress toward full readiness.
Step 1: Review Your Policies and Procedures
Start by checking all your written policies and procedures. These are the rules your team follows every day. Surveyors from the accreditation commission for health care (ACHC) will compare what’s written with what actually happens in your office or facility.
Here’s how to do it:
- Make sure each policy is current. Update any that use old names, outdated forms, or expired standards.
- Confirm that your staff understand these rules and follow them. You can ask simple questions during staff meetings to test understanding.
- Label your files clearly, so surveyors can find what they need without searching through folders.
Example: If you updated your cleaning process six months ago, make sure the infection control policy says the same thing. Mismatched information often causes small—but costly—deficiencies.
Step 2: Organize Personnel and Training Files
Next, gather all employee files and check that they’re complete. Each staff member’s folder should show qualifications, licenses, health records, and proof of training. ACHC surveyors use this information to confirm that your staff are qualified for their roles.
Things to include in every personnel file:
- Current licenses or certifications
- Orientation and ongoing training logs
- Annual performance evaluations
- Health screenings or vaccinations, if required
- Background check and reference results
Tip: Use a tracking sheet to monitor renewal dates. When files are neat and up to date, you’ll save time during the survey and reduce stress for everyone.
Step 3: Prepare Patient and Client Records
Accurate, well-documented patient records are a major focus during the healthcare survey. Surveyors often pick random files to review. They check for consistency, signatures, and clear notes showing that care was provided as planned.
Check for:
- Signed and dated care plans
- Complete progress notes
- Proper physician orders, if needed
- Discharge summaries or outcome notes
If you use an electronic record system, make sure staff can log in quickly to show requested information. A slow or confusing system can delay your review and cause frustration. Do a quick practice run before survey week to confirm that everyone knows how to navigate the software.
Step 4: Conduct a Mock Survey
A “mock survey” is a rehearsal for the real one. It helps your team see what’s working and what might need more attention. Use the ACHC accreditation checklist as your guide. It lists the exact areas surveyors will examine.
How to run a mock survey:
- Choose a team leader who understands ACHC standards.
- Walk through your facility as if you were the surveyor.
- Review documents, talk to staff, and check safety measures.
- Record any gaps you find and fix them immediately.
You can even invite an outside consultant for a fresh perspective. They may notice details your team overlooks. This step also helps staff feel more comfortable with the survey process since they’ll know what to expect.
Step 5: Review Facility Safety and Equipment
Safety is a key part of every accreditation process. Make sure your building and equipment meet ACHC requirements for cleanliness, security, and maintenance.
Look for these points:
- Are fire extinguishers inspected and labeled?
- Are hallways and exits clear?
- Are chemicals and supplies stored properly?
- Is all medical equipment cleaned and maintained regularly?
If your organization includes durable medical equipment suppliers, confirm that each product is stored, labeled, and tracked by lot or serial number. Equipment must be safe, functional, and ready for use at all times.
These checks protect both your patients and your staff, and they show ACHC that your organization takes safety seriously.
Step 6: Focus on Staff Communication and Confidence
Your team’s confidence can make a big difference. During the survey, staff may be asked questions about their roles, safety plans, or procedures. Encourage clear and calm answers. Remind them it’s okay to say, “Let me find that policy,” instead of guessing.
Tips for effective preparation:
- Hold short “survey readiness huddles.”
- Review common questions surveyors might ask.
- Encourage teamwork—staff can support each other if someone gets nervous.
- Recognize good performance to keep morale high.
Confidence grows through practice. When your staff understand the process, they’ll communicate naturally and show their strengths.
Step 7: Keep Your Quality Program Active
ACHC values quality improvement. That means your team should track data, find areas to improve, and take action. Keep notes from your Quality Assurance and Performance Improvement (QAPI) meetings organized and ready to share.
For example:
- Track patient satisfaction surveys and discuss results.
- Record steps you’ve taken to fix repeated issues.
- Keep follow-up notes showing that improvements worked.
This section shows that your organization is serious about progress, not just meeting basic standards. Surveyors appreciate seeing evidence of real improvement.
Step 8: Stage Your “Survey Day” Materials
In the days before your survey, gather everything you’ll need in one easy-to-reach place. You can use a binder, folder, or digital file labeled “Survey Ready.”
Include items such as:
- A current staff roster with job titles and start dates
- Patient or client census lists
- Copies of required licenses and certificates
- QAPI meeting minutes
- Emergency preparedness plan and drill records
Having this ready helps the visit go smoothly. You’ll look organized and professional, which sets a positive tone right from the start.
Step 9: Maintain Calm and Flexibility During the Survey
When the day arrives, greet surveyors warmly and guide them through your facility. Assign one point person to accompany them and answer questions. This keeps communication clear and avoids confusion.
If they find small issues, don’t panic. Take notes and show willingness to correct them quickly. Remember, surveyors from ACHC aim to help you stay aligned with high-quality standards. Their goal is to ensure your organization continues to provide safe, effective care.
Step 10: Continue Readiness After the Survey
Once the survey ends, review the results with your team. Celebrate what went well! Then create an action plan for any items that need follow-up. This builds accountability and shows ongoing improvement.
For businesses starting a DME business, this habit is especially important. Consistent recordkeeping, staff training, and organized maintenance will support your growth and help you stay compliant over time.
Continuous improvement is part of being a trusted healthcare provider. Treat readiness as a cycle, not a one-time task. With steady effort, your next survey will feel easier and more predictable.
Conclusion
Preparing for an ACHC survey can feel complex, but breaking it into clear steps makes it manageable.
With steady planning, teamwork, and attention to detail, you can turn the process into a chance to grow stronger. Each small step—checking files, reviewing policies, and keeping communication open—brings you closer to success.
Use ACHC’s resources and tools to guide you. Keep your communication open, stay organized, and focus on patient safety. With a plan like this, your team can face any survey with calm, skill, and pride.
Your patients, staff, and community all benefit from the care you take to stay ready. Keep building those good habits, and you’ll walk into your next survey with confidence.
For extra support or professional guidance, reach out to QPI Health Care Services today and take your readiness to the next level.
Frequently Asked Questions
1. How often do ACHC surveys take place?
Usually every three years, but timelines can vary based on your program and accreditation type.
2. What should I do if my policies are outdated?
Update them right away. Make sure all staff members know about the new versions and where to find them.
3. Can ACHC surveys happen without notice?
Yes. Some surveys, especially for deemed-status programs, are unannounced to show daily performance.
4. What’s included in the ACHC accreditation checklist?
It includes items like policies, training files, patient records, and safety plans that surveyors will review.
5. How can I make DME compliance administration easier?
Use digital tracking systems and schedule monthly audits to keep supplier files accurate and current.