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NAB Flashcard Haul > 2024 FTAGs > Flashcards

2024 FTAGs Flashcards

1
Q

Facility Must Post statement that resident may file a complaint with the _____ for any suspected _________.

A

SSA, noncompliance.

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2
Q

Facility Shall post Contacts for 9 Following Agencies

A
  1. SSA
  2. APS
  3. State Licensure Office
  4. Ombudsman
  5. Protection & Advocacy Network
  6. HCBS Programs
  7. Medicaid Fraud Control Unit
  8. QIO
  9. ADRC or other No Wrong Door Program
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3
Q

Grievance Policy states that following grievance info shall be posted or notified to residents…

A
  1. Right to anonymous grievance
  2. Grievance official’s contact info
  3. Timeframe for grievance review
  4. Right to obtain written decision
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4
Q

Contact info for grievance officer shall include:

A

Grievance official’s name, address, email, phone.

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5
Q

Grievance policy should include what 8 components?

A
  1. Notifying residents of policy
  2. Appointing grievance officer
  3. Protection during investigation
  4. Greivance Reporting
  5. Contents of written grievance decisions
  6. Corrective actions if grievance confirmed
  7. Holding duration of grievance result
  8. Educating staff on policy
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6
Q

Grievance decisions shall indicate these 7 pieces:

A
  1. Grievance received
  2. Summary of statement
  3. Steps of investigation
  4. Summary of findings
  5. Statement to confirm/deny grievance
  6. Corrective action
  7. Date of issuance of written decision
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7
Q

Grievance decision and evidence shall be maintained for…

A

3 years from date of decision issuance

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8
Q

What survey info shall be posted and where?

A
  1. Most recent survey results in accessible location.
  2. Notice of availability of surveys, certifications, and complaints from past 3 previous years
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9
Q

What survey info shall NOT be posted?

A

Any info that reveals resident / res. rep. identity

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10
Q

Mail shall be delivered to residents within what time frame?

A

24 hours

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11
Q

Personal care shall occur where…

A

outside public view

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12
Q

F586 - Resident Contact with External Entities

A

Resident always has right to contact external entities. Period.

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13
Q

Advanced Directives must be…

A

Offered, documented, governed by facility policy

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14
Q

NOMNC stands for…

A

Notice of Medicare Non-Coverage

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15
Q

NOMNC must be given to Medicare pt. A residents when?

A

At least 2 days before their end of coverage

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16
Q

NOMNC must be given to Medicare pt. B residents when…

A
  1. At least 2 days before end of their therapies coverage
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17
Q

NOMNC need not be give under what 3 conditions

A
  1. Beneficiary exhausts 100 day coverage period
  2. Beneficiary initiates discharge
  3. Beneficiary elects or revokes hospice benefits
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18
Q

SNF ABN stands for…

A

Advanced Beneficiary Notice (of Non-coverage)

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19
Q

When and why is a SNF ABN typically issued?

A

To transfer liability to Medicare beneficiaries that are about to receive a service that Medicare will likely not cover.

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20
Q

To whom/for what reason would a resident submit a “Demand Bill”

A

To Medicare for a Medicare Admin. Contractor to review non-covered charges to see if they should be covered

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21
Q

If resident dies or discharges, facility must refund the remainder of their un-used deposit(s) within _____ days of discharge date

A

30 days

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22
Q

The facility’s services that the resident WILL be charged for and the services the resident WON’T be charged for must be conveyed to the resident when?

A
  1. At time of admission or time of eligibility for Medicare/Medicaid
  2. When there are changes to facility offerings.
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23
Q

When price of services change, facility must notify resident how and when

A

By writing at least 60 days prior to change

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24
Q

How/what should a resident find out about their ability to get Medicare/caid benefits, and what they’ve already paid Out of Pocket?

A

Facility must display and provide oral and written info about how to apply and get reimbursed for privately covered bills.

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25
Q

Facility shall report resident representative to state when…

A

Representative is making clearly bad decisions for the resident

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26
Q

To what powers is a resident rep. entitled

A

Only the powers and controls that are given to the resident rep. by the resident or the courts (if rep is court mandated)

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26
Q

Resident right to adequate lighting shall include -

A
  1. Minimal glare
  2. Even light
  3. As much daylight as poss
  4. Extra lighting for tasks like reading
  5. Dimming options when poss
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27
Q

in a language they understand, resident should be informed of what 3 elements of their treatment

A
  1. Type of care/treatment they’re about to received
  2. Type of professional about to provide said care
  3. Risks and alternative trtmnt options
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27
Q

Resident Care Planning shall account for these 7 rights:

A
  1. Choose who is part of process
  2. Request a care plan
  3. Request Care plan revision
  4. Decide goals/types/freq/ duration of care plan
  5. Be informed in advance of care plan changes
  6. Actually receive the care that the C.P. outlines
  7. See the CP and sign off on sig. changes
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28
Q

5 IDT considerations before allowing medication self-administration

A
  1. Resident physical ability to self administer
  2. Resident cognitive ability to self administer
  3. Which meds are appropriate for self-admin
  4. Ability to store drugs safely
  5. DOCUMENT if rez self-admins
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29
Q

Each rez is entitled to what details about their attending physician?

A
  1. Name
  2. Specialty
  3. Contact info
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30
Q

If physician is not feasible, licensed or declines to work with rez, facility must…

A

Work with resident/rez rep to appoint new physician

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31
Q

Resident, Resident Rep, and Resident Physician shall be notified of what changes…

A
  1. Accident causes doctor-worthy injury
  2. Sig change in physical/mental
  3. Need to sig. alter treatment
  4. Decision to transfer/DC resident
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32
Q

Physician need not be notified, but resident and resident rep shall be notified of what changes?

A
  1. Change in room or roommate
  2. Change in resident rights or fed/state regulations that affect resident
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33
Q

Within what time frame, and in what format, must facility offer visibility to part or whole of medical record?

A

Within 24 hours (excl. holidays and weekends) in format requested by individual

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34
Q

Within what time frame must facility offer a COPY of medical record? What can they charge for?

A

Within 2 working days of request. Can charge for postage, labor, and supplies for the copy process.

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35
Q

7 Care components resident can never be personally charged for?

A
  1. Nursing services
  2. Food & Nutritional services
  3. Activities programming
  4. Room and bed
  5. Personal hygiene supplies
  6. Medically related social services
  7. Hospice services under Medicare/Medicaid
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36
Q

According to federal law, can resident be charged for a private room?

A

Yes, but only when not therapeutically required.

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37
Q

Phone, TV, Computer Personal reading, above and beyond food/beverages, and personal clothes have what in common?

A

CAN be charged to rez. personal funds.

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38
Q

4 Conditions must be satisfied to charge resident personal funds

A
  1. Not already covered by Medicare/caid
  2. Knowingly requested by resident/rep
  3. NOT required condition of stay to purchase
  4. Informed orally & in writing what the charge is for and how much
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39
Q

In what situation does resident NOT have right to pick a roommate

A
  1. Would require kicking out their current roommate
  2. Different payment sources, and facility doesn’t take one.
  3. The roomie isn’t eligible to live there or doesn’t need to be there
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40
Q

Only 3 reasons a resident can refuse room transfer

A
  1. From skilled to unskilled
  2. From unskilled to skilled
  3. Solely for staff convenience
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41
Q

6 categories of external ppl resident has right to IMMEDIATE access from

A
  1. Rep. of state
  2. Rep of feds (secretary)
  3. Rep of ombudsman
  4. Rep of DD or mental disorder agency
  5. Resident representative
  6. Resident physician
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42
Q

What 4 criteria must be satisfied for resident to perform work for facility

A
  1. # is at or above prevailing rates
  2. Care planned appropriately
  3. Resident agrees
  4. Rez has right to refuse
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43
Q

Care plan must reflect ________ if resident works for facility

A
  1. Resident wants to and is appropriate for work at facility
  2. Paid or voluntary
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44
Q

When must a resident’s withdrawal request be granted?

A

MEDICARE:
$100 or less, same day. $100 or more, within 3 banking days

MEDICAID
$50 or less, same day. $50 or more, within 3 banking days

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45
Q

Resident has 24/7 right to visitation except for these 6 limitations:

A
  1. Prevent Infection
  2. Visitor performed criminal acts
  3. Visitor = innebriated/disruptive
  4. Nighttime. Still must have system in place for approved visitors
  5. Visitor history of bringing in contraband
  6. Visitor suspected of abuse, exploitation, etc. can be supervised, limited, or denied until investigation is complete
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46
Q

Facility must do what with visitation rights?

A

Inform residents!

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47
Q

Facility must make what 5 accommodations for resident council?

A
  1. Provide space and notice
  2. No staff/visitors unless invited
  3. Provide designated staff member to assist and respond to group
  4. Actually consider, respond, document what rez council says
  5. Allow family council as well
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48
Q

If facility pools resident funds, each resident’s funds must still be accounted

A

Seperately

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49
Q

Upon each transaction of resident funds…

A

Record info and give receipt to resident of transaction

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50
Q

Account statements must be provided to resident/representative when?

A
  1. Upon request.
  2. Quarterly, within 30 days after end of fiscal quarter
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51
Q

Facility must insure all resident deposited funds by…

A

Surety bond equal to the $ a rez has deposited (with resident as beneficiary)

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52
Q

Resident shall be informed of their rights/rules…

A
  1. Prior to/upon admission
  2. Orally AND in writing
  3. Receipt of info acknowledged in writing
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53
Q

To satisfy resident right to communication privacy, resident shall have reasonable access to private forms of:

A
  1. Phone
  2. Internet
  3. Mail/packages (incl. stationary, writing, postage at resident’s expense)
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54
Q

6 Required Notices

A
  1. How personal funds will be protected
  2. List of all pertinent agencies & rez advocacy groups
  3. Statement that rez may file a complaint with state survey agency
  4. Info re: Medicaid/Care coverage
  5. How to file grievances/complaints
  6. Resident Rights
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55
Q

F600 (Freedom from Abuse and Neglect) Citation are always…

A

Level 2 or a bove

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56
Q

Abuse Definition?

A

Willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish

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57
Q

Neglect Definition?

A

When facility is aware of, or should’ve been aware of, goods or services that rez requires but facility fails to provide, resulting in phys. harm, pain, or mental anguish

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58
Q

Resident living in secured/locked area would not be considered involuntary seclusion as long as following 4 criteria are met:

A
  1. Clinical reason given for confinement (not diagnosis alone)
  2. Rez/rez rep involved in care planning
  3. Facility still provides immediate access to visitors
  4. Documentation and review ongoing by physician and IDT
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59
Q
  1. Criteria MANDATORY for physical restraint to be employed:
A
  1. Very last resort (
  2. Monitor rez while restrained
  3. Least restrictive restraint for least time possible
  4. Restraint is treating a specific medical symptom
  5. All above is documented
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60
Q

If chemical restraint is being used, documentation and procedure shall reflect which 5 components?

A
  1. Adequate indication meriting use
  2. Lowest possible dose & duration
  3. Monitor Efficacy & Adverse Effects
  4. Gradual dose reduction
  5. Behavior interventions attempted
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61
Q

If PRN in place for chem. restraint…

A

Still cannot be administered w/o a specific diagnosed symptom being doc’d in the clinical record

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62
Q

Facility must not employ ppl guilty of abuse, neglect, exploitation, misappropriation of property. Where must facility look to see if such guilt exists?

A
  1. Court of law
  2. Nurse aide registry
  3. Disciplinary action from a licensure body
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63
Q

What if facility has its own intel about a nurse/cna being unfit for service according to a court of law?

A

Must report to state registry/licensing bodies

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64
Q

Written policies about abuse and neglect shall include the following 8 components:

A
  1. screening
  2. training
  3. prevention
  4. identification
  5. investigation
  6. protection
  7. reporting/response
  8. QAPI to improve policies
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65
Q

How should workers learn about reporting coworkers?

A

Conspicuous notice of employee rights including right to file a complaint about coworker crime(s)

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66
Q

How often must facility re-educate their staff about violation reporting policies? How shall training be documented?

A

Annually at least. Document by each employee’s signing they were notified.

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67
Q

If a covered individual witnesses a crime, who reports to whom?

A

Covered individual reports crime to administrator, state survey agency, and 1+ law enforcement agency

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68
Q

If a covered individual witnesses a non-criminal violation (abuse, neglect, exploitation, etc.) who reports to whom?

A

Covered individual reports to admin . Admin reports to Survey Agency

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69
Q

What is the timeframe for reporting a crime or violation?

A

Within 24 hours.
If serious bodily injury occurs, report within 2 hours.

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70
Q

What are penalties for a covered individual’s failure to report?

A

$200K, and potential ban from work in federal health.
If failure to report leads to additional violations, increase to $300K

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71
Q

Report of violation shall be documented and include

A
  1. Date and time report was made
  2. Thorough account of incident allegation
  3. How residents are being protected
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72
Q

For what types of violations should a follow-up investigation be conducted?

A

ALL!

Criminal, non criminal. Doesn’t mater. Even if external agency does an investigation, facility must still investigate.

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73
Q

When should investigation results of alleged violations be reported?

A

Within 5 working days of alleged incident.

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74
Q

To whom should investigation results of alleged violations be reported?

A

Administrator, Survey Agency, additional relevant agencies

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75
Q

An injury of an unknown source considered reportable when all of the following are true:

A
  1. Source of injury not observed by anybody
  2. Source of injury could not be explained by resident
  3. Injury is suspicious due to any of following:
    -extent
    -location
    -reccuring
    -multiple at once
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76
Q

Five situations when a facility can discharge one of its residents.

A
  1. Facility cannot meet resident’s needs
  2. Resident’s health has reached a point where no NF services are needed.
  3. Resident’s presence threatens other residents’ safety/health.
  4. Resident cannot pay for stay. MCR/MCD coverage lapsed
  5. Facility Closes
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77
Q

Which reasons for discharge require PHYSICIAN documentation?

A

Basis for discharge must ALWAYS be documented.
Physician documentation required when…

  1. Facility cannot meet resident’s needs (exact needs that cannot be met require documentation)
  2. Resident’s health has reached a point where no NF services are needed.
  3. Resident’s presence threatens other residents’ safety/health.
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78
Q

Can a resident be discharged while they are appealing their MCR/MCD coverage?

A

No

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79
Q

6 pieces of info to be given to resident’s RECIPIENT of discharge (who is receiving resident)

A
  1. Contact of practitioner responsible
  2. Rez representative’s contact info
  3. Advanced directive
  4. Special instructions / precautions
  5. Comprehensive Care Plan Goals
  6. DC Summary
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80
Q

Notice must be given to resident/representative in writing how long before DC?

A

At least 30 days

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81
Q

Timing of DC notice can be shorter when…

A
  1. Safety/health of ppl in facility is endangered
  2. Rez health improves to allow sooner DC
  3. More immediate DC due to medical necessity
  4. Rez has only resided in facility less than 30 days before planned DC date
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82
Q

3 places a DC notice goes to…

A
  1. To resident in writing, in way they understand.
  2. Send copy of notice to state ombudsman (incl. proof notice was given to rez)
  3. Record reasons for DC in medical record

~Update the notice recipients with new info if notice changes~

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83
Q

In case of emergency DC, what must-do’s of DC notice can be abandoned?

A

None! All still apply.

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84
Q

7 Components that DC Notice shall contain:

A
  1. Reason for DC
  2. Effective Date of DC
  3. Location where rez is going
  4. Statement of rez. appeal rights
  5. Contact info and assistance for appeal
  6. Contact info of LTC ombudsman
  7. Advocacy org’s for IDD/Mental disorder orgs if relevant
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85
Q

F624 - Orientation for Transfer/Discharge (basic message)

A

Facility must prepare and orient resident to their DC so that its safe and orderly. Facility should document that they have oriented and prepared resident accordingly.

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86
Q

Before AND upon transfer of resident to hospital/therapeutic leave, facility must provide these two written policies to resident/representative

A

Bed hold regulations
&
Facility Bed Hold Policy

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87
Q

Where in the building shall resident be admitted upon return from therapeutic leave?

A

To same room, if still available.
To same building part. If unavailable, offer room change to same building part when available

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88
Q

What happens if facility turns down a resident’s return after therapeutic leave?

A

Constitutes a facility-initiated discharge and all D/C procedures must be followed

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89
Q

What orders must facility have for resident upon their admission?

A

Physician orders for rez’ immediate care, including at min:
-Dietary, meds, and routine care req’s

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90
Q

When must each resident be given a comprehensive assessment?

A

W/in 14 days of admission.
W/in 14 days of a significant change.
1x every 12 months.

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91
Q

What tool should facility use to conduct Comprehensive Resident Assessment?

A

Resident Assessment Instrument (RAI)

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92
Q

Who shall conduct the RAI (execution and signature)?

A

Executed by IDT. Finalized by signature of RN Assessment Coordinator.

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93
Q

The comprehensive assessment shall be derived from what 4 information sources?

A
  1. Resident communication and observation
  2. Staff members of all shifts
  3. Record Review
  4. Optionally, resident’s doctor, fam member(s), and/or representative
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94
Q

When is a Significant Change in Status determined?

A
  1. 2+ health areas improve or decline
  2. Hospice status changes
  3. IDT determines assessment & care plan revision would be beneficial.
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95
Q

How often must a facility conduct a quarterly resident assessment?

A

Once every 92 days

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96
Q

What tool shall the quarterly resident assessment use?

A

CMS Quarterly Review Instrument

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97
Q

How long after the A.R.D. shall the MDS be completed?

A

14 days

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98
Q

How long must resident assessments be maintained in active clinical record?

A

15 months before data can be moved to Medical Records department.

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99
Q

How long after ARD shall facility have MDS encoded and ready to send to CMS?

A

7 days

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100
Q

How long after ARD shall facility actually TRANSMIT the encoded MDS?

A

14 days.

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101
Q

What MDS information should be encoded?

A
  1. Admission Assessment & Updates
  2. SCSRs
  3. Quarterly Review Assessments
  4. Items pertaining to DC, Re-entry, and Death
  5. Background facesheet info, if no admission assessment available
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102
Q

Who must certify a resident assessment?

A

Each person who helps with the assessment must sign and certify.

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103
Q

Penalty for falsely signing MDS?
Penalty for getting somebody else to false sign?

A

$1K for false signing.
$5K for making someone else.

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104
Q

Typically, a facility may NOT admit a patient with a mental disorder or intellectual disability. What are the exceptions?

A
  1. Readmission from hospital.
  2. Facility srvcs are for the same condition as the one treated in hospital
  3. Attending physician has certified that patient is likely to require less than 30 days.
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105
Q

F646 - MD/ID Significant Change Notification

A

Facility must notify relevant ID or Mental Health Disability Authority when and ID/MD resident has a significant change.

106
Q

How shall a facility navigate the levels of a PASRR?

A

Incorporate the PASRR Level 2 findings in care planning, and refer residents with Level 1 findings to Level 2 review if there is a significant change in status.

107
Q

When must a baseline care plan be created for a new resident admission?

A

Within 48 hours of admission

108
Q

What 6 components must the Baseline Care Plan include?

A
  1. Initial Goals from admission orders
  2. PASRR rec’s if applicable
  3. Physician Orders
  4. Dietary orders
  5. Therapy Services
  6. Social Services
109
Q

Summary of the baseline care plan must be…

A
  1. Given to Resident and Resident Rep
  2. Written in language that resident and rep can understand
  3. Documented in Medical Record
110
Q

What should happen if the comprehensive assessment shows changes to the baseline?

A

Baseline should be updated, and a new summary distributed.

111
Q

When must facility complete comprehensive care plan?

A

Within 7 days of completion of comprehensive resident assessment.

Reviewed & revised after each MDS/RAI assessment

112
Q

Care Plan shall include what 6 considerations

A
  1. Expected services and rehab received
  2. Services that resident declines
  3. Specialized services per PASRR rec’s
  4. Goals & desired outcomes
  5. Discharge Plans(document if rez wants to go back to community and if agencies were contacted to achieve this).
  6. Cultural competency and trauma-informed care
113
Q

How should goals be formatted in the care plan?

A

GOAL -> OBJECTIVE -> INTERVENTION

Goal example: “Receive necessary care to return to independent living”

Objective example: “Report adequate pain control during stay as proven by 1-3 for pain on 1-10 scale”

Intervention example: “Give pain meds 45 mins b4 physical therapy”

114
Q

IDT team for care planning must include, at minimum…

A
  1. Attending Physician
  2. RN for the rez
  3. Nurse Aide for the rez
  4. Member of food/nutrition srvcs staff
  5. Rez/Rez rep (must be documented if not included).

Recomended to include other appropriate staff determined by rez needs

115
Q

All facility services must be provided by

A

Qualified persons with up to date professional standards

116
Q

When asking resident about returning to the community during DC planning…

A
  1. Document asking about return
  2. Document referrals to local agencies
  3. If the answer is no, document who said no and why
117
Q

If DCing resident to unsafe location…

A

Document that alternatives were discussed and refused. Refer to APS as needed.

118
Q

When to contact APS in case of unsafe discharge?

A

At time of DC.

119
Q

What are the 4 categories of a discharge summary?

A
  1. Recap of resident’s stay and current status.
  2. Reconciliation of meds
  3. Plan of care for life after rehab
  4. Facility must convey info to receiving provider
120
Q

What shall take place during a DC reconciliation of meds?

A

Compare the meds during stay w/ meds upon DC. Assess & resolve discrepancies.

121
Q

4 components to be included in a “Plan of Care” for life after rehab?

A
  1. Where resident will live after leaving facility
  2. Provider(s) who will provide F.U. care for resident (inc. their contact info)
  3. Needed medical/non-medical services & equipment
  4. Community care and support services
122
Q

When should ADLs decline?

A

Only when its absolutely unavoidable

123
Q

Defining Resident Assistance Levels - “Independent”

A

Resident completed activity w/ no help/oversight every time during 7 day look back period

124
Q

Defining Resident Assistance Levels - “Supervision”

A

Oversight, cueing, or encouragement provided 3+ times during 7 day look back period

125
Q

Defining Resident Assistance Levels - “Limited Assistance”

A

Resident highly involved but received physical help in maneuvering or other NON-weight bearing assistance 3+ times during 7 day look back period

126
Q

Defining Resident Assistance Levels - “Extensive Assistance”

A

i) Weight bearing support 3+ times during last 7 days

OR

ii) Full staff performance of ADL during part (but not all) of last 7 days

127
Q

Defining Resident Assistance Levels - “Total Dependence”

A

Full staff performance of ADL with no participation by resident at all during 7 day look back period

128
Q

F678 - CPR

A

-CPR trained personnel (with CURRENT certification) must be immediately available

-Facility must have CPR policies

129
Q

7 Domains of wellbeing

A
  1. Security
  2. Autonomy
  3. Growth
  4. Connectedness
  5. Identity
  6. Joy
  7. Meaning
130
Q

Activities Program Director must be qualified, as demonstrated by:

A
  1. Licensed as Rec Therapist
    AND
  2. One of following:
    i) Eligible for certification as rec specialist
    ii) 2+ years in social/rec program in last 5 years
    iii) Occupational Therapist or COTA
    iv) Completed state-approved training course
131
Q

Vision/ Hearing/Foot Care/Lab/Radiology
Services

Facility must get proper treatment and assistive devices for hearing and vision impairment and foot care by…

A

1) Making appt’s w approp provider
2) Arranging transport to/fro office of said provider

132
Q

How often must weight be taken of resident?

A

Weekly for first 4 weeks.
Monthly thereafter

133
Q

Unplanned Weight Loss

A

Interval | Sig. Loss | Severe Loss
1 Month | 5% | > 5%
3 Month | 7.5% | > 7.5%
6 Month | 10% | > 10%

134
Q

Some of the policies that must be included for SNF to offer IV

A

Hand hygiene, use of aseptic technique, PPE use, staff competency, administration of IV solutions according to orders for details like infusion rate and administration route, labels and dating, assessment frequency, etc.

135
Q

Three Steps of Pain Management

A
  1. Recognize pain
  2. Evaluate pain and its causes
  3. Intervene (non-pharmacologically when possible)
136
Q

Some Bed Rail alternatives include..

A

Roll guards, foam bumpers, low bed, concave mattress

137
Q

Bed Rails should only be installed when the following 4 elements are followed:

A
  1. Try appropriate alternatives
  2. Discuss risk/benefit
  3. Obtain informed consent for rails
  4. Install and use according to manufacturer’s guidelines
138
Q

What must a physician do in order for an individual to be admitted to a SNF?

A

Approve in writing a recommendation that the individual be admitted

139
Q

Who must provide orders for a resident’s care and supervise all of their medical care?

A

A licensed physician.

140
Q

What must a physician do at each visit?

A
  1. Write/sign/date progress notes
  2. Review the resident’s total program of care and treatments
141
Q

Physician must sign and date all orders except…

A

Flu and pneumococcal vaccines, which can be given by other practitioner as long as there’s a physician approved policy in place and resident was assessed for contraindications

142
Q

Physician orders can be faxed if…

A

-Original order is signed & retained
-Facility photocopies faxed order

143
Q

Rubber stamp can be subbed for a signature if….

A

There’s a written attestation that the rubber stamp is equivalent to the physician’s signature.

144
Q

When can/cannot a PA, Nurse Practitioner, or CNS sub in for a Physician?

When can a Physician delegate tasks to a NP/PA/CNS?

A

Every other visit. Medically necessary visits. Signing orders.

CANNOT sub for FIRST visit or ADMISSION orders.

Physician can delegate all tasks unless specifically req’d to be done by physician

145
Q

How often must the facility have a physician available to respond to emergencies?

A

24 hours a day!

146
Q

To whom can a physician delegate to a dietary orders? How about therapy orders?

A

Qualified Dietician; qualified therapist

147
Q

How often must there be licensed nurse coverage?

A

24 hours a day (unless waived)

148
Q

When must a licensed nurse serve as a charge nurse?

A

Every shift (unless waived)

149
Q

How often must a facility use a registered nurse (RN)?

A

At least 8 consecutive hours per day, 7 days a week

150
Q

Facility must designate a _______ nurse to serve as a ____-time director of nursing, which means at least ___ hours per week

A

Registered;
Full;
40

151
Q

By what month must a nurse’s aide have completed a nurse aide training and competency program?

A

By the end of four months.

152
Q

No temporary/agency aide can be used unless they have…

A

Completed a NATCEP

153
Q

NATCEP stands for

A

Nurse Aide Training & Competency Evaluation Program

154
Q

A nurse aide can work four months without certification if they…

A

Are actively engaged in a state approved training course

155
Q

CNA must re-do training if they haven’t worked a shift as a CNA in what duration of time?

A

24

156
Q

Facility must complete a performance review for every nurse aide once every ______.

A

12 months

157
Q

Waiver for 24 hours a day of licensed nurse can be waived for Medicaid NF’s when these 7 conditions transpire…

A
  1. Facility tried to hire
  2. Waiver won’t endanger residents
  3. RN/physician still on call
  4. subject to annual review
  5. Subject to requiring other replacement personell
  6. State to provide notice to ombudsman & advocacy agencies
  7. Facility to notify residents and resident reps of waiver
158
Q

Waiver for 40/hr hours a day of licensed nurse can be waived for Medicare SNF’s when these 5 conditions are met…

A
  1. Rural location
  2. Typically there is at least an RN on duty 40 hrs/wk
  3. Facility either has
    a)only residents whose phsyicians document they don’t require RN/MD for 48 hrs
    OR
    b) arranged for nurse or doc to visit facility when RN cannot
  4. CMS to notify ombudsman and advocacy agencies
  5. Facility to notify residents/representatives
159
Q

When/how must facility post their staffing data?

A
  1. Daily
  2. Legibly
  3. Prominent place available to residents and visitors
  4. Beginning of each shift
  5. To public upon request (can charge)
160
Q

Facility staffing data to include:

A
  1. Facility Name
  2. Current Date
  3. Total hours worked that shift of RNS, LPNS, and CNAs
  4. Resident Census
161
Q

How long must facility retain their staffing data?

A

18 months, or state required duration, if longer

162
Q

Unlicensed person can only administer drugs if…

A

State permits and licensed nurse supervises

163
Q

How often must a medication regimen review be conducted for each resident? By whom?

A

Once per month
by
Licensed pharmacist

164
Q

What occurs if an “irregularity” is noted during medication regimen review?

A

Pharmacist sends report to DON, Attending, and Medical Director.

Attending must document that irregularity was reviewed, and what actions are being taken. If no actions are taken, attending must document why not in EHR

165
Q

A drug is considered unnecessary when one of the following 5 criteria is met:

A
  1. Excessive in dose
  2. Excessive in duration
  3. Without adequate monitoring
  4. Without adequate indication meriting drug’s use
  5. no changes in presence of adverse consequences
166
Q

TRUE or FALSE: Pre-paid deposits can be accepted as form of payment for medicare/aid residents?

A

False

167
Q

A facility can make a resident responsible for payment while pending Medicaid, but if they win eligibility, the facility must reimburse the resident for all payments from the last ________ months. This reimbursement must be made to resident within _____ days.

A

3 month

60 days

168
Q

If a facility has a composite distinct part, they must disclose…

A

Their layout

169
Q

Composite Distinct Part?

A

Multiple non-contiguous parts of same facility. Think of Hawaii and Mainland US.

170
Q

How to calculate Medication Error Rate?

A

Med Error Rate = [(# of errors observed) / (opportunity for errors)] X 100

171
Q

How to calculate Opportunities for Errors?

A

Opportunities for Errors = Doses Given + Doses ordered but not given

172
Q

There are 8 Medication Error Types. What are they?

A
  1. Omitted Meds
  2. Un-Authorized Meds
  3. Wrong Dose
  4. Wrong route (i.e. wrong eye for eye drops)
  5. Wrong form (i.e. pills instead of liquid)
  6. Wrong Medicine
  7. Wrong Time
  8. Failure to follow instructions (Failure to shake or crush, etc.)
173
Q

When is “Wrong Time” counted as a medication error?

A

When off by 60 minutes & jeopardizing of resident safety.

OR

When given at wrong meal time (or before meal when should be after)

174
Q

Facility doing its own lab/blood transfusion/radiology services must have what certification?

A

CLIA certificate

175
Q

If facility does not provide lab/radiology services on site, it must…

A

Have a written agreement to provide services from a compliant lab services provider.

176
Q

Lab/radiology services can only be conducted when ordered by a…

A

Practitioner (often physician, depending on state)

177
Q

When should practitioner be promptly notified of lab/radiology results?

A

When results veer outside of “clinical range.”

178
Q

Lab reports must be filed in the resident’s clinical record with what info?

A

Name of laboratory
Address of laboratory
Date of lab

179
Q

Which of the following services must a skilled nursing facility provide to its Medicaid residents without any additional charges?

A. Cable television
B. Private room accommodation
C. Routine and emergency dental services
D. Unlimited visiting hours for family

A

C. Routine and emergency dental services

180
Q

Which of the following services is a skilled nursing facility allowed to charge Medicare residents additional fees for?

A. Skilled nursing care
B. Semiprivate room and board
C. Routine and emergency dental services
D. Medically necessary medications

A

C. Routine and emergency dental services

181
Q

If a resident’s dentures are lost or damaged, how must a facility react and in what time constraint?

A

Facility must refer resident to dental services within 3 days. If the three day mark is missed, facility must document how the resident was assisted with eating and drinking.

182
Q

Qualified Dietician/Nutritionist Credentials shall include:

A
  1. Bachelor’s degree w dietary emphasis
  2. 900+ hours of supervised dietetics practice under registered dietician
  3. Licensed/certified by either: STATE or Commission on Dietetic Registration
183
Q

Must a facility have a full-time nutritionist on staff?

A

No, they can have a consulting dietician, but then they must also employ a “Director of Food and Nutrition Services”

184
Q

Facility’s menus must follow what 6 guidelines?

A
  1. Meet nutritional needs of residents
  2. Be prepared in advance
  3. Be followed
  4. Reflect the cultural/relig needs of population
  5. Be updated periodically
  6. Be reviewed by dietician
185
Q

What do facility’s do for residents that don’t like the initial food menu offering?

A

Appetizing and nutritiously equivalent food substitute must be available

186
Q

Who can prescribe a therapeutic diet?

A

Attending physician. Can also be delegated to a licensed/registered dietician, as long as supervised by physician.

187
Q

Facility must provide how many meals per day (not including snacks)

A

3

188
Q

Paid feeding assistants must complete what kind of training course?

A

8 hour minimum, state approved training course

189
Q

Can a feeding assistant work alone?

A

No, must work under supervision of RN or LPN and summon them i.c.e.

190
Q

Can a feeding assistant work with a resident with feeding/swallowing complications?

A

No!

191
Q

What are the three types of food contamination?

A

Biological (pathogens)
Chemical (think cleaning agents)
Physical (foreign objects in food

192
Q

What’s the “Danger Zone” of food contamination?

A

41 - 135

193
Q

Foods under what pH are less susceptible to bacterial growth?

A

pH of 5

194
Q

Cooked then cooled foods held in danger zone for what amount of time may cause illness.

What about normal, uncooked foods?

A

6 hours.

4 hours.

195
Q

4 Human hygiene no-no’s for food handling.

A

No…
1. Food handling employees with communicable diseases
2. bare-handed food contact
3. head/facial hair without nets
4. jewelry/accessories exposed to food.

196
Q

When are gloves needed for serving food?

A

When resident on transmission precautions.

197
Q

According to food safety guidelines, where should food NOT be stored in a skilled nursing facility?

A) On shelves in a cool, dry storage room
B) In the refrigerator or freezer units
C) In sealed, pest-proof containers
D) On the floor or near vents, sprinklers, or pipes

A

D) On the floor or near vents, sprinklers, or pipes

198
Q

Where should kitchen surface cloths be stored?

A

In sanitizer solution at manufacturer recommended concentration

199
Q

What temperature should a refrigerator be at or under?

A

40 degrees

200
Q

What temperature should a freezer be at or under?

A

0 degrees

201
Q

Where should meat be stored relative to produce?

A

Below, in case of drippage.

202
Q

Heat dishwashers require a wash temperature of ______ and a final rinse temperature of _______

A

150-165 degrees wash
180 degrees rinse

203
Q

Chemical dishwashers require a wash temperature of _________ and a chemical presence of ____________ for final rinse

A

120 degrees wash
50 ppm of chlorine on dish surface for final rinse

204
Q

Recommended min. internal temperature for poultry?

A

165 degrees

205
Q

Recommended min. internal temperature for ground meat and eggs held for service?

A

155 degrees

206
Q

Recommended min. internal temperature for fish, pork, beef, and other non-ground meats?

A

145 degrees

207
Q

Recommended min. internal temperature for cooked, fruits, and vegetables?

A

Recommended min. internal temperature for 135 degrees

208
Q

How long to cook unpasteurized eggs?

A

Until all parts of the egg are firm. When cooking sunny side up or other runny styles, use pasteurized eggs

209
Q

When cooking raw food in the microwave, how to prepare re: temperature?

A

Heat until all parts are 165+ degrees then let stand covered for 2 minutes

210
Q

What temp should PHFs (potentially hazards foods) and mechanically altered foods be reheated to?

A

All parts to reach 165 degrees for minimum of 15 seconds before holding for service

211
Q

When manually washing dishes, what is the order of operations?

A

Scrape -> Wash in hot water & soap -> Rinse in hot water -> immerse in hot water or chemical sanitizer

212
Q

How hot should the water be that dishes get immersed in for manual washing and how long immersion?

A

170 degrees for 30+ seconds

213
Q

What are the four main conditions of proper garbage disposal?

A
  1. Containers covered & in good condition
  2. Garbage areas kept clean
  3. No pests
  4. Garbage covered while being taken out to dumpster
214
Q

Specialized rehab services must be ordered

A

In writing by physician

215
Q

Who must participate in the facility assessment?

A
  1. Administrator
  2. DON
  3. Medical Director
  4. Governing Body representative
    (Additional members encouraged, like department heads and EVS manager)
216
Q

How often must a facility assessment be executed?

A

Annually, and upon substantial change that alters assessment (i.e. intro of a dialysis program)

217
Q

Facility assessment must address what 8 components

A
  1. Residents (Census, capacity, needs, culture, etc.)
  2. Staff (number and qty needed)
  3. Resources
  4. Services
  5. Training programs
  6. Contracts with 3rd parties
  7. Health I.T.
  8. Disaster Preparedness
218
Q

How long after discharge must Health Records be retained?

A

5 years

219
Q

6 Parts that a medical record must contain?

A
  1. Sufficient info to identify the resident
  2. Record of assessments
  3. Care plans and services provided
  4. PASARR
  5. Progress Notes
  6. Labs and diagnostic reports
220
Q

Facility should always have at least one hospital in mind to send their residents out to in case of emergency. Why is that?

A

Facility must have a transfer agreement in place with a medicare/medicaid approved hospital that is reasonably convenient to get to

221
Q

Facility must provide written notice to the state if one of the of the following higher-up positions change…

A
  1. Persons w ownership interest
  2. People on the board
  3. Organization/company responsible for facility mngmnt
  4. Facility administrator or Director of Nursing
222
Q

If a facility is to close, administrator must send notice to…

A

SSA, Ombudsman, residents, and resident representatives

223
Q

How long in advance of closure must administrator send notice?

After date of notification, what can facility NOT do?

A

60 days, OR a date that CMS decides?

Accept new patients

224
Q

4 rules of arbitration agreements

A
  1. Understood that signing is not requisite of stay
  2. Explained in manner resident understands
  3. Declare right to rescind choice up to 30 calendar days
  4. Cannot discourage communication with external officials
225
Q

If arbitration process occurs, where must it take place?

A

Neutral Arbitrator at convenient venue

226
Q

When dispute is resolved via arbitration, the final decision shall be retained by facility for how long after resolution date?

A

5 years

227
Q

What are a facility’s two options for providing hospice services?

A
  1. Obtain a WRITTEN agreement with a Medicare certified hospice to provide care
  2. Xfer resident to a facility that DOES offer hospice services
228
Q

What are the 8 things that must be laid out in a written agreement with hospice?

A
  1. Services hospice will provide vs. those facility
  2. Hospice to develop and execute hospice plan of care
  3. How comm’s will take place & be documented btwn hospice <> facility
  4. Facility to notify hospice ASAP upon sig. change
  5. Facility remains responsible for room/board, personal care, & nursing needs
  6. Facility must report violations by hospice (like abuse) to hospice administrator ASAP
  7. Lay out responsibilities for facility staff bereavement service
  8. Facility still allowed/responsible to administer therapies, as permitted by states
229
Q

How shall facility communicate with their partnered hospice?

A

With a designated member of the IDT to serve as a Liasion

230
Q

How frequently must facility E-submit their staffing information?

A

No less than quarterly.

231
Q

What four categories shall be included in staffing report facility submits to CMS?

A
  1. Category of work of employees (must include all direct care staff, incl. therapists, and distinguish btwn agency and employee)
  2. Resident census data
  3. Turnover & Tenure
  4. Hours of staff per rez per day
232
Q

When must facility present their QAPI plan?

A

At each annual recertification survey

233
Q

Who must oversee the facility QAPI program?

A

Governing body

234
Q

How many PIPs must be conducted, and in what time frame?

A

At least one annually

235
Q

Who, at minimum, must be a part of the QAA team?

A
  1. DNS
  2. Medical Director or Designee
  3. Administrator
  4. Infection Preventionist
  5. 2 other people in people in leadership roles (board members)
236
Q

To comply with the Antibiotic stewardship program, orders for antibiotics shall include:

A
  1. indications
  2. dosage
  3. duration
237
Q

How must the infection Preventionist in charge of IPCP & ASP be qualified?

Where/how often must they work?

A
  1. Primary professional training (Bachelor’s +)
  2. Qualified by additional infection training
  3. Must work for the facility AT (not remote) least part time
238
Q

4 Required policies for Pneumococcal & Influenza Immunizations

A
  1. Educate before offering vax on side effects & benefits
  2. Offer to every resident unless contraindicated
  3. Refusal allowed
  4. Medical Record to show that resident was educated, and whether they accepted vax/
239
Q

What time of year shall flu vaccine be offered?

A

Annually between Oct. 1 and March 31st

240
Q

How often should ethics and compliance program be reviewed?

A

Annually

241
Q

Who shall be allowed to serve as a compliance officer?

A

High level employee who is given enough enough power and resources to actually have power of enforcement.

242
Q

For organizations with 5+ facilities, the compliance officer should…

A

Not be under the level of CFO, COO, or general counsel. Must designate a compliance liaison for each facility.

243
Q

What is a positive latch?

A

A positive latch is a latch that catches automatically when the door is closed

244
Q

Which doors must have positive latching?

A

Corridor Doors and Doors to rooms with combustibles

245
Q

Where shall battery operated single station smoke alarms be placed?

A

In resident rooms and common areas

246
Q

When sprinkler system is down for more than 10 hours, facility must either…

A

Evacuate affected portion of building

OR

Establish fire watch until system back in service

247
Q

Emergency electric power system must supply enough power for what three systems?

A
  1. Lighting for entrances and exits
  2. Fire detection, alarm, and extinguishment
  3. Life support
248
Q

What type of facility must have its emergency electricity linked to an on-site generator?

A

Facility that uses life support systems (i.e. ventilators/suction machines)

249
Q

If a facility is certified, constructed or reconstructed after Nov. 2016, how many residents are they certified to have live in one room?

A

2 residents per room max

250
Q

If a facility is certified, constructed or reconstructed before Nov. 2016, how many residents are they certified to have live in one room?

A

4 residents per room max

251
Q

F914 - Bedroom Visual Privacy

A

Resident must be able to fully withdraw from view of others while in bed.

252
Q

What’s the max height of the window sill in a resident’s room off of the floor?

A

Must not exceed 36 inches

253
Q

F915 - Resident Room Window

A

Every sleeping room must have a window to the outside. Atrium counts.

254
Q

Where must resident rooms be relative to ground level?

A

Above.
Cannot be in basements or below ground level.

255
Q

What sleeping furniture must facility provide each resident with?

A
  1. Their own bed of proper height and safety
  2. Clean comfy mattress
  3. Bedding appropriate for weather/climate
256
Q

If facility constructed/certified BEFORE Nov 2016, where must bathroom be relative to room?

A

“NEAR”

257
Q

If facility constructed/certified AFTER Nov 2016, where must bathroom be relative to room?

A

Each residential room must have its own bathroom with a toilet and sink.

258
Q

Calls from call bells should be relayed to…

A

Directly to a staff member

OR

Centralized staff work area

259
Q

From where shall resident be able to access their call bell system?

A

-In Bed
-Toilet/Bathing
-Accessible if resident is on the floor

260
Q

F920 - Dining and Activities Rooms

A

Facility must provide one or more rooms for resident dining and activities.

261
Q

How shall the space be ventilated?

A

By means of window, mechanical ventilation or both.

262
Q

Corridors shall be equipped with firmly secured handrails where?

A

On both sides of corridor

263
Q

Oxygen is not allowed where?

A

Smoking areas

264
Q

The public policy that was initially responsible for the protection of resident funds is the:

Safe Harbor Act.
Omnibus Budget Reconciliation Act.
Health Insurance Portability and Accountability Act.
Consumer Protection Act.

A

OBRA

265
Q

6 Mandated Responsibilities of Hospice when they provide care to resident at LTC facility:

A
  1. Medical direction
  2. Nursing
  3. Counseling
  4. Social work
  5. Medical supplies
  6. Pain drugs

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