2024 FTAGs Flashcards
1
Q
Facility Must Post statement that resident may file a complaint with the _____ for any suspected _________.
A
SSA, noncompliance.
2
Q
Facility Shall post Contacts for 9 Following Agencies
A
- SSA
- APS
- State Licensure Office
- Ombudsman
- Protection & Advocacy Network
- HCBS Programs
- Medicaid Fraud Control Unit
- QIO
- ADRC or other No Wrong Door Program
3
Q
Grievance Policy states that following grievance info shall be posted or notified to residents…
A
- Right to anonymous grievance
- Grievance official’s contact info
- Timeframe for grievance review
- Right to obtain written decision
4
Q
Contact info for grievance officer shall include:
A
Grievance official’s name, address, email, phone.
5
Q
Grievance policy should include what 8 components?
A
- Notifying residents of policy
- Appointing grievance officer
- Protection during investigation
- Greivance Reporting
- Contents of written grievance decisions
- Corrective actions if grievance confirmed
- Holding duration of grievance result
- Educating staff on policy
6
Q
Grievance decisions shall indicate these 7 pieces:
A
- Grievance received
- Summary of statement
- Steps of investigation
- Summary of findings
- Statement to confirm/deny grievance
- Corrective action
- Date of issuance of written decision
7
Q
Grievance decision and evidence shall be maintained for…
A
3 years from date of decision issuance
8
Q
What survey info shall be posted and where?
A
- Most recent survey results in accessible location.
- Notice of availability of surveys, certifications, and complaints from past 3 previous years
9
Q
What survey info shall NOT be posted?
A
Any info that reveals resident / res. rep. identity
10
Q
Mail shall be delivered to residents within what time frame?
A
24 hours
11
Q
Personal care shall occur where…
A
outside public view
12
Q
F586 - Resident Contact with External Entities
A
Resident always has right to contact external entities. Period.
13
Q
Advanced Directives must be…
A
Offered, documented, governed by facility policy
14
Q
NOMNC stands for…
A
Notice of Medicare Non-Coverage
15
Q
NOMNC must be given to Medicare pt. A residents when?
A
At least 2 days before their end of coverage
16
Q
NOMNC must be given to Medicare pt. B residents when…
A
- At least 2 days before end of their therapies coverage
17
Q
NOMNC need not be give under what 3 conditions
A
- Beneficiary exhausts 100 day coverage period
- Beneficiary initiates discharge
- Beneficiary elects or revokes hospice benefits
18
Q
SNF ABN stands for…
A
Advanced Beneficiary Notice (of Non-coverage)
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.
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
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
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
- At time of admission or time of eligibility for Medicare/Medicaid
- When there are changes to facility offerings.
23
Q
When price of services change, facility must notify resident how and when
A
By writing at least 60 days prior to change
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.
25
Facility shall report resident representative to state when...
Representative is making clearly bad decisions for the resident
26
To what powers is a resident rep. entitled
Only the powers and controls that are given to the resident rep. by the resident or the courts (if rep is court mandated)
26
Resident right to adequate lighting shall include -
1. Minimal glare
2. Even light
3. As much daylight as poss
4. Extra lighting for tasks like reading
5. Dimming options when poss
27
in a language they understand, resident should be informed of what 3 elements of their treatment
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
27
Resident Care Planning shall account for these 7 rights:
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
28
5 IDT considerations before allowing medication self-administration
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
29
Each rez is entitled to what details about their attending physician?
1. Name
2. Specialty
3. Contact info
30
If physician is not feasible, licensed or declines to work with rez, facility must...
Work with resident/rez rep to appoint new physician
31
Resident, Resident Rep, and Resident Physician shall be notified of what changes...
1. Accident causes doctor-worthy injury
2. Sig change in physical/mental
3. Need to sig. alter treatment
4. Decision to transfer/DC resident
32
Physician need not be notified, but resident and resident rep shall be notified of what changes?
1. Change in room or roommate
2. Change in resident rights or fed/state regulations that affect resident
33
Within what time frame, and in what format, must facility offer visibility to part or whole of medical record?
Within 24 hours (excl. holidays and weekends) in format requested by individual
34
Within what time frame must facility offer a COPY of medical record? What can they charge for?
Within 2 working days of request. Can charge for postage, labor, and supplies for the copy process.
35
7 Care components resident can never be personally charged for?
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
36
According to federal law, can resident be charged for a private room?
Yes, but only when not therapeutically required.
37
Phone, TV, Computer Personal reading, above and beyond food/beverages, and personal clothes have what in common?
CAN be charged to rez. personal funds.
38
4 Conditions must be satisfied to charge resident personal funds
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
39
In what situation does resident NOT have right to pick a roommate
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
40
Only 3 reasons a resident can refuse room transfer
1. From skilled to unskilled
2. From unskilled to skilled
3. Solely for staff convenience
41
6 categories of external ppl resident has right to IMMEDIATE access from
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
42
What 4 criteria must be satisfied for resident to perform work for facility
1. # is at or above prevailing rates
2. Care planned appropriately
3. Resident agrees
4. Rez has right to refuse
43
Care plan must reflect ________ if resident works for facility
1. Resident wants to and is appropriate for work at facility
2. Paid or voluntary
44
When must a resident's withdrawal request be granted?
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
45
Resident has 24/7 right to visitation except for these 6 limitations:
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
46
Facility must do what with visitation rights?
Inform residents!
47
Facility must make what 5 accommodations for resident council?
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
48
If facility pools resident funds, each resident's funds must still be accounted
Seperately
49
Upon each transaction of resident funds...
Record info and give receipt to resident of transaction
50
Account statements must be provided to resident/representative when?
1. Upon request.
2. Quarterly, within 30 days after end of fiscal quarter
51
Facility must insure all resident deposited funds by...
Surety bond equal to the $ a rez has deposited (with resident as beneficiary)
52
Resident shall be informed of their rights/rules...
1. Prior to/upon admission
2. Orally AND in writing
3. Receipt of info acknowledged in writing
53
To satisfy resident right to communication privacy, resident shall have reasonable access to private forms of:
1. Phone
2. Internet
3. Mail/packages (incl. stationary, writing, postage at resident's expense)
54
6 Required Notices
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
55
F600 (Freedom from Abuse and Neglect) Citation are always...
Level 2 or a bove
56
Abuse Definition?
Willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish
57
Neglect Definition?
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
58
Resident living in secured/locked area would not be considered involuntary seclusion as long as following 4 criteria are met:
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
59
5. Criteria MANDATORY for physical restraint to be employed:
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
60
If chemical restraint is being used, documentation and procedure shall reflect which 5 components?
1. Adequate indication meriting use
2. Lowest possible dose & duration
3. Monitor Efficacy & Adverse Effects
4. Gradual dose reduction
5. Behavior interventions attempted
61
If PRN in place for chem. restraint...
Still cannot be administered w/o a specific diagnosed symptom being doc'd in the clinical record
62
Facility must not employ ppl guilty of abuse, neglect, exploitation, misappropriation of property. Where must facility look to see if such guilt exists?
1. Court of law
2. Nurse aide registry
3. Disciplinary action from a licensure body
63
What if facility has its own intel about a nurse/cna being unfit for service according to a court of law?
Must report to state registry/licensing bodies
64
Written policies about abuse and neglect shall include the following 8 components:
1. screening
2. training
3. prevention
4. identification
5. investigation
6. protection
7. reporting/response
8. QAPI to improve policies
65
How should workers learn about reporting coworkers?
Conspicuous notice of employee rights including right to file a complaint about coworker crime(s)
66
How often must facility re-educate their staff about violation reporting policies? How shall training be documented?
Annually at least. Document by each employee's signing they were notified.
67
If a covered individual witnesses a crime, who reports to whom?
Covered individual reports crime to administrator, state survey agency, and 1+ law enforcement agency
68
If a covered individual witnesses a non-criminal violation (abuse, neglect, exploitation, etc.) who reports to whom?
Covered individual reports to admin . Admin reports to Survey Agency
69
What is the timeframe for reporting a crime or violation?
Within 24 hours.
If serious bodily injury occurs, report within 2 hours.
70
What are penalties for a covered individual's failure to report?
$200K, and potential ban from work in federal health.
If failure to report leads to additional violations, increase to $300K
71
Report of violation shall be documented and include
1. Date and time report was made
2. Thorough account of incident allegation
3. How residents are being protected
72
For what types of violations should a follow-up investigation be conducted?
ALL!
Criminal, non criminal. Doesn't mater. Even if external agency does an investigation, facility must still investigate.
73
When should investigation results of alleged violations be reported?
Within 5 working days of alleged incident.
74
To whom should investigation results of alleged violations be reported?
Administrator, Survey Agency, additional relevant agencies
75
An injury of an unknown source considered reportable when all of the following are true:
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
76
Five situations when a facility can discharge one of its residents.
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
77
Which reasons for discharge require PHYSICIAN documentation?
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.
78
Can a resident be discharged while they are appealing their MCR/MCD coverage?
No
79
6 pieces of info to be given to resident's RECIPIENT of discharge (who is receiving resident)
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
80
Notice must be given to resident/representative in writing how long before DC?
At least 30 days
81
Timing of DC notice can be shorter when...
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
82
3 places a DC notice goes to...
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~
83
In case of emergency DC, what must-do's of DC notice can be abandoned?
None! All still apply.
84
7 Components that DC Notice shall contain:
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
85
F624 - Orientation for Transfer/Discharge (basic message)
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.
86
Before AND upon transfer of resident to hospital/therapeutic leave, facility must provide these two written policies to resident/representative
Bed hold regulations
&
Facility Bed Hold Policy
87
Where in the building shall resident be admitted upon return from therapeutic leave?
To same room, if still available.
To same building part. If unavailable, offer room change to same building part when available
88
What happens if facility turns down a resident's return after therapeutic leave?
Constitutes a facility-initiated discharge and all D/C procedures must be followed
89
What orders must facility have for resident upon their admission?
Physician orders for rez' immediate care, including at min:
-Dietary, meds, and routine care req's
90
When must each resident be given a comprehensive assessment?
W/in 14 days of admission.
W/in 14 days of a significant change.
1x every 12 months.
91
What tool should facility use to conduct Comprehensive Resident Assessment?
Resident Assessment Instrument (RAI)
92
Who shall conduct the RAI (execution and signature)?
Executed by IDT. Finalized by signature of RN Assessment Coordinator.
93
The comprehensive assessment shall be derived from what 4 information sources?
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
94
When is a Significant Change in Status determined?
1. 2+ health areas improve or decline
2. Hospice status changes
3. IDT determines assessment & care plan revision would be beneficial.
95
How often must a facility conduct a quarterly resident assessment?
Once every 92 days
96
What tool shall the quarterly resident assessment use?
CMS Quarterly Review Instrument
97
How long after the A.R.D. shall the MDS be completed?
14 days
98
How long must resident assessments be maintained in active clinical record?
15 months before data can be moved to Medical Records department.
99
How long after ARD shall facility have MDS encoded and ready to send to CMS?
7 days
100
How long after ARD shall facility actually TRANSMIT the encoded MDS?
14 days.
101
What MDS information should be encoded?
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
102
Who must certify a resident assessment?
Each person who helps with the assessment must sign and certify.
103
Penalty for falsely signing MDS?
Penalty for getting somebody else to false sign?
$1K for false signing.
$5K for making someone else.
104
Typically, a facility may NOT admit a patient with a mental disorder or intellectual disability. What are the exceptions?
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.
105
F646 - MD/ID Significant Change Notification
Facility must notify relevant ID or Mental Health Disability Authority when and ID/MD resident has a significant change.
106
How shall a facility navigate the levels of a PASRR?
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
When must a baseline care plan be created for a new resident admission?
Within 48 hours of admission
108
What 6 components must the Baseline Care Plan include?
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
Summary of the baseline care plan must be...
1. Given to Resident and Resident Rep
2. Written in language that resident and rep can understand
3. Documented in Medical Record
110
What should happen if the comprehensive assessment shows changes to the baseline?
Baseline should be updated, and a new summary distributed.
111
When must facility complete comprehensive care plan?
Within 7 days of completion of comprehensive resident assessment.
Reviewed & revised after each MDS/RAI assessment
112
Care Plan shall include what 6 considerations
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
How should goals be formatted in the care plan?
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
IDT team for care planning must include, at minimum...
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
All facility services must be provided by
Qualified persons with up to date professional standards
116
When asking resident about returning to the community during DC planning...
1. Document asking about return
2. Document referrals to local agencies
3. If the answer is no, document who said no and why
117
If DCing resident to unsafe location...
Document that alternatives were discussed and refused. Refer to APS as needed.
118
When to contact APS in case of unsafe discharge?
At time of DC.
119
What are the 4 categories of a discharge summary?
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
What shall take place during a DC reconciliation of meds?
Compare the meds during stay w/ meds upon DC. Assess & resolve discrepancies.
121
4 components to be included in a "Plan of Care" for life after rehab?
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
When should ADLs decline?
Only when its absolutely unavoidable
123
Defining Resident Assistance Levels - "Independent"
Resident completed activity w/ no help/oversight every time during 7 day look back period
124
Defining Resident Assistance Levels - "Supervision"
Oversight, cueing, or encouragement provided 3+ times during 7 day look back period
125
Defining Resident Assistance Levels - "Limited Assistance"
Resident highly involved but received physical help in maneuvering or other NON-weight bearing assistance 3+ times during 7 day look back period
126
Defining Resident Assistance Levels - "Extensive Assistance"
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
Defining Resident Assistance Levels - "Total Dependence"
Full staff performance of ADL with no participation by resident at all during 7 day look back period
128
F678 - CPR
-CPR trained personnel (with CURRENT certification) must be immediately available
-Facility must have CPR policies
129
7 Domains of wellbeing
1. Security
2. Autonomy
3. Growth
4. Connectedness
5. Identity
6. Joy
7. Meaning
130
Activities Program Director must be qualified, as demonstrated by:
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
Vision/ Hearing/Foot Care/Lab/Radiology
Services
Facility must get proper treatment and assistive devices for hearing and vision impairment and foot care by...
1) Making appt's w approp provider
2) Arranging transport to/fro office of said provider
132
How often must weight be taken of resident?
Weekly for first 4 weeks.
Monthly thereafter
133
Unplanned Weight Loss
Interval | Sig. Loss | Severe Loss
1 Month | 5% | > 5%
3 Month | 7.5% | > 7.5%
6 Month | 10% | > 10%
134
Some of the policies that must be included for SNF to offer IV
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
Three Steps of Pain Management
1. Recognize pain
2. Evaluate pain and its causes
3. Intervene (non-pharmacologically when possible)
136
Some Bed Rail alternatives include..
Roll guards, foam bumpers, low bed, concave mattress
137
Bed Rails should only be installed when the following 4 elements are followed:
1. Try appropriate alternatives
2. Discuss risk/benefit
3. Obtain informed consent for rails
4. Install and use according to manufacturer's guidelines
138
What must a physician do in order for an individual to be admitted to a SNF?
Approve in writing a recommendation that the individual be admitted
139
Who must provide orders for a resident's care and supervise all of their medical care?
A licensed physician.
140
What must a physician do at each visit?
1. Write/sign/date progress notes
2. Review the resident's total program of care and treatments
141
Physician must sign and date all orders except...
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
Physician orders can be faxed if...
-Original order is signed & retained
-Facility photocopies faxed order
143
Rubber stamp can be subbed for a signature if....
There's a written attestation that the rubber stamp is equivalent to the physician's signature.
144
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?
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
How often must the facility have a physician available to respond to emergencies?
24 hours a day!
146
To whom can a physician delegate to a dietary orders? How about therapy orders?
Qualified Dietician; qualified therapist
147
How often must there be licensed nurse coverage?
24 hours a day (unless waived)
148
When must a licensed nurse serve as a charge nurse?
Every shift (unless waived)
149
How often must a facility use a registered nurse (RN)?
At least 8 consecutive hours per day, 7 days a week
150
Facility must designate a _______ nurse to serve as a ____-time director of nursing, which means at least ___ hours per week
Registered;
Full;
40
151
By what month must a nurse's aide have completed a nurse aide training and competency program?
By the end of four months.
152
No temporary/agency aide can be used unless they have...
Completed a NATCEP
153
NATCEP stands for
Nurse Aide Training & Competency Evaluation Program
154
A nurse aide can work four months without certification if they...
Are actively engaged in a state approved training course
155
CNA must re-do training if they haven't worked a shift as a CNA in what duration of time?
24
156
Facility must complete a performance review for every nurse aide once every ______.
12 months
157
Waiver for 24 hours a day of licensed nurse can be waived for Medicaid NF's when these 7 conditions transpire...
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
Waiver for 40/hr hours a day of licensed nurse can be waived for Medicare SNF's when these 5 conditions are met...
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
When/how must facility post their staffing data?
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
Facility staffing data to include:
1. Facility Name
2. Current Date
3. Total hours worked that shift of RNS, LPNS, and CNAs
4. Resident Census
161
How long must facility retain their staffing data?
18 months, or state required duration, if longer
162
Unlicensed person can only administer drugs if...
State permits and licensed nurse supervises
163
How often must a medication regimen review be conducted for each resident? By whom?
Once per month
by
Licensed pharmacist
164
What occurs if an "irregularity" is noted during medication regimen review?
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
A drug is considered unnecessary when one of the following 5 criteria is met:
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
TRUE or FALSE: Pre-paid deposits can be accepted as form of payment for medicare/aid residents?
False
167
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.
3 month
60 days
168
If a facility has a composite distinct part, they must disclose...
Their layout
169
Composite Distinct Part?
Multiple non-contiguous parts of same facility. Think of Hawaii and Mainland US.
170
How to calculate Medication Error Rate?
Med Error Rate = [(# of errors observed) / (opportunity for errors)] X 100
171
How to calculate Opportunities for Errors?
Opportunities for Errors = Doses Given + Doses ordered but not given
172
There are 8 Medication Error Types. What are they?
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
When is "Wrong Time" counted as a medication error?
When off by 60 minutes & jeopardizing of resident safety.
OR
When given at wrong meal time (or before meal when should be after)
174
Facility doing its own lab/blood transfusion/radiology services must have what certification?
CLIA certificate
175
If facility does not provide lab/radiology services on site, it must...
Have a written agreement to provide services from a compliant lab services provider.
176
Lab/radiology services can only be conducted when ordered by a...
Practitioner (often physician, depending on state)
177
When should practitioner be promptly notified of lab/radiology results?
When results veer outside of "clinical range."
178
Lab reports must be filed in the resident's clinical record with what info?
Name of laboratory
Address of laboratory
Date of lab
179
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
C. Routine and emergency dental services
180
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
C. Routine and emergency dental services
181
If a resident's dentures are lost or damaged, how must a facility react and in what time constraint?
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
Qualified Dietician/Nutritionist Credentials shall include:
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
Must a facility have a full-time nutritionist on staff?
No, they can have a consulting dietician, but then they must also employ a "Director of Food and Nutrition Services"
184
Facility's menus must follow what 6 guidelines?
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
What do facility's do for residents that don't like the initial food menu offering?
Appetizing and nutritiously equivalent food substitute must be available
186
Who can prescribe a therapeutic diet?
Attending physician. Can also be delegated to a licensed/registered dietician, as long as supervised by physician.
187
Facility must provide how many meals per day (not including snacks)
3
188
Paid feeding assistants must complete what kind of training course?
8 hour minimum, state approved training course
189
Can a feeding assistant work alone?
No, must work under supervision of RN or LPN and summon them i.c.e.
190
Can a feeding assistant work with a resident with feeding/swallowing complications?
No!
191
What are the three types of food contamination?
Biological (pathogens)
Chemical (think cleaning agents)
Physical (foreign objects in food
192
What's the "Danger Zone" of food contamination?
41 - 135
193
Foods under what pH are less susceptible to bacterial growth?
pH of 5
194
Cooked then cooled foods held in danger zone for what amount of time may cause illness.
What about normal, uncooked foods?
6 hours.
4 hours.
195
4 Human hygiene no-no's for food handling.
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
When are gloves needed for serving food?
When resident on transmission precautions.
197
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
D) On the floor or near vents, sprinklers, or pipes
198
Where should kitchen surface cloths be stored?
In sanitizer solution at manufacturer recommended concentration
199
What temperature should a refrigerator be at or under?
40 degrees
200
What temperature should a freezer be at or under?
0 degrees
201
Where should meat be stored relative to produce?
Below, in case of drippage.
202
Heat dishwashers require a wash temperature of ______ and a final rinse temperature of _______
150-165 degrees wash
180 degrees rinse
203
Chemical dishwashers require a wash temperature of _________ and a chemical presence of ____________ for final rinse
120 degrees wash
50 ppm of chlorine on dish surface for final rinse
204
Recommended min. internal temperature for poultry?
165 degrees
205
Recommended min. internal temperature for ground meat and eggs held for service?
155 degrees
206
Recommended min. internal temperature for fish, pork, beef, and other non-ground meats?
145 degrees
207
Recommended min. internal temperature for cooked, fruits, and vegetables?
Recommended min. internal temperature for 135 degrees
208
How long to cook unpasteurized eggs?
Until all parts of the egg are firm. When cooking sunny side up or other runny styles, use pasteurized eggs
209
When cooking raw food in the microwave, how to prepare re: temperature?
Heat until all parts are 165+ degrees then let stand covered for 2 minutes
210
What temp should PHFs (potentially hazards foods) and mechanically altered foods be reheated to?
All parts to reach 165 degrees for minimum of 15 seconds before holding for service
211
When manually washing dishes, what is the order of operations?
Scrape -> Wash in hot water & soap -> Rinse in hot water -> immerse in hot water or chemical sanitizer
212
How hot should the water be that dishes get immersed in for manual washing and how long immersion?
170 degrees for 30+ seconds
213
What are the four main conditions of proper garbage disposal?
1. Containers covered & in good condition
2. Garbage areas kept clean
3. No pests
4. Garbage covered while being taken out to dumpster
214
Specialized rehab services must be ordered
In writing by physician
215
Who must participate in the facility assessment?
1. Administrator
2. DON
3. Medical Director
4. Governing Body representative
(Additional members encouraged, like department heads and EVS manager)
216
How often must a facility assessment be executed?
Annually, and upon substantial change that alters assessment (i.e. intro of a dialysis program)
217
Facility assessment must address what 8 components
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
How long after discharge must Health Records be retained?
5 years
219
6 Parts that a medical record must contain?
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
Facility should always have at least one hospital in mind to send their residents out to in case of emergency. Why is that?
Facility must have a transfer agreement in place with a medicare/medicaid approved hospital that is reasonably convenient to get to
221
Facility must provide written notice to the state if one of the of the following higher-up positions change...
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
If a facility is to close, administrator must send notice to...
SSA, Ombudsman, residents, and resident representatives
223
How long in advance of closure must administrator send notice?
After date of notification, what can facility NOT do?
60 days, OR a date that CMS decides?
Accept new patients
224
4 rules of arbitration agreements
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
If arbitration process occurs, where must it take place?
Neutral Arbitrator at convenient venue
226
When dispute is resolved via arbitration, the final decision shall be retained by facility for how long after resolution date?
5 years
227
What are a facility's two options for providing hospice services?
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
What are the 8 things that must be laid out in a written agreement with hospice?
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
How shall facility communicate with their partnered hospice?
With a designated member of the IDT to serve as a Liasion
230
How frequently must facility E-submit their staffing information?
No less than quarterly.
231
What four categories shall be included in staffing report facility submits to CMS?
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
When must facility present their QAPI plan?
At each annual recertification survey
233
Who must oversee the facility QAPI program?
Governing body
234
How many PIPs must be conducted, and in what time frame?
At least one annually
235
Who, at minimum, must be a part of the QAA team?
1. DNS
2. Medical Director or Designee
3. Administrator
4. Infection Preventionist
5. 2 other people in people in leadership roles (board members)
236
To comply with the Antibiotic stewardship program, orders for antibiotics shall include:
1. indications
2. dosage
3. duration
237
How must the infection Preventionist in charge of IPCP & ASP be qualified?
Where/how often must they work?
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
4 Required policies for Pneumococcal & Influenza Immunizations
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
What time of year shall flu vaccine be offered?
Annually between Oct. 1 and March 31st
240
How often should ethics and compliance program be reviewed?
Annually
241
Who shall be allowed to serve as a compliance officer?
High level employee who is given enough enough power and resources to actually have power of enforcement.
242
For organizations with 5+ facilities, the compliance officer should...
Not be under the level of CFO, COO, or general counsel. Must designate a compliance liaison for each facility.
243
What is a positive latch?
A positive latch is a latch that catches automatically when the door is closed
244
Which doors must have positive latching?
Corridor Doors and Doors to rooms with combustibles
245
Where shall battery operated single station smoke alarms be placed?
In resident rooms and common areas
246
When sprinkler system is down for more than 10 hours, facility must either...
Evacuate affected portion of building
OR
Establish fire watch until system back in service
247
Emergency electric power system must supply enough power for what three systems?
1. Lighting for entrances and exits
2. Fire detection, alarm, and extinguishment
3. Life support
248
What type of facility must have its emergency electricity linked to an on-site generator?
Facility that uses life support systems (i.e. ventilators/suction machines)
249
If a facility is certified, constructed or reconstructed after Nov. 2016, how many residents are they certified to have live in one room?
2 residents per room max
250
If a facility is certified, constructed or reconstructed before Nov. 2016, how many residents are they certified to have live in one room?
4 residents per room max
251
F914 - Bedroom Visual Privacy
Resident must be able to fully withdraw from view of others while in bed.
252
What's the max height of the window sill in a resident's room off of the floor?
Must not exceed 36 inches
253
F915 - Resident Room Window
Every sleeping room must have a window to the outside. Atrium counts.
254
Where must resident rooms be relative to ground level?
Above.
Cannot be in basements or below ground level.
255
What sleeping furniture must facility provide each resident with?
1. Their own bed of proper height and safety
2. Clean comfy mattress
3. Bedding appropriate for weather/climate
256
If facility constructed/certified BEFORE Nov 2016, where must bathroom be relative to room?
"NEAR"
257
If facility constructed/certified AFTER Nov 2016, where must bathroom be relative to room?
Each residential room must have its own bathroom with a toilet and sink.
258
Calls from call bells should be relayed to...
Directly to a staff member
OR
Centralized staff work area
259
From where shall resident be able to access their call bell system?
-In Bed
-Toilet/Bathing
-Accessible if resident is on the floor
260
F920 - Dining and Activities Rooms
Facility must provide one or more rooms for resident dining and activities.
261
How shall the space be ventilated?
By means of window, mechanical ventilation or both.
262
Corridors shall be equipped with firmly secured handrails where?
On both sides of corridor
263
Oxygen is not allowed where?
Smoking areas
264
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.
OBRA
265
6 Mandated Responsibilities of Hospice when they provide care to resident at LTC facility:
1. Medical direction
2. Nursing
3. Counseling
4. Social work
5. Medical supplies
6. Pain drugs
