CH 5 Flashcards
at risk elder means
person aged 70 or older
department means
the colorado department of public health and environment
designated facility means
agency that has applied and been approved by the department of human services to provide mental health services
governing body means
individual or group of individuals or corporate entity that has ultimate authority and legal responsibility for the operation of the facility
medical director means
physician who oversees the medical care services in the facility
non physician practitioner means
physician assistant or advanced practice nurse ie: nurse practitioner
licensed health care entity that is planned organized operated and maintained to provide restorative and preventative services to persons who require continuous or regular in patient nursing care
nursing care facility
nursing care facility that is federally certified by the centers for medicare and medicaid services
skilled nursing care facility
what are the responsibilities of the governing body
a. provide necessary facilities, qualified personnel, and services to meet the needs of the residents
b. appoint a full time administrator with an active license whose authority it is to run the facility day to day
c. be responsible for the performance of all persons providing services
d. ensure the facility has a quality management program
who is responsible to the governing body for planning organizing developing and controlling the operations of the facility
administrator
the administrator is responsible for, at a minimum….
- act as liaison among the governing body medical staff and practitioners
- manage personnel and finances
- provide for appropriate resident care
- maintain relationships with the community
- ensure facility compliance with regulations
how often shall care policies and procedures be reviewed
at least annually
where shall the facility post its most recent statement of deficiencies
conspicuously in public view
facility personnel shall report suspected elder abuse to law enforcement within blank hours of observation
24 hours
there shall be no more than ___ residents admitted to one bedroom
4 residents
can inpatient residents be admitted to any room in the facility?
inpatient residents must be admitted to a room regularly designated and equipped as a bedroom
what is the bed hold policy
the facility must develop a policy for holding beds and provide a copy upon admission to each resident
how often must staff education be provided for infection control
annually
how often must staff education be provided for fire prevention and safety
annually
how often must staff education be provided for accident prevention
annually
how often must staff education be provided for confidentiality of resident information
annually
how often must staff education be provided for rehabilitative nursing
annually
how often must staff education be provided for resident rights
annually
how often must staff education be provided for dietary
annually
how often must staff education be provided for pharmacy
annually
how often must staff education be provided for dental
annually
how often must staff education be provided for behavior management
annually
how often must staff education be provided for person centered care
annually
how often must staff education be provided for disaster preparedness
annually
how often must staff education be provided for dementia or behavioral health issues
annually
what shall be in each employee record
employment application verification of credentials references orientation evidence that health status is appropriate
residents shall receive the care necessary to meet what
individual physical, psycho-social, and rehabilitative needs to achieve and maintain their highest possible level of independence self care self worth and well being
when shall the facility assess the potential for skin breakdown and provide measures to prevent pressure ulcers in residents identified as being at risk for developing them
upon admission
for residents who are admitted with pressure ulcers the facility shall
- develop an individualized treatment plan
- provide active treatment to improve the condition
- evaluate the residents progress at least weekly
- provide proper nutrition and hydration to promote healing
for residents with behavioral health issues the facility shall
- note the behavioral issues and evaluate
- develop and implement an individualized treatment plan
- obtain a mental health evaluation
- evaluate the resident progress
for residents requiring adaptive devices or personal assistance to ambulate the facility shall
provide and maintain such devices according to the manufacturers recommendations the facility shall also assist residents in obtaining appropriate footwear
for residents with an indwelling urinary catheter the facility shall
- evaluate appropriateness for continued use at least monthly
- assess the reason for the incontinence
- evaluate the potential for bladder re-training
- implement any practitioner order for irrigation
- notify the practitioner of any symptoms of UTI
for residents with weight changes, the facility shall
- evaluate the resident the resident to determine the cause
- develop and implement an individualized plan of care
- observe food and fluid intake
- provide reasonable choices of food to meet personal preferences
- document all food and snack intake
- provide assistance in eating or adaptive eating devices if needed
- meet requirements for dental services
for residents who are incontinent or immobile the facility shall
- complete an initial skin evaluation upon admission
- provide measures to prevent excoriation that include: 1. maintain clean dry well lubricated skin 2. take incontinent residents to the bathroom regularly 3. evaluate the need for daily bath 4. determine potential problem spots
the facility shall allow for personalization of rooms through
use of residents personal furniture, appliances, decorations, plants and memorabilia the facility may limit the number of furniture items in residents rooms per fire codes resident and staff safety
regarding personal choice the facility shall provide
a. reasonable efforts to accommodate preference of roommate
b. flexibility in times to eat main meals consistent with requirements
c. flexibility in times to bathe, rise and retire
d. provide at least one alternate meal choice
providing residents information about grievance procedure contact info of the local ombudsman contact of the colorado department of public health and environment health facilities and emergency medical services division is called
problem resolution
under the direction of an RN an individualized nursing care plan shall be prepared for each resident based on the resident assessment and practitioner orders for what
create an individualized tool for carrying out preventative therapeutic and rehabilitative nursing care
nursing staff shall prepare and implement a preliminary nursing care plan when
within 24 hours of admission
nursing staff shall prepare and implement a comprehensive nursing care plan when
within 21 days of admission
social services staff shall assess the needs of each resident within ___ days of admission
14 days
all care plans shall be developed within __ days of admission
21 days
all residents shall receive face to face evaluation by a practitioner within __ days of admission
7 days
all residents shall receive a face to face comprehensive medical evaluation by a practitioner within __ days of admission
30 days
the facility shall ensure that all residents are seen by a practitioner every __ days for the first ___ days after admission and at least ___ days thereafter
30 days for the first 90 days and then every 60 days thereafter
the facility shall ensure that there is ___ practitioner coverage available to promptly assess and significant change of condition
24 hours
who is allowed to accept a verbal or electronic order from a practitioner
licensed nurse or other appropriate discipline as authorized
all practitioner orders shall be signed within ___ and entered into the health information record within ___
14 days and 30 days
all medications and therapies ordered by a practitioner must be ___
supported by diagnosis and documentation of attempts to discuss benefits and risks of those medications and therapies
how often must the medical director visit the facility in person
at least once in 3 months
the medical director is responsible for
- acting as liasion between facility and admitting physician, prompt writing of orders and responding to requests by the facility
- consulting on the development and implementation of resident care policies
- establishing standards governing the conduct of physicians
- consulting on development and implementation of procedures to provide care in emergencies or when a residents practitioner is unavailable
- review accidents and hazards
- participate in pharmaceutical advisory committee
- participate in psycho-tropic medication review committee
- chairing or co-chairing the quality management committee
the nursing care facility shall employ a ___ who is a registered nurse qualified by education and experience to direct facility nursing care
director of nursing
what are the minimum nurse staffing requirements
- 24/7 RN
- sufficient to meet the needs of residents but no less than 2 hours of nursing time per resident per day (facilities of 60 residents or more the DON and supervisory personnel do no count)
A rural facility is located in
- county with population of fewer than 15,000
- municipality with population of fewer than 15,000
- unincorporated part of county 10 miles or more from municipality with population of 15,000 or more
24/7 RN can be waived if
- facility is located in a rural area
- facility has at least 1 full time RN who is on duty 40 hours per week
- attending physician or admission notes indicate that each resident does not require services of an RN for 48 hour period
- facility has made and continues to make efforts to comply with the 24/7 RN rule
drug reactions and significant medication errors shall be reported within ___ to the residents practitioner
30 min; a call to the practitioner office or answering service does not meet the facilities responsibility to provide emergency care the residents condition shall be monitored for 72 hours
if a resident is administered psycho-active medications he or she shall be evaluated for medication effectiveness at least every ____. the resident shall be assessed every ___ for adverse effects.
- 3 months
2. 6 months
restraint means
any method or device used to involuntarily limit freedom of movement including but not limited to physical force mechanical devices or chemicals
chemical restraint involves
medication involuntarily given for the purpose of restraining the individual
physical restraint involves
use of bodily physical force to involuntarily limit an individuals freedom of movement
mechanical restraint involves
use of a physical device to involuntarily restrict the movement of an individual or the movement or normal function of a portion of the individuals body
a restraint does not include
- the use of protective devices or adaptive devices for providing physical support prevention of injury or voluntary life saving procedures
- the holding of a resident for less than 5 min by a staff person for the protection of the resident or others
- placement of a resident in his or her room for the night
residents in mechanical restraints shall be observed every ___ minutes
15 min
residents shall have physical restraints removed at least every ___
2 hours
if a safety device meets the definition of a restraint a comprehensive physical and functional assessment shall be completed no less often then after the 1st ___ and ___ thereafter
24 hours and quarterly
residents with safety devices shall be observed at least every ___
2 hours
social services staff shall record information on social history and review it at least ___
annually
social services staff shall record progress notes at least ___
quarterly
a qualified social work staff member is a person who is either
- social worker with bachelors degree in social work or authorized by Colorado law to practice as a social worker who has 1 year experience under the supervision of a licensed social worker
- social worker with a masters degree in social work who is licensed as a LSW or LCSW
- a person with a masters or bachelors in related human services field who has monthly consultation with a LSW or LCSW
the facility shall provide engagement activities ___ including at least ____ evening per week
daily
1 evening; these activities are in addition to religious services which shall be provided on weekends each week
the facility shall provide each resident with an oral examination by a dentist or dental hygienist ___
upon admission
the facility shall provide meals that are
nutritious attractive well balanced and in conformity with practitioner orders and resident choice.
all diets and nourishment’s shall be provided and served as ordered by
the attending practitioner
the facility shall maintain a current diet manual conveniently available o the __ and ___ staffs. current means initially published or revised within ___
dietary and nursing staffs
within 5 years
menus shall be written, and approved by a ___ and planned at least ___ in advance
registered dietitian
1 week
walk in refrigerators and freezers shall have inside __ and inside ___
lighting
lock releases
residents or resident representative or resident council has the right to present grievances orally or in writing within ___ calendar days of the alleged incident
14 calendar days
the resident advisory council must consist of no less than ___ members
5
the resident council shall meet at least ___ with the administrator and a staff representative
monthly
staff shall respond to resident council suggestions in writing by ___
the next meeting
a resident shall not be transfered or discharged unless
- is necessary for the residents welfare. residents needs cannot be met in the facility
or - is for medical reasons
or - to preserve the welfare of other residents
or - the resident has failed to pay for a stay at the facility
when a 30 day notice of discharge is given the resident has __ days to appeal to staff designee and/or ___ days to the facility grievance committee and ___ days to the Colorado department of public health
14 days to staff designee
10 days to grievance committee
10 days to department of health
if a facility intends to close or change bed classification it shall notify ___ and ___ at least ___ days before the change and at least ___ days before it notifies residents and families
department of public health and environment
the colorado department of healthcare policy and financing
60 days
7 days
health information records shall be maintained and stores safely out of direct access of
water
fire
and other hazards
all health information records shall be competed no later than ___ days following discharge
30 days
health information records shall be filed and archived and reproducible for ___ after the date of last discharge
10 years
the facility shall ensure that therapists communicate to the facility the residents condition and response to treatment within ___ days of initiation of treatment and every ___ days thereafter
14 days
30 days
who is on the pharmaceutical advisory committee
RN
Consultant pharmacist
medical director
who is on the psycho-tropic advisory committee
RN
Consultant pharmacist
medical director
social worker
medication must be stored in ___
its original container
the facility must provide each resident a copy of the resident rights upon ____
admission
the resident has the right to receive adequate and appropriate health care consistent with ___
established and recognized practice standards within the community
what are the residents civil and religious liberties
- knowledge of available choices and the right to independent decisions
- the right to encouragement and assistance from staff
- the right to vote
- the right to participate in activities both inside and outside the facility
the resident has the right to present grievances to staff of administrator or governmental officials without fear and to join other patients within ____
- the right to participate in resident council
- the right to contact information for the ombudsman, colorado department of public health and environment, health facilities and emergency medical services division (the facility must post the contact information)
resident has the right to manage their own financial affairs. how often must an accounting of financial transactions be made?
quarterly
resident has the right to be fully informed of their medical condition and proposed treatment. they have the right to participate in planning of treatment including ____
- the right to refuse treatment and medication and to know the consequences
- the right to participate in discharge planning
- the right to review their medical records
resident has the right to have private communications with any person including ___
- right to privacy for phone calls
- right to receive mail unopened
- right to private consensual sexual activity
Resident has the right to be free from abuse and from physical and chemical restraints except ___
restraints initiated through the judgement of professional staff for a specified and limited period of time or on the written authorization of a practitioner
Resident has the right to freedom of choice in selecting ___
a health care facility
Resident has the right to be transferred or discharged only for ___
- medical reasons
- their welfare or that of other residents
- for non payment
Resident has the right not to be transferred or discharged for ___
Raising concerns or complaints
Resident has the right to have privacy in treatment and security in ___
storing and using personal possessions
Resident has the right to be treated ___, ____ and with the ___ measure of dignity
courteously
fairly
fullest measure of dignity
If the resident lacks decisional capacity the rights shall transfer to ___
resident representative
Grievances may be presented ___ or in ___ within ___ days of the incident
orally
writing
14 days
Within __ days of receiving a grievance staff designee shall provide written explanation of findings to the complainant
3 days
if the resident is dissatisfied with the findings of the staff designee, of a grievance, the resident has ___ days to file with the grievance committee
10 days
After filing grievance with the grievance committee, the committee has ___ days to provide explanation of findings to the resident
10 days
The resident may file a grievance with the executive director ___ days after receiving findings of the grievance committee
10 days
If controlled substances are no longer needed the facility shall conduct an onsite destruction as follows
- the facility shall properly inventory the destruction and keep the inventory copy on file for at least 2 years
- destruction shall be witnessed in writing by the administrator or designee and 2 clinically licensed individuals
- the destruction shall be performed in a manner that renders the controlled substances totally irretrievable
upon discharge the facility shall release medications to a resident only with ___
written practitioner authorization
standards adopted by the director of the division of fire prevention and control began when
july 1, 2013
a resident care unit is no more than __ residents
60
private room minimum room area is ___
100 square feet excluding closets, lockers, wardrobes, and toilet rooms
multi-bed minimum room area is ___
80 square feet per bed
true or false each bedroom shall have direct entry from a corridor
true
each bedroom shall have an exterior window. how much of the window shall open without tools
one half of the window
There may be 1 toilet for ___ resident rooms but not more than __ beds
2 resident rooms
4 beds
minimum dimensions for any room containing 1 toilet room shall be ___
3 feet by 6 feet
the door to the toilet room shall be at least ___ wide
2 feet 10 inches (34 inches)
resident bedrooms shall be equipped with he following furniture
- adjustable washable water proof bed and mattress with a comfortable pillow
- cabinet or bedside table
- over-bed table
- waste receptacle with liner
- personal care equipment
- storage facilities adequate for residents personal articles and grooms
the minimum size of a residents closet shall be
1 foot 8 inches wide (20 inches) by 1 foot 10 inches deep (22 inches)
the clean linen room shall be equipped with
- counter, sink with mixing faucet, sanitary soap and method for drying hands
- waste container with cover and liner
- area for supplies
there shall be a soiled holding room equipped with
- counter, double sink with mixing faucet, sanitary soap and method for drying hands
- waste container with cover and liner
- space for short time holding of specimens
- adequate counter space
- clinical flushing sink
there shall be a utility closet equipped with
- sink with mixing faucets
- hook strip for mop handles
- shelving for cleaning materials
- hand washing facilities
- waste container with liner
hallways shall be free of ___ such as furniture, medical supplies and equipment
obstructions
the team designated to evaluate placement of a resident in a secured unit shall include at a minimum ___
the director of nursing
social services staff member
administrator and
individual who NOT a facility staff member (with mental health or social work training)
in order to place a resident into a secure unit the facility shall
- evaluate resident
- a practitioner must authenticate the placement
- written findings and the factual basis for the placement are documented
- the resident or resident representative has given informed written consent
To be placed in a secure unit the evaluation must include
- resident is in serious danger to self or others
- resident habitually wanders and is unable to find their way back
- resident has significant behavioral health issue that disrupts the rights of others
- less restrictive alternatives have been unsuccessful in preventing harm
a secure unit must provide at least ___ square feet of common area per resident
10 square feet excluding hallways
laundry services shall be of sufficient capacity to process a continuous ___ supply based on ___ of dry laundry per bed per day
continuous 7 day supply
based on 10 pounds of dry laundry
linen supply such as sheets pillow cases washcloths and towels shall be at least ___ the number of licensed beds
3 complete change times
all linens from residents with infectious disease shall be placed in ___
bio hazardous bags
the facilities written policies regarding infection control shall be consistent with ___
the centers for disease control and prevention; guidelines for precautions; preventing transmission of infectious agents in health care settings 2007
