CH 5 Flashcards

1
Q

at risk elder means

A

person aged 70 or older

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2
Q

department means

A

the colorado department of public health and environment

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3
Q

designated facility means

A

agency that has applied and been approved by the department of human services to provide mental health services

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4
Q

governing body means

A

individual or group of individuals or corporate entity that has ultimate authority and legal responsibility for the operation of the facility

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5
Q

medical director means

A

physician who oversees the medical care services in the facility

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6
Q

non physician practitioner means

A

physician assistant or advanced practice nurse ie: nurse practitioner

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7
Q

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

A

nursing care facility

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8
Q

nursing care facility that is federally certified by the centers for medicare and medicaid services

A

skilled nursing care facility

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9
Q

what are the responsibilities of the governing body

A

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

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10
Q

who is responsible to the governing body for planning organizing developing and controlling the operations of the facility

A

administrator

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11
Q

the administrator is responsible for, at a minimum….

A
  1. act as liaison among the governing body medical staff and practitioners
  2. manage personnel and finances
  3. provide for appropriate resident care
  4. maintain relationships with the community
  5. ensure facility compliance with regulations
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12
Q

how often shall care policies and procedures be reviewed

A

at least annually

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13
Q

where shall the facility post its most recent statement of deficiencies

A

conspicuously in public view

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14
Q

facility personnel shall report suspected elder abuse to law enforcement within blank hours of observation

A

24 hours

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15
Q

there shall be no more than ___ residents admitted to one bedroom

A

4 residents

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16
Q

can inpatient residents be admitted to any room in the facility?

A

inpatient residents must be admitted to a room regularly designated and equipped as a bedroom

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17
Q

what is the bed hold policy

A

the facility must develop a policy for holding beds and provide a copy upon admission to each resident

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18
Q

how often must staff education be provided for infection control

A

annually

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19
Q

how often must staff education be provided for fire prevention and safety

A

annually

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20
Q

how often must staff education be provided for accident prevention

A

annually

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21
Q

how often must staff education be provided for confidentiality of resident information

A

annually

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22
Q

how often must staff education be provided for rehabilitative nursing

A

annually

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23
Q

how often must staff education be provided for resident rights

A

annually

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24
Q

how often must staff education be provided for dietary

A

annually

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25
Q

how often must staff education be provided for pharmacy

A

annually

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26
Q

how often must staff education be provided for dental

A

annually

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27
Q

how often must staff education be provided for behavior management

A

annually

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28
Q

how often must staff education be provided for person centered care

A

annually

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29
Q

how often must staff education be provided for disaster preparedness

A

annually

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30
Q

how often must staff education be provided for dementia or behavioral health issues

A

annually

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31
Q

what shall be in each employee record

A
employment application
verification of credentials 
references 
orientation 
evidence that health status is appropriate
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32
Q

residents shall receive the care necessary to meet what

A

individual physical, psycho-social, and rehabilitative needs to achieve and maintain their highest possible level of independence self care self worth and well being

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33
Q

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

A

upon admission

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34
Q

for residents who are admitted with pressure ulcers the facility shall

A
  1. develop an individualized treatment plan
  2. provide active treatment to improve the condition
  3. evaluate the residents progress at least weekly
  4. provide proper nutrition and hydration to promote healing
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35
Q

for residents with behavioral health issues the facility shall

A
  1. note the behavioral issues and evaluate
  2. develop and implement an individualized treatment plan
  3. obtain a mental health evaluation
  4. evaluate the resident progress
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36
Q

for residents requiring adaptive devices or personal assistance to ambulate the facility shall

A

provide and maintain such devices according to the manufacturers recommendations the facility shall also assist residents in obtaining appropriate footwear

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37
Q

for residents with an indwelling urinary catheter the facility shall

A
  1. evaluate appropriateness for continued use at least monthly
  2. assess the reason for the incontinence
  3. evaluate the potential for bladder re-training
  4. implement any practitioner order for irrigation
  5. notify the practitioner of any symptoms of UTI
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38
Q

for residents with weight changes, the facility shall

A
  1. evaluate the resident the resident to determine the cause
  2. develop and implement an individualized plan of care
  3. observe food and fluid intake
  4. provide reasonable choices of food to meet personal preferences
  5. document all food and snack intake
  6. provide assistance in eating or adaptive eating devices if needed
  7. meet requirements for dental services
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39
Q

for residents who are incontinent or immobile the facility shall

A
  1. complete an initial skin evaluation upon admission
  2. 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
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40
Q

the facility shall allow for personalization of rooms through

A

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

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41
Q

regarding personal choice the facility shall provide

A

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

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42
Q

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

A

problem resolution

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43
Q

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

A

create an individualized tool for carrying out preventative therapeutic and rehabilitative nursing care

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44
Q

nursing staff shall prepare and implement a preliminary nursing care plan when

A

within 24 hours of admission

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45
Q

nursing staff shall prepare and implement a comprehensive nursing care plan when

A

within 21 days of admission

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46
Q

social services staff shall assess the needs of each resident within ___ days of admission

A

14 days

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47
Q

all care plans shall be developed within __ days of admission

A

21 days

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48
Q

all residents shall receive face to face evaluation by a practitioner within __ days of admission

A

7 days

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49
Q

all residents shall receive a face to face comprehensive medical evaluation by a practitioner within __ days of admission

A

30 days

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50
Q

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

A

30 days for the first 90 days and then every 60 days thereafter

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51
Q

the facility shall ensure that there is ___ practitioner coverage available to promptly assess and significant change of condition

A

24 hours

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52
Q

who is allowed to accept a verbal or electronic order from a practitioner

A

licensed nurse or other appropriate discipline as authorized

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53
Q

all practitioner orders shall be signed within ___ and entered into the health information record within ___

A

14 days and 30 days

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54
Q

all medications and therapies ordered by a practitioner must be ___

A

supported by diagnosis and documentation of attempts to discuss benefits and risks of those medications and therapies

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55
Q

how often must the medical director visit the facility in person

A

at least once in 3 months

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56
Q

the medical director is responsible for

A
  1. acting as liasion between facility and admitting physician, prompt writing of orders and responding to requests by the facility
  2. consulting on the development and implementation of resident care policies
  3. establishing standards governing the conduct of physicians
  4. consulting on development and implementation of procedures to provide care in emergencies or when a residents practitioner is unavailable
  5. review accidents and hazards
  6. participate in pharmaceutical advisory committee
  7. participate in psycho-tropic medication review committee
  8. chairing or co-chairing the quality management committee
57
Q

the nursing care facility shall employ a ___ who is a registered nurse qualified by education and experience to direct facility nursing care

A

director of nursing

58
Q

what are the minimum nurse staffing requirements

A
  1. 24/7 RN
  2. 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)
59
Q

A rural facility is located in

A
  1. county with population of fewer than 15,000
  2. municipality with population of fewer than 15,000
  3. unincorporated part of county 10 miles or more from municipality with population of 15,000 or more
60
Q

24/7 RN can be waived if

A
  1. facility is located in a rural area
  2. facility has at least 1 full time RN who is on duty 40 hours per week
  3. attending physician or admission notes indicate that each resident does not require services of an RN for 48 hour period
  4. facility has made and continues to make efforts to comply with the 24/7 RN rule
61
Q

drug reactions and significant medication errors shall be reported within ___ to the residents practitioner

A

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

62
Q

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.

A
  1. 3 months

2. 6 months

63
Q

restraint means

A

any method or device used to involuntarily limit freedom of movement including but not limited to physical force mechanical devices or chemicals

64
Q

chemical restraint involves

A

medication involuntarily given for the purpose of restraining the individual

65
Q

physical restraint involves

A

use of bodily physical force to involuntarily limit an individuals freedom of movement

66
Q

mechanical restraint involves

A

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

67
Q

a restraint does not include

A
  1. the use of protective devices or adaptive devices for providing physical support prevention of injury or voluntary life saving procedures
  2. the holding of a resident for less than 5 min by a staff person for the protection of the resident or others
  3. placement of a resident in his or her room for the night
68
Q

residents in mechanical restraints shall be observed every ___ minutes

A

15 min

69
Q

residents shall have physical restraints removed at least every ___

A

2 hours

70
Q

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

A

24 hours and quarterly

71
Q

residents with safety devices shall be observed at least every ___

A

2 hours

72
Q

social services staff shall record information on social history and review it at least ___

A

annually

73
Q

social services staff shall record progress notes at least ___

A

quarterly

74
Q

a qualified social work staff member is a person who is either

A
  1. 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
  2. social worker with a masters degree in social work who is licensed as a LSW or LCSW
  3. a person with a masters or bachelors in related human services field who has monthly consultation with a LSW or LCSW
75
Q

the facility shall provide engagement activities ___ including at least ____ evening per week

A

daily

1 evening; these activities are in addition to religious services which shall be provided on weekends each week

76
Q

the facility shall provide each resident with an oral examination by a dentist or dental hygienist ___

A

upon admission

77
Q

the facility shall provide meals that are

A

nutritious attractive well balanced and in conformity with practitioner orders and resident choice.

78
Q

all diets and nourishment’s shall be provided and served as ordered by

A

the attending practitioner

79
Q

the facility shall maintain a current diet manual conveniently available o the __ and ___ staffs. current means initially published or revised within ___

A

dietary and nursing staffs

within 5 years

80
Q

menus shall be written, and approved by a ___ and planned at least ___ in advance

A

registered dietitian

1 week

81
Q

walk in refrigerators and freezers shall have inside __ and inside ___

A

lighting

lock releases

82
Q

residents or resident representative or resident council has the right to present grievances orally or in writing within ___ calendar days of the alleged incident

A

14 calendar days

83
Q

the resident advisory council must consist of no less than ___ members

A

5

84
Q

the resident council shall meet at least ___ with the administrator and a staff representative

A

monthly

85
Q

staff shall respond to resident council suggestions in writing by ___

A

the next meeting

86
Q

a resident shall not be transfered or discharged unless

A
  1. is necessary for the residents welfare. residents needs cannot be met in the facility
    or
  2. is for medical reasons
    or
  3. to preserve the welfare of other residents
    or
  4. the resident has failed to pay for a stay at the facility
87
Q

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

A

14 days to staff designee
10 days to grievance committee
10 days to department of health

88
Q

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

A

department of public health and environment
the colorado department of healthcare policy and financing
60 days
7 days

89
Q

health information records shall be maintained and stores safely out of direct access of

A

water
fire
and other hazards

90
Q

all health information records shall be competed no later than ___ days following discharge

A

30 days

91
Q

health information records shall be filed and archived and reproducible for ___ after the date of last discharge

A

10 years

92
Q

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

A

14 days

30 days

93
Q

who is on the pharmaceutical advisory committee

A

RN
Consultant pharmacist
medical director

94
Q

who is on the psycho-tropic advisory committee

A

RN
Consultant pharmacist
medical director
social worker

95
Q

medication must be stored in ___

A

its original container

96
Q

the facility must provide each resident a copy of the resident rights upon ____

A

admission

97
Q

the resident has the right to receive adequate and appropriate health care consistent with ___

A

established and recognized practice standards within the community

98
Q

what are the residents civil and religious liberties

A
  1. knowledge of available choices and the right to independent decisions
  2. the right to encouragement and assistance from staff
  3. the right to vote
  4. the right to participate in activities both inside and outside the facility
99
Q

the resident has the right to present grievances to staff of administrator or governmental officials without fear and to join other patients within ____

A
  1. the right to participate in resident council
  2. 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)
100
Q

resident has the right to manage their own financial affairs. how often must an accounting of financial transactions be made?

A

quarterly

101
Q

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 ____

A
  1. the right to refuse treatment and medication and to know the consequences
  2. the right to participate in discharge planning
  3. the right to review their medical records
102
Q

resident has the right to have private communications with any person including ___

A
  1. right to privacy for phone calls
  2. right to receive mail unopened
  3. right to private consensual sexual activity
103
Q

Resident has the right to be free from abuse and from physical and chemical restraints except ___

A

restraints initiated through the judgement of professional staff for a specified and limited period of time or on the written authorization of a practitioner

104
Q

Resident has the right to freedom of choice in selecting ___

A

a health care facility

105
Q

Resident has the right to be transferred or discharged only for ___

A
  1. medical reasons
  2. their welfare or that of other residents
  3. for non payment
106
Q

Resident has the right not to be transferred or discharged for ___

A

Raising concerns or complaints

107
Q

Resident has the right to have privacy in treatment and security in ___

A

storing and using personal possessions

108
Q

Resident has the right to be treated ___, ____ and with the ___ measure of dignity

A

courteously
fairly
fullest measure of dignity

109
Q

If the resident lacks decisional capacity the rights shall transfer to ___

A

resident representative

110
Q

Grievances may be presented ___ or in ___ within ___ days of the incident

A

orally
writing
14 days

111
Q

Within __ days of receiving a grievance staff designee shall provide written explanation of findings to the complainant

A

3 days

112
Q

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

A

10 days

113
Q

After filing grievance with the grievance committee, the committee has ___ days to provide explanation of findings to the resident

A

10 days

114
Q

The resident may file a grievance with the executive director ___ days after receiving findings of the grievance committee

A

10 days

115
Q

If controlled substances are no longer needed the facility shall conduct an onsite destruction as follows

A
  1. the facility shall properly inventory the destruction and keep the inventory copy on file for at least 2 years
  2. destruction shall be witnessed in writing by the administrator or designee and 2 clinically licensed individuals
  3. the destruction shall be performed in a manner that renders the controlled substances totally irretrievable
116
Q

upon discharge the facility shall release medications to a resident only with ___

A

written practitioner authorization

117
Q

standards adopted by the director of the division of fire prevention and control began when

A

july 1, 2013

118
Q

a resident care unit is no more than __ residents

A

60

119
Q

private room minimum room area is ___

A

100 square feet excluding closets, lockers, wardrobes, and toilet rooms

120
Q

multi-bed minimum room area is ___

A

80 square feet per bed

121
Q

true or false each bedroom shall have direct entry from a corridor

A

true

122
Q

each bedroom shall have an exterior window. how much of the window shall open without tools

A

one half of the window

123
Q

There may be 1 toilet for ___ resident rooms but not more than __ beds

A

2 resident rooms

4 beds

124
Q

minimum dimensions for any room containing 1 toilet room shall be ___

A

3 feet by 6 feet

125
Q

the door to the toilet room shall be at least ___ wide

A

2 feet 10 inches (34 inches)

126
Q

resident bedrooms shall be equipped with he following furniture

A
  1. adjustable washable water proof bed and mattress with a comfortable pillow
  2. cabinet or bedside table
  3. over-bed table
  4. waste receptacle with liner
  5. personal care equipment
  6. storage facilities adequate for residents personal articles and grooms
127
Q

the minimum size of a residents closet shall be

A

1 foot 8 inches wide (20 inches) by 1 foot 10 inches deep (22 inches)

128
Q

the clean linen room shall be equipped with

A
  1. counter, sink with mixing faucet, sanitary soap and method for drying hands
  2. waste container with cover and liner
  3. area for supplies
129
Q

there shall be a soiled holding room equipped with

A
  1. counter, double sink with mixing faucet, sanitary soap and method for drying hands
  2. waste container with cover and liner
  3. space for short time holding of specimens
  4. adequate counter space
  5. clinical flushing sink
130
Q

there shall be a utility closet equipped with

A
  1. sink with mixing faucets
  2. hook strip for mop handles
  3. shelving for cleaning materials
  4. hand washing facilities
  5. waste container with liner
131
Q

hallways shall be free of ___ such as furniture, medical supplies and equipment

A

obstructions

132
Q

the team designated to evaluate placement of a resident in a secured unit shall include at a minimum ___

A

the director of nursing
social services staff member
administrator and
individual who NOT a facility staff member (with mental health or social work training)

133
Q

in order to place a resident into a secure unit the facility shall

A
  1. evaluate resident
  2. a practitioner must authenticate the placement
  3. written findings and the factual basis for the placement are documented
  4. the resident or resident representative has given informed written consent
134
Q

To be placed in a secure unit the evaluation must include

A
  1. resident is in serious danger to self or others
  2. resident habitually wanders and is unable to find their way back
  3. resident has significant behavioral health issue that disrupts the rights of others
  4. less restrictive alternatives have been unsuccessful in preventing harm
135
Q

a secure unit must provide at least ___ square feet of common area per resident

A

10 square feet excluding hallways

136
Q

laundry services shall be of sufficient capacity to process a continuous ___ supply based on ___ of dry laundry per bed per day

A

continuous 7 day supply

based on 10 pounds of dry laundry

137
Q

linen supply such as sheets pillow cases washcloths and towels shall be at least ___ the number of licensed beds

A

3 complete change times

138
Q

all linens from residents with infectious disease shall be placed in ___

A

bio hazardous bags

139
Q

the facilities written policies regarding infection control shall be consistent with ___

A

the centers for disease control and prevention; guidelines for precautions; preventing transmission of infectious agents in health care settings 2007