Complaint and Incident Intake Triage (answers not completed yet)

Question 1

1.Section 5010, General Intake Process, has been updated in which of the following ways?
2.Word “allegation” has been updated to “complaint
3.The guidance makes sure SA respond appropriately by requiring the actions are consistent with Federal requirements and procedures in SOM
4. When responding to allegation, SA must include timelines and process to document the action

Answer 1

1,2,4 are partially corrected only

Question 2

Section 5330, Reporting Abuse to Law Enforcement and the Medicaid Fraud Control Unit for Nursing Homes, not only reiterates the requirement for SA to report crimes suspected to have occurred in a facility, it also provides information about how to do which of the following:
1. Notify covered individual
2. Write and submit report - WRONG
3.Verify a report was made to law enforcement
4 Contact witness

Question 3

When the SA or CMS substantiates a finding of abuse, to whom must they report the substantiated findings, if appropriate?
1.National Incident based report system NIBRS
2. Medicaid Fraud Control Unit MFCU
3. Medicaid Fraud and Abuse hotline- WRONG
4. National Crime Information Center NCIC

Answer 3

2. Medicaid Fraud Control Unit- investigates abuse/neglect and criminal fraud by Medicaid providers and assist local and Federal authorities.
   In addition to any investigation that SA conducts, it can also make referrals of the incident to the following agencies:
   * Local law enforcement.
   * Adult protective services or social services agency.
   * Nurse aide registry.
   * Professional licensure boards.
   * Attorney General.
   * Medicaid Fraud Control Unit

Question 4

Which of the following statements are valid regarding the Sample Form for facility-reported incidents? (select all that apply):
1. Includes information about facility, alleged victims, and alleged perpetrations
2. Developed as an aid for facilities in preparing initial report of alleged violations
3. Developed to guide facilities in preparing a final report of alleged violations.
4.Designed to provide minimum information in the interest of timely report submission

Answer 4

1. Includes information about facility, alleged victims, and alleged perpetrations
2. Developed as an aid for facilities in preparing initial report of alleged violations

Question 5

Which of the following is information that a SA should review to confirm that a complainant , facility, or covered individual has reported a suspected crime to law enforcement?
1. Date and time report was filed
2. Original copies of report made to law enforcement
3. Polic report number provided by law enforcement
4. Information that was conveyed to law enforcement.

Answer 5

1 and 2 are only partially correct

Question 6

Revised guidance at Section 5060.1 states that SA and SMS must enter all self-reported incidents into ASPEN Complaints/Incidents Tracking System (ACTS) regarding nursing homes: select all that apply:
1. Reported under Federal Law and the requirements of participation.
2. Reported under State Law and the requirements of participation.
3. Except for those involving injuries of unknown source
4. That require a Federal onsite survey

Answer 6

1. Reported under Federal Law and the requirements of participation.

Question 7

Which of the following is not a valid statement regarding a complaint or incident that should be assigned an immediate referral priority?
1. An onsite survey maybe required
2. The nature and seriousness of complaint or incident requires the referral or reporting of this information for investigation to another agency, board, or end stage renal disease (ESRD) network without delay- WRONG
3. It has criminal implications but has not been reported to law Enforcment
4. It has criminal implications and has been reported to law Enforcment

Question 8

Which priority is assigned if alleged noncompliance with 1 or more requirements caused no actual physical or psychosocial harm (or both) but there is the potential for more than minimal harm to residents (severity level 2)
1. Immediate Jeopardy (IJ) - WRONG
2. Non immediate jeopardy -medium
3. Non immediate jeopardy -high
3. No immediate jeopardy-low

Answer 8

2. Non immediate jeopardy -medium

Question 9

Reports from the media and other government agencies revealed which of the following issues about how states process and track reports of abuse and neglect (select all that apply):
1. Timeliness
2. Consistency
3. Variation in reporting
4. Excessive reporting

Answer 9

1. Timeliness
2. Consistency
3. Variation in reporting

Question 10

Investigating and resolving complaints are critical certification activities. As a surveyor, you are (select al that apply):
1. Required to follow most of the procedures regarding complaints and reported incidents in the SOM Chapter 5-Complaint procedures
2. Central to making sure timely and appropriate actions are taken
3. On the front lines of making sure that nursing homes continually meet Federal requirements.
4. Fulfilling a significant role because of the vulnerable population nursing homes serve.

Answer 10

2. Central to making sure timely and appropriate actions are taken
3. On the front lines of making sure that nursing homes continually meet Federal requirements.
4. Fulfilling a significant role because of the vulnerable population nursing homes serve.

Question 11

The SA or CMS assign a No Action necessary priority when they determine with certainty that which further actions are unnecessary? (select all that apply)
1. Observation
2. Interviews.
3. Investigation
4. Analysis

Answer 11

3. Investigation
4. Analysis

Question 12

Regarding a No Action Necessary priority assignment, which of the following are examples of sufficient evidence that a facility does not have continuing noncompliance? (Select all that apply)
1. A recent onsite survey
2. Interview with the Long-Term Care Ombudsman that revealed no concerns
3. A recent survey that reviewed the concern
4. No additional complaints or facility-reported incidents have been received regarding the same issue.

Answer 12

1 and 4 are partially correct answers.

Question 13

Which of these revisions to the SOM Chapter 5 Complaint Procedures, make sure that SA have policies and procedures that are consistent with the Federal requirements? (select all that apply)
1. All reports from facilities must be tracked in CMS system
2. Timeframes for investigations have been revised .
3. The word “complaint” has been updated to “allegation”
4. SA must report all suspected crimes to law enforcement if they have not yet been reported.

Answer 13

I answered all of them, but it is partially correct only.

Question 14

Section 5310.1, Written Procedures, emphasizes that SA must do what?
1. Develop and implement written procedures
2. Implement written procedures
3. Develop written procedures
4. Develop and implement written procedures only when they are deemed necessary by the SA

Answer 14

1. Develop and implement written procedures

Question 15

In nursing homes, facility reported incidents are assigned which priority if IJ may have occurred, regardless of whether an immediate risk may continue to exist?
1. Immediate referral- WRONG
2. Non IJ medium
3. IJ
4. Non-IJ high

Question 16

Which new categories applicable to NH have been added to maximum timeframes related to investigating complaints and incidents (select all that apply)
1. Nursing home complaints
2. Deemed providers and suppliers
3. Nursing home incidents
4. Nursing homes.

Answer 16

1 and 2 are partially correct only

Question 17

The SA may take which of the following actions regarding investigating complaints and facility reported incidents? (select all that apply)
1.Consider other factors in its triage decision such as a trend in allegations that could mean increased risk to residents
2Focus solely on the information received regarding a complaint or incident.
3. Investigate within a shorter timeframe than required
4 Investigate within a longer timeframe than required.

Answer 17

1 and 2 are partially correct only.

Question 18

Which of the following are NH required to send to their SA: (select all that apply)
1. All alleged violations of abuse, neglect, exploitation, or mistreatment
2. Misappropriation of resident property
Results of facility investigations of alleged violations
Injuries of unknow source.

Answer 18

All of them
1. All alleged violations of abuse, neglect, exploitation, or mistreatment
2. Misappropriation of resident property
Results of facility investigations of alleged violations
Injuries of unknow source.

Question 19

Which of the following are valid statements regarding a complaint or incident that has been assigned an immediate referral priority? (select all that apply)
1. If it has been reported as a suspected crime to law enforcement, the referral is recorded in the Contact/Refer tab in the ASPEN Complaints/Incidents Tracking System (ACTS)
2. An onsite survey may be required.
3. An immediate referral may also be assigned 1 of the priorities of the SOM Chapter 5-complaint Procedures.
4. An onsite survey is not required.

Answer 19

1 and 3 are partially correct

Question 20

For N, when a determination is made that IJ may be present and ongoing, the SA must start the onsite investigation within how many business days of receipt of the initial complaint or incident report?
-3 days
-5 days
-7 days
-10 days

Answer 20

3 days

Question 21

Which of the following tables in the SOM, chapter 5-Complaint procedures contains all updated guidance for nursing home intake priority timeframe?
1. Minimum Time Frames Related to the Federal Onsite Investigation of Complaints/Incidents
2. Regulatory Time Frames Related to the Federal Investigation of Complaints/Incidents.- WRONG
3. Maximum Time Frames Related to the Federal Onsite Investigation of Complaints/ incidents
4. Suggested Time Frames for Federal Onsite Investigation of Complaints/ Incidents.

Question 22

A note in &5075.2, Non immediate Jeopardy- High Priority (for Nursing Homes) states, “ Please refer to Tag F610 in App PP of the SOM for information related to facility responses to alleged violations, including facility investigation, resident protection, and corrective actions.” To which of the following priorities does the note not apply? (select all that apply)
1. Non- immediate jeopardy medium
2. Non- immediate jeopardy (IJ) low - WRONG
3. IJ
4. Non- IJ high

Question 23

Examples of self-reported incidents in nursing homes that State Survey Agency and CMS must enter into the ASPEN Complaint/ Incidents Tracking System (ACTS) are: (Select all that apply)
1. Reporting to law enforcement of crimes occurring in LTC facilities
2. Alleged violations of abuse, neglect, exploitation, or mistreatment
3. Alleged violations that exclude misappropriation of resident property.
4. Alleged violations that exclude injuries of unknown source.

Answer 23

I checked all, it is partially correct

Question 24

Which is 1 factor that limits CMS’s ability to determine whether nursing home residents are protected from serious threats stemming from abuse and neglect?
1. Lapses in oversight of nursing homes
2. Staffing shortages in nursing homes
3. Insufficient training of nursing home staff
4. Obsolete reporting systems. - WRONG

Question 25

Which of the following are examples of nursing home-specific intakes prioritized as No Action Necessary? (Select all that apply)
1. Facility-reported incidents that are not required to be reported under Federal law or regulations.
2.An alleged event that occurred before the last standard survey with evidence the facility remains in compliance.
Incidents involving minor injuries sustained by a resident resulting from another resident’s actions.
Incidents involving lost items that are found and where no theft is suspected.

Answer 25

Answer 4 is partially correct

Question 26

Incident vs complaint

Answer 26

• Self-reported, it is an incident.
• Reported by another person, it is a complaint

Question 26

What Centers for Medicare & Medicaid Services (CMS) is responsible for?

Answer 26

The Federal agency that is responsible for certification, oversight, and payment of health care facilities and the Medicare and Medicaid programs.

Question 27

What questions/issues Department of Insurance or Consumer Affairs/Department of Agriculture and Consumer
Services covers

Answer 27

Provides information for insurance consumers, insurers, agents, and brokers including advice, regulations, news, reports, and online forms.

Question 28

SA receives complaint alleging discrimination in assignment of overtime to direct care
staff. What agency should referral be made to:
A. Department of Labor.
B. Medicaid Fraud Control Unit or Medicare Administrative Contractor.
C. Do not refer

Answer 28

A. Department of Labor.

Question 28

SA receives complaint alleging fraudulent billing practices. What agency should be referred to:
A. Department of Labor.
B. Medicaid Fraud Control Unit or Medicare Administrative Contractor.
C. Do not refer

Answer 28

B. Medicaid Fraud Control Unit or Medicare Administrative Contractor.

Question 29

SA receives complaint alleging that the facility fails to provide nursing staff in
accordance with specific staff/patient ratios mandated by the State Nurse Practice Act. What agency referral should be made to:
A. Department of Labor.
B. Medicaid Fraud Control Unit or Medicare Administrative Contractor.
C. Do not refer

Answer 29

C. Do not refer

Question 30

I may be 82, but I am still very alert and socially active. My friends and I like to get together in the evenings to have discussions and play cards, but our facility has a strict policy that requires us to return to our rooms at an early hour. They treat us like children.
Select the agency you think has jurisdiction.
A. Local health department.
B. State Survey Agency.
C. Department of Labor.
D. LTC Ombudsman.
E. Department of Mental Health or Division of Disabilities.
F. U.S. Department of Health & Human Services (HHS) Office for Civil Rights (OCR).
G. Local law enforcement

Answer 30

B. State Survey Agency.

Question 31

Scenario: A nursing home hasn’t been paying their employees.
“The facility where I work had its local funding cut over a health violation. When I went to pick
up my check last Friday, they said I’d have to wait until Monday. There was no check on
Monday either. I called some of my coworkers and they are having the same problem.”

Select the agency you think has jurisdiction.
A. Local health department.
B. State Survey Agency.
C. Department of Labor.
D. LTC Ombudsman.
E. Department of Mental Health or Division of Disabilities.
F. U.S. Department of Health & Human Services (HHS) Office for Civil Rights (OCR).
G. Local law enforcement

Answer 31

C. Department of Labor.

Question 32

Scenario: An employee of a facility asserts that the MD of the facility prescribes controlled
substances to staff upon their request.
“I was at work and I smelled a strange scent. I asked my co-worker about it and they mentioned that another employee smokes marijuana during his shift. Apparently, the Medical Director of
the facility prescribes it to the staff upon request. “

Select the agency you think has jurisdiction.
A. Local health department.
B. State Survey Agency.
C. Department of Labor.
D. LTC Ombudsman.
E. Department of Mental Health or Division of Disabilities.
F. U.S. Department of Health & Human Services (HHS) Office for Civil Rights (OCR).
G. Local law enforcement

Answer 32

G. Local law enforcement

Question 33

A nursing home employee writes the SA alleging that the facility discriminates in
provision of services to residents based on the race, disability, and gender of the resident.
“I’m writing to file an official complaint about the facility where I work. We have several
residents who are visually impaired or legally blind. However, a majority of the daily activities provided are geared toward crafts, movies, nature walks—things that are difficult for them to
participate in.”

Select the agency you think has jurisdiction.
A. Local health department.
B. State Survey Agency.
C. Department of Labor.
D. LTC Ombudsman.
E. Department of Mental Health or Division of Disabilities.
F. U.S. Department of Health & Human Services (HHS) Office for Civil Rights (OCR).
G. Local law enforcement

Answer 33

B. State Survey Agency.
E. Department of Mental Health or Division of Disabilities.

Question 34

In some cases, the SA must immediately notify the CMS location and discuss further action.
These include the following issues or incidents:
* Fires resulting in serious injury or death.
* Issues concerning Federal facilities.
* Death of a patient in a hospital while in restraints or seclusion.
* Civil rights violations.
* Medicare or Medicaid fraud.
* Cases that are especially significant or sensitive or that attract broad public or media
attention

Answer 34

(answer is provided in the question)

Question 35

Select all of the statements that are true.
A. State Survey Agencies (SAs) are authorized to review complaints of health care related services that are alleging noncompliance with Federal law, regulation, or policy in
Medicare or Medicaid certified facilities. SAs may also review concerns related to
state licensure requirements.
B. SAs may review any complaint regarding any Medicare-Medicaid certified facility.
C. The SA and CMS location are always the authorities having jurisdiction regarding any
complaint about a Medicare-Medicaid certified facility.
D. The SA may be required to refer complaints regarding accredited facilities to the CMS
location for authorization prior to conducting an investigation.

Answer 35

A. State Survey Agencies (SAs) are authorized to review complaints of health care related
services that are alleging noncompliance with Federal law, regulation, or policy in
Medicare or Medicaid certified facilities. SAs may also review concerns related to
state licensure requirements.

D. The SA may be required to refer complaints regarding accredited facilities to the CMS
location for authorization prior to conducting an investigation.

Question 36

What is the significance of revising the guidance in the SOM chapter 5. check all that apply
-Makes sure that the SA reports complaints in CMS system
-Makes sure that SA have policies and procedures that are consistent with Federal requirements
-Revised timeframes for investigation will make sure serious threats to residents are investigated immediately
SAs will report all suspected crimes to law enforcement, if the crime has not yet been reported.

Answer 36

All of the above
Makes sure that the SA reports complaints in CMS system
-Makes sure that SA have policies and procedures that are consistent with Federal requirements
-Revised timeframes for investigation will make sure serious threats to residents are investigated immediately
SAs will report all suspected crimes to law enforcement, if the crime has not yet been reported.

Question 37

A revision to General intake process updates the use of the word complaint to allegation. True or false

Answer 37

true

Question 38

Select all of the statements that are true.
A. State Survey Agencies (SAs) are authorized to review complaints of health care related
services that are alleging noncompliance with Federal law, regulation, or policy in
Medicare or Medicaid certified facilities. SAs may also review concerns related to
state licensure requirements.
B. SAs may review any complaint regarding any Medicare-Medicaid certified facility.
C. The SA and CMS location are always the authorities having jurisdiction regarding any
complaint about a Medicare-Medicaid certified facility.
D. The SA may be required to refer complaints regarding accredited facilities to the CMS
location for authorization prior to conducting an investigation.

Answer 38

A. State Survey Agencies (SAs) are authorized to review complaints of health care related
services that are alleging noncompliance with Federal law, regulation, or policy in
Medicare or Medicaid certified facilities. SAs may also review concerns related to
state licensure requirements.

D. The SA may be required to refer complaints regarding accredited facilities to the CMS
location for authorization prior to conducting an investigation.
( The correct answers are A and D. Complaints alleging noncompliance with federal law or regarding accredited facilities may be reviewed by the SA. Specific state
regulations may exist in addition to the federal requirements. The SA does not have jurisdiction
over all complaints and requires CMS location approval to review federal requirements in
accredited facilities

Question 39

Which of the following are characteristics of resident abuse?
Select all that apply.
A. Willful infliction of injury, unreasonable confinement, intimidation, or punishment—
deprivation of goods or services that are necessary to attain or maintain physical,
mental, and psychosocial well-being.
B. Includes verbal abuse, sexual abuse, physical abuse, and mental abuse.
C. The individual must have acted deliberately.
D. The intent to harm the resident always has to be proven

Answer 39

A. Willful infliction of injury, unreasonable confinement, intimidation, or punishment—
deprivation of goods or services that are necessary to attain or maintain physical,
mental, and psychosocial well-being.
B. Includes verbal abuse, sexual abuse, physical abuse, and mental abuse.
C. The individual must have acted deliberately.