Dave's Notes Flashcards
Doc notified if weight change of
5lbs in 30 days
Menu cycle at least
3 weeks revise Q 90 days
Treatment restraints to be used ONLY
for the time required to complete the treatment.
Soft ties, seat belts, spring release trays or cloth vests are restraints UNLESS
used for “postural support”
All patients to be assisted and encouraged to maintain the
“highest level of self care and independance”
Patient call lights to be answered
promptly
Humidifier bottles change and sterlize
Q24 hours fill only with sterile distilled, deionized or demineralized water.
Dentist inservice for staff
annually
Care plans revised
quarterly
Food service supervisor requires
90 hour course
Drugs destroyed in
90 days
Drugs at room temp
59F - 86F
Initial assesment finished within
within 7 days
Minimum dishwashing temp
110F
Utensils clean
170F 2 minutes, 180F 30 Sec
Autoclaving
250F for 20 minutes
Persishable foods stored
below 45 or over 140
Non Perishable food
1 week, staples 2 days
Sanitize washbasins
30minutes boiling water or autoclave or gas sterilization: NOT with chemicals
Employee health records kept
3 years
CNA certificate renewal costs
$20
CNA orientation time requirements
16 hours in first 40 worked (first 8 MUST be before providing care)
1 hour of learning experience is
50 min
Drug DESTRUCTION records kept
for 3 years
Drug ORDER records kept
for 1 year
Glass thermometers cleaned
70% alcohol 10 min
Drugs ordered stat given within
1 hour given in 2 hours max
Diet Manual reviewed
annually revised Q 5years
Handicap parking space width
13’ wide
Test Ice
every month
Test drinking water
every 3 months
Lighting in room
20 ft candles
Lighting for reading
30ft candles
Bedhold lasts
7 days
Nurses progress notes updated
as neccessary
Prepaid room and board returned within
2 weeks from dc
Patients money returned within how many days after death
30 days of death
Unusual occurrences report within
24 hours keep one year
Patient Care Policy comittee reviewed
annually
Patient records keep
7 years (title 22) 5 years OBRA
Notify DHS of construction within
5 days
Autoclave thermometer check
weekly
Test Autoclave
monthly
Curtains located
18” below sprinklers
Windows no higher than
36”
Hand rails between
34” and 38” high
Handicap parking width
13’ wide
Medicaid fraud unit info
must be posted (HCFA office info not required
Minimum RN hours
8 per day
Drugs brought in check with
DOC and Pharmacist
Written Manual required for
HVAC
Surveyors review upon entrance
Facility Characteristics, QI profile, Resident Level Summary
Admission eval completed
5 days prior-48 hours after admit
Weights taken
monthly
Bug Screens
16 wires per square inch
CNA training complete
in 4 months
Water over 125F must have
warning sign 2” letters
Hot water temperature between
105F and 120F
100+ beds must have RN
at all times (not DON)
Generator must come on
in 10 seconds and run 6 hours
PCP committee includes
DON, Activities, Admin, pharmacist and at least one physician
Isolation bed ratio
1:35
Medical Director
liason between admin and MD’s
Storing of NON-legend drugs at bedside
original container, recorded in chart, amount recorded - NOT ordered by prescriber
Convert utility room to office
DHS approval required
Admin policy and procedures from
governing body
Extended survey follows
standard survey
Oxygen equipment needs
3 prong hospital grade plug
Temperature of pipes regulated by
title 24
Non contested citations, facility pays
25% in 4 days
Not in compliance in 6 months
23 day fast track to term
Not in compliance in 3 months
Denial of payments for new admissions
Survey can come
at any time
Self administration of drugs determined
by IDT
Bowel and bladder management within
2 weeks of admit
Notify DHS of change in Administrator within
10 days
ADMIN can oversee
3 buildings up to 200 beds IF same company
Trained and competent non licenced staff can give
medicinal baths and shampoo, non legend cream or ointment to intact skin, and laxative suppositories
Audiology can be
an optional service
Phone not req’d if
less than 6 beds all ambulatory
Minimum info on ID band
name and facility name
No mingling of funds between
facilities
Health Records can leave the facility for
storage after discharge
3 req’d committees
PCP, Infection control and Pharmacy
ADMIN or designee screens
patients for admit
Change of physician requires
review of orders for care and treatment
Final responsibility for care in ICF
MD
Final responsibility for care in SNF
ADMIN
Signed orders sent to pharmacy
in 48 hours
Therapuetic diet manual approved by
dietician & PCP
Unit dose medication supply on hand
min 24hrs max 48hrs supply
All nurses need
CPR training
Patients financials reported how often
Quarterly
Who is responsible for Informed consent
the Physician
Outpatient therapy must have
handwashing facility
Soiled linen sorted in
a seperate room
Mentally disordered get special rehab time of
27 hours a week
Piped gasses checked
at time of installation, if changes are made, or integrity breached
Emergency supply drugs to be checked by
pharmacist
Non movable solid waste containers must be
leak proof, rodent proof, tight fitting lids, and external handles. label is not required
Beds must be
clean comfortable and have blanket, sheets, pillow w/pillowcase and mattress
SNF may have more patients than licenced beds with approval of
director of DHS
Log of registry workers kept for
3 years
Hours and dates employees worked kept
12 months
Rights cannot be
denied or taken away
External disaster plan reviewed
annually
Facility must release drugs on discharge IF
doc orders do not include provision for drug disposition
Optional services approved by
PCP
Med error rate
5% or less
Provisional licence valid for
6 months
Pt. may not smoke in bed
unless supervised
Transfer record shall include:
Date, time, condition of Pt and reason for transfer - Name NOT included
Cannot say “approved by DHS”
ever…
Admit patients only on
physicians orders
Admin must be present
sufficient hours to run facility
Resident injury
notify physician, family member, legal representative
Bond for $750 or less in patient trust =
$1000
Committee NOT req’d by title 22
QA
Resident being involuntarily Dc’d requires
30 day notice
DON can be charge nurse IF
ADC less than 60
Fridges storing drugs must have
accurate thermometers
Patient bacteriological tests kept for
12 months
Infectious waste stored with other waste requires
DHS approval
Medical Director responsible for
standards, surveillance, coordination and improvement of medical care. Acts as consultant to DON, liason between ADMIN and MD’s, and is responsible for employee physicals
If equipment is maintained by outside company, must have
documentation of req’d standards
Handwashing facility shall not have
aerators
Test generator every
14 days for 30 min load conditions
Bedpans emptied in
utility rooms or toilets with flushing attachments
Soiled linen transported in
closed containers
Linen supply requirements
3 complete changes for capacity
Housekeeping leader qualified by
training and experience
Mop heads removed and changed
daily
Thermometer check logs
keep 12 months
Rooms must have
bedside table, chair, reading light, and overbed table
Fire drills every
quarter for all shifts
Close chart
30 days after DC
If Pt records damaged or defaced notify DHS
3 days
Employees health exam completed
90 days prior or 7 days after employment - annually thereafter
Admin must appoint acting admin if
absent 30 days
Size of activity room
not stipulated in regulations
Activities inservice
annually
Emergency drugs stored in
portable sealed container
Drugs for internal and external use
stored seperately
Dishwasher standards
National Sanitation Foundation
ICF with less than 50 beds
no additional licenced personnell required
Piped oxygen tests are by
the National Fire Protection Agency standards
Inspection and cleaning record of air filters must include
information on static pressure drop
Staff may not transfer gasses
between containers
Gases for medical use:
CO2, NO, O2, Ethylene, Cyclopropane, helium (NOT Nitrogen or CO)
Utility rooms must have
rim flush sink, work counters, and storage cabinets (call system NOT required)
Must maintain grab bars
in resident bathrooms
Ambulatory rooms required signage
“reserved for ambulatory patients” in half inch letters next to door.
Housekeeping schedule
daily, weekly, monthly
Telephone installed
on each floor with residents
Must maintain generalized and specialized
storage space
External disaster program must have:
P&P for recalling off duty staff, unified medical command, P&P for Pt relocation
ADMIN office must have contracts for
dentist
Working flashlights required for
emergency supply
Must report which diseases
TB, Brucellosis, Pertussis
Standard for measuring student learning is
Student Performance Standard
Demonstration and return demonstration is
clinical training
At a citation review conference the licencee cannot
subpeona witnesses, record testimony, or cross examine
Centralized services may be
shared by facilities
Water that is too hot in fixtures used by patients is a
class B violation
Direct supervision means
that the supervisor is in the same building
Violations with direct relationship to health and safety of patients are
class B violations
Hospital License correction not req’d
for ownership change.
Occupational Therapy Assistant certified through
AOTA
PCP meets
annually
OT floor space =
PT floor space
Dietician licensed through
American Dietetic Association
Autoclaves must have
time record and mercury thermometer
Interpersonal relationship programs include
outings, educational and recreational therapy, and social counselling (NOT mental health counselling)
Violations relating to nursing staff are
class B violations
Physical Therapists are registered through
California Board of Medical Quality Assurance
Violations relating to employee personnel records
are class C violations
59 beds or less nursing requirements
at least one RN or LVN on duty and awake at all times
Dietary Card lists
likes, dislikes, allergies, diet order
Violations relating to care plans are
class B violations
Physical Therapy room must have
training stairs, full view mirror, overhead pulley and weights, and treatment table with curtain
Physical therapy evaluates
functionality, muscles and joints (NOT pain)
In deciding time for elimination of a condition of a violation - Dept considers
number of patients, seiousness, and availability of resources
Unauthorized administration of medication is either a
class A or B violation
Physician visits
As needed + every 30 days
How many hours between last meal and breakfast
14 hours
Emergency drugs used to be replaced within
72 hours; kit resealed by pharmacist
Supply storage space requirements
15 sqft per unit
Soiled linen storage space requirements
10 sqft per unit
Clean linen storage space requirements
8sqft per unit
Dining room space requirements
12sqft per bed plus 100sqft
Utility rooms minimum space requirements
100sqft
Max distance from nurses station to patient room door
90 ft
Refrigerated drugs stored at
36F-46F
Violations relating to fire safety procedures are
class A or class B violations
Powdered milk can only be used
in cooking - NOT for drinking.
Standing orders may
not be used
DON must have how much supervising experience
one year of supervising experience in the last 5 years
Trash storage dimensions
25 sq ft
Corridor widths
8ft wide in pt areas, 6 ft wide in service areas
Toilets ratio
1:6
Showers ratio
1:12
Ceiling minimum height
8ft
Wheelchair storage space requirements
15 sqft per unit
PT space minimum
300sqft (12ft min dimension)
Menu AS SERVED to be kept
30 days
Menus to be posted
in kitchen one week prior
Itemized food purchase records kept
ONE year
Unit dose system is responsibility of
Pharmacist
CNA training records kept for
4 years
24 hours per year of training for
CNA’s
Medications must be given no more than
2 hours after being prepared and given by the preparer - drug prep for more than one administration time is not permitted
Keep certification program records for
4 years
3 hours clinical training =
1 CEU
CNA training must be completed in
4 months
DSD requirements for facility with certification program
100+ requires 40 hours per week; 60-99 beds requires 30 hours per week; 59 or less beds requires 20 hours per week
DSD experience requirements
one year of patient care and one year planning and implementing educational programs
Student to instructor ratio
1:15 maximum
Immediate supervsion means
instructor in the building AND present when clinical procedure performed.
If Dept initiates disciplinary action nurse can request hearing
within 15 days - hearing within 5 days of request.
Substantial Compliance means
conformity to regulations to an extent that patient safety, welfare and quality of care are assured.
Clinical Social Worker licensed by
California Board of Behavioral Science Examiners.
Legend drugs have label
stating federal law prohibits dispensing without prescription, or are dangerous drugs under the Business and professions code
Orientation - first 8 hours include:
Tour, emergency P&P’s, intro to patient care
DON can only be DON in
one facility, work 8 hours a day 5 days a week on the day shift be an RN
Infectious disease - residents shall have room
vented to the outside with a separate towel, handwashing facility, soap dispenser, and toilet.
Restraints checked
every 30 minutes
Dry foods to be stored
12” above floor
Facility may dispute survey findings with an
Informal Dispute Resolution
Pharmacist req’d
as many hours as needed + quarterly review
E-kit contents
Max 6 emergency drugs; max 4 doses each
Seclusion as a restraint
may NOT be used
Physical restraints shall NOT have a
PRN order and must have written physicians order specifying the duration and circumstances of use.
Special treatment programs in ICF must have
30 pt’s initially - cannot drop below 27
ICF - After 90 days from admission resident must be seen
every 60 days
ICF menus
posted 3 days in advance, written one week in advance
ICF - if LVN only on day shift must have RN consultant
4 hours a week
ICF required services
MD, intermittent nursing, Dietary, Pharmacy and Activity
ICF - must obtain written dept approval to acquire
10% or more of a facility
Drugs returned to facility in ICF keep log
3 years
Facility to provide physician for emergency care if
attending physician is unavailable
ICF special programs orientation requirements
20 hours orientation in first 60 days of employment
ICF special programs eval done
30 days prior or within 15 days after admit.
Pharmacist review patients drug regimen
monthly
Drug orders signed in
5 days transmitted in 48 hours
Legend drugs stored at bedside
1.) locked 2.) recorded in chart 3.) be ordered by prescriber 4.) stored in original containers 5.) sublingual or inhalation 6.) not kept in stock after expiration
Drug labels must be
legible
Automatic dishwashers must have
180F water on the rinse cycle.
ICF space per bed
110 sqft for single bed room; 80 sqft for multi bed
DON and ADMIN may not be
special program director
ICF - check E-kit
monthly
ICF activity staff -
50+ bed requires full time, 25-49 bed requires 20 hrs per week, 24 and under requires 10 hrs per week
ICF activities requirements
10 hours a week for each patient
ICF patient rights
1.) Privacy for visits 2.) Reimbursement for lost property 3.) Visiting hours daily for clergy
Special treatment programs for the mentally disordered include:
1.) Money management 2.) Use of community resources 3.) Use of public transportation
(NOT homemaking)
Special Disability services in ICF for
1.) mentally disordered 2.) substance abusers 3.) developmentally disabled
ICF STP - pro IDT staff
49 patients or less is 48 hrs per week, 50-69 patients is 64 hrs per week, 70-99 patients is 96 hrs per week, over 100 patients is 144 hrs per week
ICF psychiatric special treatment hours requirement
30 hours ppweek
ICF Ekit
3 doses max
ICF menu written
1 week in advance posted 3days in advance
ICF RN or Pharm reviews drug order how frequently
monthly
ICF Drug orders signed in
48 hours
ICF may have skilled care that is
non continuous
ICF minimum nursing hours
1.1 ppd
ICF bedside nursing permitted if orders are for
temporary and minor care
ICF storage space requirements
12 sqft per bed
