Facility Policies Flashcards
If a nursing facility has been certified by Medicare and Medicaid under Final Rules and federal requirements, in effect, it
Must still meet all state and local licensure requirements
Establishing and implementing policies regarding the management of the facility are assigned to
The governing body or persons designated as such
In order to begin collecting better data about the nursing home industry, federal legislation mandated development and use of
A Minimum Data Set
The comprehensive care plan does not include a
Medical director
Nurse’s aides who have completed a training and competency evaluation program and passed the required competency test(s)
Must still be judged by surveyors as competent to provide services
Responsibility for ascertaining professional performance standards for licensed, certified, or registered allied health persons used by the facility rests with the
Facility
Organizations that actually pay the Medicare claims submitted by doctors and other medical suppliers are called
Carriers
The facility is not required to use its resources effectively and efficiently to attain the highest practical
Profitability
A person who is determined by the state mental health authority to need nursing facility service but is receiving active treatment for mental illness
Can be admitted
Each facility must designate a physician to serve as medical director
On a part time or full time basis
The administrator believes that once the obligation to meet federal, state, and local laws is met the requirements applicable to the operation of the facility have been satisfied. The administrator is
Only partially correct
The terms for Medicare and Medicaid participating homes used in the Final Rules effect are
Skilled nursing facility and nursing facility
Having a transfer agreement with one or more hospitals is
A condition of participation requirement
Nursing homes are licensed by
The states
Regulations such as those implementing Medicare and Medicaid; Requirements for Long Term Care Facilities, are first published in the
Federal Register
All facilities are required to
Have a governing body or designated persons functioning as a governing body
The facility administrator establishes written transfer agreements with their local hospitals, one of which is approved only for participation under the Medicare program, and the second approved only for participation under Medicaid. The administrator has
Failed to meet transfer agreement requirements
The transfer agreements signed by the administrator ensure that the medical and other information needed for care and treatment of the resident is available and that a bed will be available for the resident on return from the hospital. This is the entire agreement. A visiting surveyor would
Require changes to the transfer agreement
The discharge social worker at the hospital determines that the resident cared for under the transfer agreement should return, not to the facility, but be placed din an assisted living facility that is a less expensive setting. Normally
This is appropriate
If persons with controlling interest in the facility, the company owning the facility or the administrator or DON change, the facility should
Inform the state licensing agency in writing
The administrator decides the trained therapeutic recreation specialist is too costly for the facility and hires instead a less expensive qualified occupational therapy assistant. This is
Within the federal hiring guidelines
The recently graduated social worker job applicant for a 140 bed facility states that she has a bachelor’s degree in psychology and 1 year’s experience as supervisor of four social workers at a nearby nursing hospital. The administrator should
Explore the applicant’s experience in more depth
The administrator of a 50 bed facility asks the director of nursing to serve as both director of nursing and as a charge nurse on the weekend shift
This is appropriate
If a facility provides the state minimum number of hours per resident day of care a state or federal inspector
May still cite nursing for insufficient staffing
If the administrator of an average daily total occupancy of 80 residents requires the DON to serve as charge nurse, the administrator
Has failed to meed Final Rules requirements
The consultant pharmacist at his monthly visit requires the director of nursing to provide him with a reconciliation report for all controlled drugs signed verified by the DON. The pharmacist
Should determine himself that drug records are in order
The personnel director recommends a part time nurse’s aide who has worked at the facility for the past 6 months and is nearing the end of her competency evaluation program be hired as a full time aide. The administrator should feel that the personnel director is
Not understanding the requirements
At least every 12 months the facility requires all full and part time nurses aides to fill in a report on the continuing education done by each aide in the facility. This report is then filed in the employees personnel file. The facility is
Failing to train based on outcome of these review
When the facility does not employ a qualified professional to furnish a service to be provided by the facility, the facility
Must have that service furnished
The facility must train ___ in emergency procedures___
all employees/when they begin to work
When a facility learns a court of law has taken action against one of its employees indicating unfitness for service, the facility must
report the courts’ action to licensing authorities
Ms. Brown alleges for the 12th documented time that she was abused by an employee. The facility
I negligent in protecting patients
If the facility does not employ a full-time qualified dietitian the facility
Designates a director of food services who receives consultation from qualified dietician
The facility must employ a ____ either full time, part time , or on a consultant basis
Qualified dietitian
Orders fro routine care or to improve th residents functional abilities must be available
At admission
If mental health rehabilitative services for mental illness or mental retardation are required in the resident’s plan of care, the facility
Must provide in house or obtain such services
The care plan team determines that although they had not anticipated it, the resident needs physical therapy. The facility should
Get a physicians written order
A resident who has ben determined by the courts to be incompetent decides he no longer wants the court appointed representative to handle his personal funds and asks the facility to establish a personal funds account for him. The facility should
Establish a personal funds account for that resident
Perhaps the most basic purpose of the new management of personal resident funds rules is to
Avoid commingling resident fund with facility funds
Notifying ___ residents when their account reaches ___ less than the ___ resource limit for one person is required
Medicaid/$200/SSI
on discovering that the new intake social worker required the individual holding durables power of attorney for a patient’s funds to sign a contract guaranteeing payment from that patient’s funds, the administrator should
Praise the intake social worker
Rights of residents who are adjudged incompetent by a court are exercised by
A person appointed by the court
Under the Final Rules, the right to immediate access to any resident by representatives of the state, ombudsman, protection agencies, and advocacy agencies is
Unrestricted
A representative of the state ombudsman office demands to see the clinical record of a Medicaid resident who had written that he wanted no one to have access to his clinical record. On receiving the request, you, the administrator should
Deny permission to the ombudsman
The resident hangs a religious ornament above her bed. Several nurse’s aides are offended and feel it is inappropriate. The facility administrator should
Advise the aides that this is appropriate
A resident may refuse to release personal and clinical records when
Required by the duly appointed state ombudsman
A resident asks the afternoon nurse on duty to access his patient records. The nurse responds. that she will have the records made available by late tomorrow morning. The nurse’s response is
Appropriate
Congress intends that residents have the right to inspect, on 48 hours notice
All their records
A resident is concerned about her cognitive status and asks to see al the facility has in her records about her cognitive status including tests administered at admission 4 weeks earlier. The resident is
Within her rights
The new resident speaks only Japanese. Before the resident was admitted, the facility advised him through this interpreter that no one in the facility spike Japanese and that solely sigh language would be used. On examining this admission condition in the residents records, the surveyor would
Cite the facility
After the first of 10 scheduled physical therapy sessions following her surgery, the resident tells the physical therapist she is not going to keep the final nine appointments. The resident is
Within her rights
The resident decides to discontinue all the nine drugs being administered daily. The facility staff feel this may result in a coma likely followed by death. The facility
Must comply and maintain the resident at highest level within the decision
Informing a resident of his rights is required
Prior to or at admission
A resident may perform services for the facility if the services are
In the plan of care
When a physician decides to discontinue an existing form of treatment due to adverse consequences, the acility
Must notify the resident and the resident’s representative
The facility staff suspect family members are abusing a resident’s funds and requires that, for the resident’s protection, his funds must be deposited with the facility. This is
Not permitted
A resident routinely maintained $40 in her personal funds account and is upset to learn the facility has her funds in a non-interest bearing account. Placing this resident’s funds in a non interest bearing account is
Permitted
A facility that informs each resident who is entitled to Medicaid benefits, in writing, at admission, and when changes of services that are paid for under the state plan occur, has
Not fully met its notice of service obligations
On the death o fa Medicaid resident, the facility conveyed the residents funds within 14 days and promised to forward a final accounting in 3 weeks. This is
Within the required notification periods
As part of a larger chain, the local facility believes that self insurance plus use of Federal Deposit Insurance Corporation insured accounts is a reasonable protection of resident funds. The surveyor is likely
To issue a deficiency
The facility routinely charges all cosmetic and grooming items and services for private, Medicare, and Medicaid residents. This charging policy
Is not permitted for Medicare and Medicaid residents
The facility proudly installed flat screen TVs in all residents rooms and added a small surcharge to all residents monthly charges. This freed up significant floor space in each room and improved resident morale. This approach to improving resident life
Violates Medicaid and Medicaid rules
The resident reports the facility to the state for releasing his medical records to the local hospitals despite his refusal to release these records when he was transferred to the local hospital. The state is likely to
Inform the resident he has no right to refuse to release his records on transfer
The resident has complained numerous times about the disruptive behavior of a nearby resident. The facility assures the resident that nothing can be done. This is
An inadequate facility response
A resident demands to see both the most recent survey results and the plan of correction. The facility shows the survey results, but tells the resident that the plan of correction is confidential and not available. The facility is
Violating resident rights
The resident requested work delivering newspapers throughout the facility. The resident receives $5.00 an hour for this work. The facility is
Not meeting work requirements
The resident demands computer and Internet access, but the facility fails to provide this. The facility
Is within its rights
A representative of the secretary knocks on the locked front door at 5:30 am. and wants immediate admission The charge nurse tells the representative to wait until the facility opens at 6am. This is
A violation
The administrator refuses to permit a large piece of furniture to be placed in the resident’s room arguing that it overly obstructs movement. The administrator is
Within her rights
Consenting married residents have a right to share a room
Regardless of their health conditions
An individual resident can self administer drugs if
The interdisciplinary team has determined this is safe
The facility may transfer a resident
If the facility will close within 1 year
The facility seeking to transfer a resident must
Record the reasons in the resident’s clinical record
When a facility notifies a resident of a transfer on Feb 1 to be accomplished Mar 1, the facility has
Failed to meed Final Rules requirements
When the nurse gives complete verbal notice of the duration of the bed-hold policy under the state plan to a resident and his family before transfer to a hospital the facility can be said to have
Failed to meet Final Rules requirements
Regarding group or family meetings, after providing space and privacy to resident families and any invented persons, the facility obligations are
Partially met
The facility is by policy a 100% private pay residents facility . The facility informs prospective residents of this both in writing and orally in a language they can understand. This
Is not permitted
The facility requires only private paying patients to designate a third party who will pay the bills. Medicare and Medicaid patients are billed only from their own funds. this
Violates Medicare and Medicaid standards
The new administrator announces that after 2 weeks, no restraints will be allowed, even those required to meet the resident’s medical symptoms. tHis is
Permitted
To lessen the risk and incidence of residents abusive treatment of other residents the facility permits a resident to remain in his room throughout the day. This is
Abusive treatment
The administrator who learns that the director of nursing obtained physicians orders for physical restraints on three ‘too time consuming’ wanderer’ residents should
Ask the physicians to remove the restraint order
An alleged violation of neglect of a resident has been lodged. The administrator has reported this to the state, conducted an investigation the next day, and concluded no violation occurred. the administrator should
Report results to state officials within 5 days of the alleged violation
The facility sets up mechanisms to listen to the views and to record grievances and recommendations of residents and families concerning a proposed policy. The facility has
Failed to meet regulations
A uniform data set describing the resident’s capability to perform daily life functions and functional impairments is known as
The uniform (minimum) (comprehensive) data set
Resident assessments must be conducted within ___ days after admission, after significant mental or physical change, and at least every ___ months
14/12
The resident assessment must be conducted or at least coordinated by and signed by
A registered nurse
A resident enters a facility continent. Due to new clinical conditions catherization becomes necessary. tHe facility’s entire response is to provide services ‘to prevent urinary tract infections’ and treat them if occurring, the facility has
Failed to meet Final Rules standards
A resident’s clinical condition demonstrates that a nasogastric tube is unavoidable. The facility documents this and begins a permanent program designed to prevent aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal pharyngeal ulcers. A mMedicare inspector would consider the facility to have
Failed to implement the intent and spirit of Final Rules
To accommodate a resident returning in from the hospital, the facility informs Mrs. Brown that in half and hour the staff will be moving in a new roommate. The facility
Is failing to meet its obligations to residents
The facility appoints the DON, the medical directors PA, and four additional staff members to serve on the Quality Assessment and Assurance Committee. this
Fails to satisfy the federal guidelines
The Quality Assessment and Assurance Committee chair informs the administrator that the committee meets every 4 months and has developed and implemented appropriate plans of action. The administrator should
Be concerned
During a Medicare survey the DON refuses to disclose the records of the Quality Assessment and assurance Committee to enable the surveyor to review the actions taken. The director of nursing is
Within her rights
The facility identifies low potassium as a nutritional problem, and provides a therapeutic diet to correct the potassium deficiency. The resident refuses the therapeutic diet and insists that he wishes to east a regular diet just like the other residents. The facility should
Serve an enriched diet
In January, Mrs. Green weighed 112 pounds. In June, she weighed 98 pounds. This is
A severe weight loss
Mrs. Gray refused to eat the meat served for lunch. The facility offered Mrs. Brown a second salad. This is
Inappropriate
The registered dietitian prescribes a therapeutic diet for Mrs. Blue because the dietitian noticed some weight loss in the past 2 months. As lunch was about to be served anyway the kitchen staff was able to implement the new diet within 10 minutes of the nutritionists recommendation. The administrator should
Meet with the dietitian
During the periodic mid afternoon visit, the consultant dietitian writes out therapeutic diets for the four new residents and hands them as soon as she writes them to the director of food services for those residents that evening. On being informed of this, that afternoon the administrator should
Tell the director of food services to serve regular diets to those four new residents that night
Snacks at bedtime
Must be offered to all residents
The air conditioning roof unit fa shaft has run dry and required repeated quick oiling for several months. The facility is
Failing to do preventative maintence
A facility initially certified under Final Rules which at the request of the resident council maintains a winter temperature of 83degrees despite protest from staff that this is too hot for the staff is
Not in noncompliance with Final Rules
The resident has mentioned to the administrator several times that he is tired of waiting for a room with a window to the outside. The facility is
Failing to meet physical building requirements
Each resident room must have
At least one window to the outside
The call systems representative’s recommendations for installing a call system to the bathing facilities in addition to the resent resident rooms and toilets call systems were turned down by the administrator as too expensive. This
Is not meeting standards
The facility has an infection control program that has effectively investigated and controlled every infectious outbreak. When the state visits and evaluates this program, the state will likely
Issue a deficiency
Such details as size of committee, scope of work, and reporting requirements for the infection control function are
Left to the facility
Maintaining a record of incidents and corrective actions related to infections is assigned under Final Rules to
the infection control program
The general approach of the Federal Requirements is to state federal requirements, for example, infection control and budgets
In general (less specific or detailed) terms
The nurse was miffed that she could not get a medical decision until the attending physician returns form a medical convention and mentions this to the administrator. The administrator should
Meet immediately with the director of nursing
A physician visit that occurred 14 days after the date the visit was required is
Not considered timely
If a facility’s policy prohibits use of physician assistants, but three physicians routinely use physician assistants for most visits, the Medicare inspectorwill
Cite the facility
Ultimate responsibility for obtaining and reporting laboratory, radiology, and other diagnostic services is assigned to the
Nursing facility
The charge nurse notices that la work recommended for a particular medication has not been ordered and places the order. The administrator should
Be uset
A facility need not first consult with the resident or the resident’s physician when there is
A medical emergency
The medical director declined to take responsibility for monitoring and ensuring implementation for a resident care policies feeling this was too time-consuming. The administrator would be well advised to
Find a new medical director
On learning that, to save expenses, the DON has determined that drug records are in order and that all controlled drugs are accounted for, the administrator should
Call the consulting pharmacist
Permitting a resident, whose physician permits drugs judge d unnecessary but demanded by the resident, to continue to take unnecessary drugs
Is not permitted
New facilities certified under Final Rules must meet the applicable provisions of the
Life. Safety Code of 2000
Plan D, implemented in 2006 was intended to
Provide relief from medication expenses
An individual who can prove that he or she recently successfully completed a training and competency evaluation program, but who is not actually registered in the required registry___ as a nurses aide
Can be hired
Responsibility for determining whether the nurses aide training and competency evaluation requirements are met in a facility falls to the
State survey agency
The owners of a facility providing nearly the best nurses aide training and competency evaluation program in the state declines to permit an unannounced visit by the state. The state will
Withdraw approval of the training program
The required curriculum for a nurse’s aide training program does not have to include
Diet management
Candidates for nurse’s aide competency evaluations are normally examined by
A state approved entity
Under federal guidelines, a candidate for nurses aide registration has ___ chances to take the evaluation
At least 3
A finding by the state survey agency of abuse or neglect by a nurse’s aide remains recorded in the nurses aide registry
Forever
Ensuring that nurse’s aides are able to demonstrate competency in skills and techniques necessary to care for residents needs is the responsibility of
The facility
Under Final Rules, a routine and emergency dental services are
Mandated
The director of nursing mentions to the administrator that although Ms. Brown had no significant change in her physical or mental condition on readmission, a full comprehensive assessment was completed within 5 days of her return. tThe administrator might feel
Facility resources might not be being utilized efficiently
To stretch resources the care planning team decides to conduct comprehensive assessments on the healthiest patients every 15 months. The administrator should feel
A deficiency is in the future
Standards of quality for care given in the nursing facility
May be found in several venues
The nurse on duty has informed Ms. Brown that Ms Brown must make arrangements for transportation to her audiologist.this is
Not permitted facility policy
Psychosocial adjustment difficulties
Must be treated by the facility
For several months in succession, it is noted in the resident’s records that the resident is becoming more withdrawn. The facility
Must develop a plan of care to address this
For nasogastrically fed patients, the facility program is to provide treatment and services to prevent aspiration, pneumonia, diarrhea, vomiting, , dehydration, and metabolic abnormalities. This is
Insufficient
Ms. Green has been shouting incoherently at nearby residents. Her physician prescribes an antipsychotic drug to calm her down. This
Is uncacceptable
The facility must provide a separate, locked, permanently affixed compartment for storage of controlled drugs listed in Schedule ___ of he Drug Act
II
The administrators policy is to discard all clinical records after 10 years. this policy is
Flawed
The resident Assessment Instrument is a set of screening, clinical, and functional status elements, which forms the basis for
A comprehensive assessment of each resident
Specific resident responses for one or a combination of Minimum Data Set elements are
The Care Area Triggers
The Minimum Data Set care planning process can be visualized as; assessment, decision making, and
Care plan
In planning an annual survey, the surveyor begins with reviewing current government data records on the facility, current complaints, Ombudsman information, and
Current Minimum Data Set (MDS) data
The surveyors expect information on contact persons for complaints or abuse, a list of ventilator dependent residents, a list of residents on hospice, and a list of dialysis patients within ___ of entering, a facility for survey
Four hours
The administrator can expect surveyors to generate ___ lists of residents to be interviewed
Three or more
As a mater of policy at the Exit Conference, ___ is/are invited to attend
The resident council president
If a facility’s plan of correction is found unacceptable
A new plan of correction must be submitted
Normally a plan of correction
Triggers a revisit
Hoping to delay an enforcement action, the administrator asks for an Informal Dispute Resolution. the administrator
Does not understand the process
A finding by surveyors that in both wings of the facility, the water to resident rooms and baths is 8 degrees above the upper temperature limit, but that no one had et been burned would result in a deficiency characterized as
Widespread, no actual harm with potential gor more than minimal harm
The Centers for Medicare and Medicaid’s goal is to reimburse based on how much ___ is required to care for each patient each month
Staff time
There are ___ levels and types of care for reimbursing nursing facility care given
66
The Minimum Data Set contains items that reflect the ___ of the resident
Acuity level
The Medicare required assessments provide information about the clinical condition of beneficiaries. These assessments
Can be scheduled or unscheduled
Readmission/return assessment, start of therapy, and end of therapy are
Standardized assessment dates
The Resource Utilization Group (RUG)IV classification system has ____ major categories
Eight
The scheduled Prospective Payment System PPS assessments (performed around days 5,14,30,60, and 90) establish ___ for associated standard payment periods
Per-diem payment rates
The activities of daily living (ADL) score is based on the following ADLs
Bed mobility, transfer, toilet use, and eating
A cancer patient receiving intensive therapies may
Cost the facility more than it will be reimbursed
The current long term health care delivery system is one in which each player seeks to minimize its own costs at the possible expense of
Other players int eh system
How much a facility can charge for care given can be characterizes as
A moving target
Establishing transfer and discharge policies according to the source of payment ___ under Final Rules
Is forbidden
The goal of the National Health Care Technology coordinator is to have ___ available to all providers, which can lead to improved quality of care at all levels
Interoperable care records
Typically the responsibility for safety and disaster preparedness falls to the
Administrator
Although the drugs in the emergency kit are the pharmacists responsibility the ___ using the kit must keep records when each item is used and trigger a reorder as needed to keep the kit fully stocked
Staff
To the extent possible ensuring that the facility reflects the culture, ethnicity, race, sexual orientation, gender, religions, and language fo the surrounding community is part of
Diversity awareness
___ is defined as separation of a resident from other residents or from his or her roommate or confinement to his or her room (with or without roommates) against the resident’s will, or the will of the residents legal representative
Involuntary seclusion
Ombudspersons ___ direct enforcement authority, but are typically part of the local government structure where their recommendations can carry weight
Don not have any
In the typical nursing facility, various maintenance and repair services are typically ___ such as grounds maintenance or HVAC services and repair
Contracted out
___ is a portable electronic device that automatically diagnoses the life threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient ,and is able to treat them through defibrillation
Automated external defibrillator AED
Complaints or accusations of abuse or neglect made by residents or staff must be
Investigated using a protocol
Normally a resident care planning conference is held for each resident at least
Montlhy
Scope and Severity is a system of rating the seriousness of
Deficiencies
