OBRA Flashcards
- Upon the death of a resident with personal funds deposited with the facility, the facility must convey within _____ days the resident’s funds, and a final accounting of those funds, to the individual or probate jurisdiction administering the resident’s estate.
30
F160
483.10(c)(6) Conveyance upon death
Upon the death of a resident with a personal fund deposited with the facility, the facility must convey within 30 days the resident’s funds, and a final accounting of those funds, to the individual or probate jurisdiction administering the resident’s estate.
- Therapeutic diets must be prescribed by the attending physician. True or False?
True
F366
§483.35(d)(4)
Therapeutic diets must be prescribed by the attending physician.
- The drug regimen of each resident must be reviewed at least _____ by a licensed pharmacist.
Monthly
F428
(Rev. 22, Issued: 12-15-06, Effective/Implementation: 12-18-06)
§483.60(c) Drug Regimen Review
(1) The drug regimen of each resident must be reviewed at least once a month by a licensed pharmacist.
(2) The pharmacist must report any irregularities to the attending physician, and the director of nursing, and these reports must be acted upon.
- A resident who can eat enough alone or with assistance is not fed by naso-gastric tube unless the resident’s clinical condition demonstrates that use of a naso-gastric tube was ______.
Unavoidable
F321
§483.25(g)(1) A resident who has been able to eat enough alone or with assistance is not fed by naso-gastric tube unless the resident’s clinical condition demonstrates that use of a naso-gastric tube was unavoidable; and
F322
§483.25(g)(2) A resident who is fed by a naso-gastric or gastrostomy tube receives the appropriate treatment and services to prevent aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers and to restore, if possible, normal eating skills.
- How much must a facility pay a resident who works for them?
Prevailing Rates
F169
§483.10(h) Work
(iii) Compensation for paid services is at or above prevailing rates;
- Is a ‘significant change reassessment’ generally indicated if improvement is consistently noted in 2 or more areas of improvement?
yes
F274
§483.20(b)(2)(ii) Guidelines
The following are the criteria for significant changes:
A significant change reassessment is generally indicated if decline or improvement is consistently noted in 2 or more areas of decline or 2 or more areas of improvement:
- SNF-Bedrooms must measure at least _______ square feet per resident in multiple resident bedrooms, and at least 100 square feet in single resident rooms.
80
F458
§483.70(d)(1)(ii) Measure at least 80 square feet per resident in multiple resident bedrooms, and at least 100 square feet in single resident rooms;
- May the facility charge to resident’s funds for personal comfort items, including smoking materials, notions and novelties and confections?
Yes
F162
483.10(c)(8) Limitation on Charges to Personal Funds
(ii) Items and services that may be charged to residents’ funds. Listed below are general categories and examples of items and services that the facility maycharge to residents’ funds if they are requested by a resident, if the facilityinforms the resident that there will be a charge, and if payment is not made by Medicare or Medicaid:
(A) Telephone;
(B) Television/radio for personal use;
(C) Personal comfort items, including smoking materials, notions and novelties, and confections;
See F-tag for rest of list.
- Does the comprehensive assessment for evaluating skin conditions include the RAI?
True
F314
§483.25(c) Pressure Sores.
The comprehensive assessment, which includes the Resident Assessment Instrument (RAI), evaluates the resident’s intrinsic risks, the resident’s skin condition, other factors (including causal factors) which place the resident at risk for developing pressure ulcers and/or experiencing delayed healing, and the nature of the pressure to which the resident may be subjected. The assessment should identify which risk factors can be removed or modified.
- Emergency power must supply:
Hint: 4 things
- Lighting all entrances and exits;
- equipment to maintain the fire detection,
- alarm and extinguishing systems; and
- life support systems.
F455
§483.70(b) Emergency Power
(1) An emergency electrical power system must supply power adequate at least for lighting all entrances and exits; equipment to maintain the fire detection, alarm, and extinguishing systems; and life support systems in the event the normal electrical supply is interrupted.
- May the administrator attend a resident group meeting without an invitation?
No
F243
§483.15(c) Participation in Resident and Family Groups
(4) Staff or visitors may attend meetings at the group’s invitation
- Does the resident have the right to participate in any religious activity?
No, only in activities that do not interfere with the rights of other residents
F245
§483.15(d) Participation in Other Activities
A resident has the right to participate in social, religious, and community activities that do not interfere with the rights of other residents in the facility.
- Is the facility responsible for addressing all needs and strengths of residents regardless of whether the issue is included in the MDS or RAPs?
Yes
F272
§483.20 Resident Assessment
The facility must conduct initially and periodically a comprehensive, accurate, standardized reproducible assessment of each resident’s functional capacity
§483.20(b) Guidelines
The information required in §483.20(b)(i-xvi) is incorporated into the MDS, which forms the core of each State’s approved RAI. Additional assessment information is also gathered using triggered RAPs.
Each facility must use its State-specified RAI (which includes both the MDS and utilization guidelines which include the RAPs) to assess newly admitted residents, conduct an annual reassessment and assess those residents who experience a significant change in status. The facility is responsible for addressing all needs and strengths of residents regardless of whether the issue is included in the MDS or RAPs. The scope of the RAI does not limit the facility’s responsibility to assess and address all care needed by the resident.
- A resident who has been able to eat enough alone or with assistance is not fed by naso-gastric tube unless the resident’s clinical condition demonstrates that use of a naso-gastric tube was _______.
unavoidable
F321
§483.25(g)(1) A resident who has been able to eat enough alone or with assistance is not fed by naso-gastric tube unless the resident’s clinical condition demonstrates that use of a naso-gastric tube was unavoidable; and
F322
§483.25(g)(2) A resident who is fed by a nasogastric or gastrostomy tube receives the appropriate treatment and services to prevent aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers and to restore, if possible, normal eating skills.
- An individual resident may self-administer drugs ______.
if the interdisciplinary team has determined that this practice is safe
F176
§483.10(n) Self-Administration of Drugs
An individual resident may self-administer drugs if the interdisciplinary team, as defined by §483.20(d)(2)(ii), has determined that this practice is safe.
- Residents who use antipsychotic drugs receive ______ dose reductions.
Gradual
F329
(Rev. 22, Issued: 12-15-06, Effective/Implementation: 12-18-06)
§483.25(l) Unnecessary Drugs
- Antipsychotic Drugs. Based on a comprehensive assessment of a resident, the facility must ensure that:
(i) Residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a specific condition as diagnosed and documented in the clinical record; and
(ii) Residents who use antipsychotic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs.
- ________ number of staff are required to assure the resident was provided activities based upon the comprehensive assessment and care plan.
Sufficient
INVESTIGATIVE PROTOCOL
ACTIVITIES
43 CFR 483.30(a), F353, Sufficient Staff
Determine if the facility had qualified staff in sufficient numbers to assure the resident was provided activities based upon the comprehensive assessment and care plan.
- The facility must provide special eating equipment and utensils for residents who need them. True or False?
True
F369
§483.35(g) Assistive Devices
The facility must provide special eating equipment and utensils for residents who need them
- Sound levels must be maintained at __________?
comfortable sound levels
F258
§483.15(h)(7) For the maintenance of comfortable sound levels
Interpretive Guidelines §483.15(h)(7)
“Comfortable” sound levels do not interfere with resident’s hearing and enhance privacy when privacy is desired, and encourage interaction when social participation is desired.
Of particular concern to comfortable sound levels is the resident’s control over unwanted noise.
- Who should pay for postage, the resident or facility?
The resident
F171
§483.10(i)(2) Have access to stationery, postage, and writing implements at the resident’s own expense.
- Does the resident have a right to work?
Yes
F169
483.10(h) Work
The resident has the right to–
(1) Refuse to perform services for the facility;
(2) Perform services for the facility, if he or she chooses, when–
(i) The facility has documented the need or desire for work in the plan of care;
(ii) The plan specifies the nature of the services performed and whether the services are voluntary or paid;
(iii) Compensation for paid services is at or above prevailing rates; and
(iv) The resident agrees to the work arrangement described in the plan of care
- The facility must provide each resident with a nourishing, _______, well-balanced diet.
Palatable
F360
§483.35 Dietary Services
The facility must provide each resident with a nourishing, palatable, well-balanced diet that meets the daily nutritional and special dietary needs of each resident.
- The facility must promote care for residents in a manner and in an environment that ______ or ________ each resident’s dignity and respect in full recognition of his or her individuality.
maintains or enhances
F241
§483.15(a) Dignity
The facility must promote care for residents in a manner and in an environment that maintains or enhances each resident’s dignity and respect in full recognition of his or her individuality.
- If a specialized rehabilitative service such as speech-language pathology is required in the resident’s comprehensive plan of care, the facility must ____________ or obtain the required services from an outside source.
provide the services
F406
§483.45(a) Provision of Services
If specialized rehabilitative services such as, but not limited to physical therapy, speech-language pathology, occupational therapy, and mental health rehabilitative services for mental illness and mental retardation, are required in the resident’s comprehensive plan of care, the facility must–
(1) Provide the required services; or
(2) Obtain the required services from an outside resource (in accordance with §483.75(h) of this part) from a provider of specialized rehabilitative services.
- What kind of housekeeping and maintenance services must a facility provide?
Hint- 3 items
Those necessary to maintain a
- sanitary,
- orderly, and
- comfortable interior
SOC
F253
§483.15(h)(2)
Housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior
- What are the 5 Activities of Daily Living (ADL)?
(1) bathing, dress, and groom, (2) transfer and ambulate, (3) toilet, (4)eat, and (5) use speech, language or other functional communication systems
F310
§483.25(a)(1) A resident’s abilities in activities of daily living do not diminish unless circumstances of the individual’s clinical condition demonstrate that diminution was unavoidable. This includes the resident’s ability to –
(i) Bathe, dress, and groom;
(ii) Transfer and ambulate;
(iii) Toilet;
(iv) Eat; and
(v) Use speech, language, or other functional communication systems.
- Within ____ days after a facility completes a resident’s assessment, the facility must encode the Quarterly review assessments.
7
F287
§483.20(f) Automated Data Processing Requirement
§483.20(f)(1) Encoding Data. Within 7 days after a facility completes a resident’s assessment, a facility must encode the following information for each resident in thefacility:
(i) Admission assessment.
(ii) Annual assessment updates.
(iii) Significant change in status assessments.
(iv) Quarterly review assessments.
(v) A subset of items upon a resident’s transfer, reentry, discharge, and death.
(vi) Background (face-sheet) information, if there is no admission assessment.
- Who is responsible for developing the comprehensive care plan?
interdisciplinary team
F280
§483.20(k)(2)
§483.20(k)(2) A comprehensive care plan must be-
(i) Developed within 7 days after the completion of the comprehensive assessment;
(ii) Prepared by an interdisciplinary team, that includes the attending physician, a registered nurse with responsibility for the resident, and other appropriate staff in disciplines as determined by the resident’s needs, and, to the extent practicable, the participation of the resident, the resident’s family or the resident’s legal representative; and
(iii) Periodically reviewed and revised by a team of qualified persons after each assessment.
- The resident or his or her legal representative has the right upon an oral or written request, to access all records pertaining to himself or herself including clinical records within _____ hours.
24 (excluding weekends and holidays)
F153
§483.10(b)(2) –
The resident or his or her legal representative has the
right–
(i) Upon an oral or written request, to access all records pertaining to himself or herself including current clinical records within 24 hours (excluding weekends and holidays); and
(ii) After receipt of his or her records for inspection, to purchase at a cost not to exceed the community standard photocopies of the records or any portions of them upon request and 2 working days advance notice to the facility.
- May the Ombudsman review a record without consent?
No
F173
§483.10(j)(3) – The facility must allow representatives of the State Ombudsman, described in paragraph (j)(1)(iv) of this section, to examine a resident’s clinical records with the permission of the resident or the resident’s legal representative, and consistent with State law.
- Must the facility provide written information regarding the bed-hold policy prior to a transfer?
Yes
F205
§483.12(b) Notice of Bed-Hold Policy and Readmission
§483.12(b)(1) Notice before transfer. Before a nursing facility transfers a resident to a hospital or allows a resident to go on therapeutic leave, the nursing facility must provide written information to the resident and a family member or legal
representative that specifies–
(i) The duration of the bed-hold policy under the State plan, if any, during which the resident is permitted to return and resume residence in the nursing facility; and
(ii) The nursing facility’s policies regarding bed-hold periods, which must be consistent with paragraph (b)(3) of this section, permitting a resident to return.
- The facility must designate a registered nurse to serve as the director of nursing on a ______.
Full-time basis
F354
§483.30(b) Registered Nurse
§483.30(b)(2) Except when waived under paragraph (c) or (d) of this section, the facility must designate a registered nurse to serve as the director of nursing on a full-time basis.
- A resident should not experience a reduction in range of motion unless the resident’s clinical condition demonstrates that it was ________.
unavoidable
F317
§483.25(e)(1) A resident who enters the facility without a limited range of motion does not experience reduction in range of motion unless the resident’s clinical condition demonstrates that a reduction in range of motion is unavoidable; and
F318
§483.25(e)(2) A resident with a limited range of motion receives appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion
- Can a person be considered a qualified social worker with a degree in chemistry?
No
F251
§483.15(g)(3)
(3) Qualifications of a social worker. A qualified social worker is an individual with-
(i) A bachelor’s degree in social work or a bachelor’s degree in a human services field including but not limited to sociology, special education, rehabilitation counseling, and psychology; and
(ii) One year of supervised social work experience in a health care setting working directly with individuals
- Is a revision of the care plan required after a significant change of condition?
Yes
F274
§483.20(b)(2)(ii)
(ii) Within 14 days after the facility determines, or should have determined, that there has been a significant change in the resident’s physical or mental condition. (For purpose of this section, a “significant change” means a major
decline or improvement in the resident’s status that will not normally resolve itself without further intervention by staff or by implementing standard diseaserelated clinical interventions, that has an impact on more than one area of the resident’s health status, and requires interdisciplinary review or revision of the care plan, or both.)
- Are injections part of Special Needs?
Yes
F328
§483.25(k) Special Needs
The facility must ensure that residents receive proper treatment and care for the following special services
§483.25(k)(1) Injections
- The facility must have evidence that all alleged violations are _____ investigated, and must prevent further potential abuse while the investigation is in progress.
Thoroughly
F225
§483.13(c)(3)
The facility must have evidence that all alleged violations are thoroughly investigated, and must prevent further potential abuse while the
investigation is in progress.
- Can the facility require the resident to deposit their personal funds with the facility?
No
F158
§483.10(c)(1) Protection of Resident Funds
The resident has the right to manage his or her financial affairs, and the facility may not require residents to deposit their personal funds with the facility.
- The resident has the right to be free from any _____ or _____ restraints imposed for purposes of discipline or convenience, and not required to treat the resident’s medical symptoms.
Physical or Chemical
F222
§483.13(a) Restraints
The resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident’s medical symptoms.
- The resident has a right to a _______ _______, _______-_________, and communication with and access to persons and services inside and outside the facility.
Dignified existence, self-determination
F150
§483.10 Resident Rights
The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility.
- The qualified social worker is an individual with a _____ degree.
Bachelor’s
F251
§483.15(g)(3)
(3) Qualifications of a social worker. A qualified social worker is an individual with-
(i) A bachelor’s degree in social work or a bachelor’s degree in a human services field including but not limited to sociology, special education, rehabilitation counseling, and psychology; and
(ii) One year of supervised social work experience in a health care setting working directly with individuals
- A facility must maintain all resident assessments completed within the previous ______ months in the resident’s active record.
15
F286
§483.20(d) Use
A facility must maintain all resident assessments completed within the previous 15 months in the resident’s active record.
- Can the facility charge a resident for copies of his/her record if the written or oral request was made by the resident?
Yes
F153
§483.10(b)(2) – The resident or his or her legal representative has the right–
(i) Upon an oral or written request, to access all records pertaining to himself or herself including current clinical records within 24 hours (excluding weekends and holidays); and
(ii) After receipt of his or her records for inspection, to purchase at a cost not to exceed the community standard photocopies of the records or any portions of them upon request and 2 working days advance notice to the facility.
- A post-discharge plan of care that is developed with the participation of the resident and his or her family, which will assist the resident to adjust to his or her new living environment. True or False?
True
F284
§483.20(l)(3) A post-discharge plan of care that is developed with the participation of the resident and his or her family, which will assist the resident to adjust to his or her new living environment.
- How soon must a facility resolve grievances?
Promptly
F166
A resident has the right to–
§483.10(f)(2) – Prompt efforts by the facility to resolve grievances the resident may have, including those with respect to the behavior of other residents.
- A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent ______ _______ from ________.
new sores from developing
F314
§483.25(c) Pressure Sores
Based on the comprehensive Assessment of a resident, the facility must ensure that–
(1) A resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable; and
(2) A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing.