presentation - joyce clark and osdh answer assisted living compliance questions
TRANSCRIPT
UNITED VOICES
PROVIDER & OSDH ADDRESS COMPLIANCE QUESTIONS
JOYCE CLARK CEO of Achievis Senior Living Associates
Developed 7 Assisted Living & Memory Care Communities in Oklahoma
Management, Marketing, & Development
Ranging from Mock Surveys & Interim Management to Turn-Key New Build
MARY FLEMING Director of Survey at Oklahoma State
Department of Health
25 Years of Experience
Bachelors in Nursing Science. Masters in Human Resources Management.
Project Officer for Development of AL Rules & Survey Protocol.
LET’S START WITH MOST FREQUENT CITATIONS…
MISSING ITEMS IN RESIDENT CONTRACT
Licensure acceptance does not necessarily mean all required items are in contract.
Modifications change original contract compliance & need OSDH approval.
SUGGEST THESE ITEMS BE BOLD OR
UNDERLINED
310:663-13-2
Center Name & Address
Admission Criteria
Services Provided
Discharge Criteria
Dispute Resolution & Grievance Procedures
Charges for Services
Agreement Includes Marketing Materials & Regulations
Term, Renewal, & Cancellation
Conformity with State Law
Provision for 5 Day Transfer
MISSING “I” OR “P”
PIG method not followed.
Person preparing dose does not GIVE it. Leaves in apt. or on table for resident to take later.
Forgot to initial.
OUT OF STOCK MEDICATIONS
Especially crucial if for prevention of seizures or for severe infection.
Failure to follow physician orders.
Suggest fee to provide emergency back-up meds plus cost. Fee terms must be in contract.
ASSESSMENTSNot Signed / Coordinated by RN in Timely Manner.
Documentation of Personal Interview Between Resident or Resident’s Representative & Person Completing Form.
Appropriate Assessment Was Not Performed.
Braden Scale
Mini-Mental
Fall Risk
AIMS
Admission Criteria Verification
Evacuation Capability
Comprehensive Evaluation of Needs and Preferences (2 years)
Pain
Elopement Risk
Skin Evaluation
Medication Review
Self-Medication Assessment
Quarterly RN Wellness Reviews – Not Required But Helpful Process
COMPLETE APPROPRIATE ASSESSMENT TO DETERMINE
IF RESIDENT HAS NURSING NEEDS. EXAMPLES:
USE ASSESSMENT(S) TO DEVELOP SERVICE PLAN
Address resident need staff is to accommodate.
Once potential problem / need is known, comprehensive care plan should have preventive measures outlined.
Clinical Nursing Skills is good guideline.
What do you do if resident has pressure ulcer? If sits or lays a lot?
“SPECIFIC INTERVENTIONS ON RESIDENT’S CARE PLAN TO PROMOTE HEALING & PREVENT
DEVELOPMENT OF POTENTIAL PRESSURE SORES”
Skin assessments for prevention of re-occurring redness and/or sores to the buttocks and skin.
Use and maintenance of pressure relieving devices.
Institution and DOCUMENTATION of a position change schedule q 2 hours to avoid prolonged pressure in one area.
Implementation of measures for the protection of the resident’s skin from excess moisture to prevent maceration.
Evaluation and possible institution of 2000 – 3000 calories / day of fluid to provide calories, protein, and fluids necessary for fluid repair.
Instructions related to interventions for direct care staff for the promotion and prevention of actual and potential pressure sores / skin breakdown.
OTHER CARE PLAN TIPS Pain Interventions Such as ROM, Exercise,
Heat, Cold, Topical Ointments, Repositioning.
Address Most Prevalent Needs.
Update Plan As Needs Change.
Create 1-Page Template Need Plans. Easy to Use for Inservices. Individualize for Resident Updates / Temporary Services.
RISK MANAGEMENT DEFICIENCIES
“Right to Fall.” Residents have “right to safety” and fall prevention measures must be taken.
“Right to Drive.”
INCIDENT TIMELINEIf on Friday or weekend, the report
(ODH 283) does not get sent within 1 business day of discovery.
ODH Form 718 - Notification of Nurse Aide Abuse, Neglect, Mistreatment or Misappropriation of Property (1 business day of identifying alleged perpetrator).
NURSE AIDE REGISTRY SKILLS PERFORMANCE CHECKLIST
INDICATES AIDES CAN NOT DO:Change colostomy bags?? Factors like RN staffing for scheduled assessments may make this a delegable task. To be discussed more.
Perform neuro checks
Injury assessment or wound care
Picc line
Setting O2 flow
ON THE OTHER HAND… SKILLS ON CHECKLIST
Perform Active and Passive Range of Motion Exercises
Provide Indwelling Catheter Care
LET’S ANSWER ADMINISTRATOR QUESTIONS…
RECENT DEFICIENCIES CITE “PLAN OF CARE DID NOT CONTAIN NURSING
INTERVENTIONS WITH MEASURABLEGOALS AND OUTCOMES”. WHAT
REGULATION OR LAW SAYS ASSISTED LIVING SERVICE PLANS MUST HAVE
“MEASURABLE GOALS AND OUTCOMES”?
This language was intended to clarify care plan contents.
IF DOCTOR WRITES A MED ORDER THAT WE KNOW
RESIDENT WON’T TAKE, DO WE HAVE TO FILL IT?
YES. Must give (offer) medications as ordered.
Have doctor clarify the order.
HOW DO I REPORT A HOME HEALTH COMPANY THAT IS NOT ABIDING
REGULATIONS?Policy. Third party contract.Admission criteria & assessment determines scope of services.Contact attending doctor & ask for change. Remind of fraud liability.OSDH Home Health Complaint Hotline.Send 3 complaints to OSDH LTC.Copy director of HH & resident’s physician.Involve Attorney General & Oklahoma Health Care Authority.
HOW CAN WE OFFER RESIDENT CHOICE WHILE ALSO EFFECTIVELY
COORDINATING THIRD PARTY CARE?
CAN WE LIMIT HOME HEALTH / HOSPICE CHOICE TO SHORT LIST OF
PROVIDERS WHO MEET FACILITY STANDARDS?
Admission policy refers to recommended list of providers.
Disclose prior to admission
IS A CNA QUALIFIED TO PUT TED HOSE ON A RESIDENT?YESOklahoma Nurse Aide Registry Skills Performance Checklist.Applying Compression Support Stockings is Part of Training / Orientation.
DO DIETARY SUPPLEMENTS NEED TO BE DOCUMENTED?
YES if supplement is administered as if was a medication / on a schedule.
YES if part of care plan from dietician or licensed professional.
Document on TAR.
WHEN ARE ADL’S REQUIRED TO BE CHARTED?ADL charting is not required. Per facility
policy.
Chart when care is performed or delegated by licensed professional.
Meal / fluid intake if ordered.
Range of motion, hand splints.
Bowel movements if monitoring constipation.
DOES ACTIVITY DIRECTOR NEED FOOD HANDLER’S
TRAINING IF WORKING WITH EDIBLES FOR RESIDENTS?
YES. Part of Orientation.
Food Handler Training Documents and Videos Online.
CODE 257
IS THE FOOD SERVICE MANAGER REQUIRED TO
HAVE DIETARY MANAGER CERTIFICATION?
NO
WHEN CHANGING LICENSURE FROM RES CARE TO ASSISTED LIVING, DOES THE PHYSICIAN
NEED TO REDO REFERRAL, H&P, & MEDICATION ORDERS?
Not required but common practice is to get “Admit to Assisted Living” on monthly order.
Physician order form needs to include all required items. Some items may not have been on Residential Care orders.
Existing history and physical is fine.
WHAT CHEMICALS / CLEANING ITEMS ARE OK TO HAVE IN
RESIDENT APARTMENT? DO THEY NEED TO BE LABELED?
Assess resident to determine they can handle the item safely.
No other residents can access chemical.
Cannot be “harmful or fatal if swallowed” if dementia resident can access. (Nail polish remover, dish detergent, deodorant, shampoo, perfume)
DO YOU HAVE ANY TIPS TO IMPROVE OUR QA PROCESS? Invite pharmacist if medication administration is
reoccurring problem. (Involve right people)
“Remind resident to use call light” as a fall prevention measure is inappropriate if resident is confused / forgetful.
Quarterly customer satisfaction measures.
Include survey plan of correction.
ARE LIFTS ALLOWED TO ASSIST IN TRANSFERRING A
RESIDENT?
YES. Lifts are a medical device and are not prohibited.
One-person assist.
Staff training required.
HOW ABOUT A TRAPESE OR HALF BEDRAIL USED FOR
PULL-UP OR SELF-POSITIONING?
Permissible medical device
No restraining bedrails allowed
WHAT OXYGEN ADMINISTRATION TASKS ARE
NURSE AIDES ALLOWED TO DO?
Nurse must set flow as ordered.
Tanks must be secured in holder.
No rules provide clear guidance on who can change tanks.
CAN A FACILITY PROVIDE TRAINING FOR ACTIVITY DIRECTOR OR MUST
THEY GO TO SPECILIIZED CLASS FOR CERTIFICATION?
310:663-9-5 (C0952) Each assisted living center shall ensure that staff members providing socialization, activity, and exercise services are qualified by training.
Training must be documented.
Can be formal class or part of orientation.
HOW DO OTC’S IN RESIDENT’S APARTMENT
NEED TO BE LABELED?
Keep box with directions.
First and last name.
Physician name and date opened not required.
WHERE CAN I GET COPY OF LIFE SAFETY CODES?
Local, State, Fed Vary. Most Restrictive Applies.
OAC 265:25-1-3 Supplement to LTC Emergency Action Plan (Incorporated National Codes & Standards). Examples:
International Building Code, 2003 Edition
International Fire Prevention Code, 2003 Edition
NFPA #101 Life Safety Code, 2003 Edition
MISC TIPS:
Kitchen trash cans need lids.
Don’t forget Initial Skills Review and Annual Performance Reviews.
RN supervision of inservices.
OSDH offers free Tai-Chi certification for staff.
CONTACT INFOJOYCE CLARKCEO OF ACHIEVIS SENIOR LIVING ASSOCIATESPhone: 405.812.9089Email: [email protected]
MARY FLEMING, BSN, MHRDIRECTOR OF SURVEY OKLAHOMA STATE DEPT. OF HEALTHPhone: 405.271.6868Email: [email protected]