Objectives Provide information resources Describe the 2567 and - PDF document

06/17/2018 THE LTC SURVEY PROCESS Speaker: Office of Long Term Care Facilities Licensure Unit – Public Health Division 402-471-3324 Objectives • Provide information resources • Describe the 2567 and identify the elements and information contained • Identify the steps in the LTC survey process • Describe how the information obtained is used in making compliance determinations • Identify the components of an acceptable POC and the steps in the process for submitting submission • Discuss the dispute process THE LTC SURVEY PROCESS AND RESOURCES • Medicare.Gov • Contacts: – Appendix PP – Dan Taylor – Memos (S&C Letters) • Daniel.taylor@Nebraska.gov • qtso.com • 402-471-3324 – LTCSP directions – LTCSP forms • CMS.gov/Nursing Homes – LTCSP forms • DHHS.ne.gov – Regulations – Reporting forms 1

06/17/2018 Tag Number Scope and Severity Licensure Reference Number Deficient Practice Statement Evidence Licensure Inspection - At Least Once Every 5 Years - 25% Sample Yearly Survey Types - Standard/Annual Alternate Special Focused - Partial/Complaint - Extended 2

06/17/2018 Off-Site Preparation • CASPER 3 65 55 55 65 10 45 55 10 3

06/17/2018 Off-Site Preparation • CASPER 3 • Complaints • Waivers • Ombudsman Information • MDS information • Team Leader assigns units 4

06/17/2018 Entrance Tasks • Introductions • Request the following Information: - Alphabetical listing of residents residing in the facility. - Matrix for New Admissions -Census Number -Residents who smoke Entrance Tasks � ������������������ � ��������������������� � ���������������������� �������������� � ���������������������� ������ Entrance Conference Worksheet 5

06/17/2018 Entrance Conference Worksheet Entrance Conference Worksheet Entrance Conference Worksheet 6

06/17/2018 Entrance Conference Worksheet Entrance Conference Worksheet Entrance Conference Worksheet 7

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06/17/2018 Sample size Grid Initial Pool • Reviewed through • Areas Reviewed: • Resident Interview – ADLs • Resident Observation – Nutrition • Chart Review – Drug Use • 3 Resident – Elimination/Incontinence Representative Interviews per team – Resident Room – Oral Health – Quality of Care – Quality of Life – Skin Care Resident Observation • Activities • Call lights • Dignity • Resident room • Abuse • Dental • Privacy • Nutrition • Accommodations of • Edema Needs • Hydration • Language/Communication • Tube Feeding • Mood/Behavior • Vision/Hearing • Restraints • ADLs • Accident Hazards • Catheter • Unsafe Wandering or • Psych Meds Elopement 10

06/17/2018 Resident Observation • Infections • ROM-Limited • Oxygen • Hospice • Positioning • Vent/Trach • Falls • Bowel/Bladder Incontinence • Pain • Smoking • Pressure Ulcers • Other Concerns • Skin Conditions-Other Resident Interview • Choices • Sufficient Staffing • Activities • Care Plan Participation • Dignity • Community Discharge • Abuse • Environment • Resident-to-Resident Interaction • Food • Privacy • Dental • Accommodation of • Nutrition Needs (Physical • Hydration Space) • Tube Feeding • Personal funds • Vision/Hearing • Personal Property • ADLs Resident Interview • ADL Decline • ROM-Limited • Catheter • Rehab • Insulin/Blood Thinner • Dialysis • Infections • Bowel/Bladder Incontinence • Hospitalizations • Constipation/Diarrhea • Falls • Smoking • Pain • Hospice • Pressure Ulcers • Other Concerns • Skin Conditions-Other 11

06/17/2018 Family Interview • 3 in each Facility • In person or phone • Most knowledge about resident/care • 2 attempts Family Interview • Same as for resident: – Sufficient Staffing – Care Plan Participation – Choices – Community Discharge – Activities – Environment – Dignity – Food – Abuse – Dental – Resident-to-Resident Interaction – Nutrition – Privacy – Hydration – Accommodation of – Tube Feeding Needs (Physical – Vision/Hearing Space) – ADLs – Personal funds – Personal Property Family Interview • ADL Decline • ROM-Limited • Catheter • Rehab • Insulin/Blood Thinner • Dialysis • Infections • Bowel/Bladder Incontinence • Hospitalizations • Constipation/Diarrhea • Falls • Smoking • Pain • Hospice • Pressure Ulcers • Other Concerns • Skin Conditions-Other 12

06/17/2018 Initial Pool Limited Record Review • For Any Resident Marked: • Review: – Pressure Ulcers • Non-Interviewable – Dialysis • Refused – Infections • Unavailable – Nutrition • Out of Facility – Falls – ADL Decline – Bowel/Bladder • Low Risk – Hospitalization – Elopement – Change of Condition Initial Pool Limited Record Review • For All Residents • For New Admissions Reviewed: Reviewed-Add – Advance Directives – High Risk Meds – Other – Diagnoses – If Indicator Present – Hospice Review For: • Insulin • Anticoagulant • Antipsychotic with Alzheimer’s or Dementia • PASARR (LevelI) Dining – First Full Meal • Dining – observe first full meal � Cover all dining rooms and room trays � Observe enough to adequately identify concerns � If feasible, observe initial pool residents with weight loss � If concerns identified, observe another meal 13

06/17/2018 Team Meetings • Brief meeting at the end of each day � Workload � Coverage � Concern � Synchronize/share data (if needed) Sample Selection • Select sample based on: � Offsite selection � Harm, SQC if suspected, IJ if identified � Abuse Concern � Identified concerns during Initial Pool Sample Process � Unnecessary Medication Review � In addition, at least 3 closed record review � Unexpected death � Hospitalization � Community discharge 14

06/17/2018 Sample Selection Unnecessary Medication Review • System selects five residents for full medication review • Based on observation, interview, record review, and MDS • Broad range of high-risk medications and adverse consequences Sample size Grid Resident Investigation General Guidelines • Conduct investigations for all concerns that warrant further investigation for sampled residents using: – Multiple observations, as required – Interview resident/representative/staff – Record review – Critical Element (CE) pathways 15

06/17/2018 Critical Element Pathways (CE) • Components: • Investigations: – Assessment – Observations – Care Planning – Resident/Family Interviews • Develop • Revise – Staff Interviews – Provision of Care – Record Reviews Facility Task Mandatory • Nine Mandatory Tasks – Dining – Infection Control – SNF Beneficiary – Kitchen – Medication – Med Storage – Resident Council – Nurse Staffing – QAA/QAPI Dining Observations • First full meal – All dining areas – Room trays • Focus on: – Staff Availability – Positive Experience – Positioning – Interactions – Furnishings 16

06/17/2018 Infection Control • Hand washing • Glove use • Precautions • Isolation • Laundry Handling • Immunization • Communicable Disease SNF Beneficiary Protection Notification Review • SNF Beneficiary Protection Notification Rights – 3 notices reviewed – Facility given worksheets to complete • Medicaid Only Facility Not Given The Review Kitchen/Food Service • Initial tour • Focus on: – General Sanitation – Cleanliness – Food-borne Illness prevention • Meal prep observation 17

06/17/2018 Kitchen/Food Service • Food Storage • Food Preparation • Sanitization Medication Pass Actual Preparation and Administration 25 Opportunities Medication Pass 25 Opportunities Multiple Individuals Multiple Routes Multiple Times Reconcile Orders 18

06/17/2018 Medication Storage • Any surveyor can do Task • Half Med Storage Rooms reviewed • Half Med Carts reviewed Resident Council Meeting • Completed with 12 or so residents • Staff can not attend • Questions for meeting about: – How often meet – Room availability to meet – Room size appropriate – Grievance procedure – Staff Treatment – Facility Rules Sufficient and Competent Nurse Staffing • All Surveyors conduct • Compliance based on Care 19

06/17/2018 Quality Assessment and Assurance and Quality Assurance and Performance Improvement • Committee Members • Leader • Frequency of Meeting Facility Tasks Triggered • Four Triggered Tasks – Personal Funds – Environment – Resident Assessment – Extended Survey Personal Funds • Notification • Accounting Process – Interest bearing – Pooled/Separate – Reconciliation – Statements • Charges for Medicare/Medicaid 20