UNITED VOICES PROVIDER & OSDH ADDRESS COMPLIANCE QUESTIONS - - PowerPoint PPT Presentation

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.

ASSESSMENTS

• Not 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 TIMELINE

• If 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

• f 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
• f Motion Exercises
• Provide Indwelling Catheter Care

LET’S ANSWER ADMINISTRATOR QUESTIONS…

RECENT DEFICIENCIES CITE “PLAN OF CARE DID NOT CONTAIN NURSING INTERVENTIONS WITH MEASURABLE GOALS 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?

• YES
• Oklahoma 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
• n 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 INFO

JOYCE CLARK CEO OF ACHIEVIS SENIOR LIVING ASSOCIATES Phone: 405.812.9089 Email: joyce@achievisseniorliving.com MARY FLEMING, BSN, MHR DIRECTOR OF SURVEY OKLAHOMA STATE DEPT. OF HEALTH Phone: 405.271.6868 Email: maryf@health.ok.gov