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END OF PAGE What is a comfortable temperature? - ANSWERS- 71 - 81 degrees How should privacy curtains be hung? - ANSWERS-Must be hung from the ceiling and extend around the bed to provide total visual privacy. What is the window requirement for residents rooms? - ANSWERS- Must have an outside window or outside door in every sleeping room, sill height must not exceed 36 inches above the floor. What is the requirement for bathroom facilities? - ANSWERS-each resident room must have it's own bathroom equipped with a commode and sink (built after 2016) How often use a resident receive a financial statement? - ANSWERS- quarterly and upon request What amount of money must be kept in an interest bearing account? - ANSWERS-$
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END OF PAGE When must a facility notify a Medicaid resident of the amount of money in their account? - ANSWERS-When the account reaches $200 of the eligibility limit. How can the software help determine the new admissions? - ANSWERS-Any residents on the alphabetical list from the facility that are not in the software should be the admissions in the last 30 days When should QAPI/QAA task be completed? - ANSWERS-At the end of the survey What should be discussed at End of Day meetings? - ANSWERS-were offsite concerns validated? were new systemic concerns validated? has more than 1 surveyor identified and validated the same concern? Make a list of the concerns that facility should be aware of/. What does an Extended Survey further evaluate? - ANSWERS- Physician services (483.30) Nursing Services (483.35)
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END OF PAGE unsatisfied with results it can be appealed to the DAB (Departmental Appeals Board). What is Judicial Review - ANSWERS-A provider may request (CMS may not) if unsatisfied with DAB. During a formal appeal, does CMS have the responsibility of showing why the provider should have enforcement? - ANSWERS-Yes What area trigger an extended survey? - ANSWERS-Residents rights
Abuse 483. QOL 483. QOC 483. Behavioral Health 483. Pharmacy 483. Administration 483. Infection Control 483.
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END OF PAGE Determining Immediate Jeopardy - ANSWERS-Appendix Q Contains what information?
- Harm a. Actual - was there an outcome of harm? b. Potential - Is there the likelihood of potential harm?
- Immediacy - Is the harm or potential harm likely to occur in the very near future?
- Culpability - a. did the entity know about the situation? If so, when did they first become aware? b. Should the entity have known about the situation? c. Did the entity thoroughly investigate the circumstances? d. Did the entity implement corrective measures? e. Has the entity re-evaluate the measures to ensure the situation was corrected? - ANSWERS-What are the three components of IJ?
- Serious injuries such as head trauma or fractures 2.non-consensual sexual interactions
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- failure to adequately monitor and intervene for serious medical/surgical conditions
- use of chemical./physical restraints without adequate monitoring
- improper feeding/positioning of individual with known aspiration ri - ANSWERS-Failure to prevent neglect triggers?
- Application of chemical/physical restraints without clinical indication
- Presence of behaviors by staff such as threatening or demeaning resulting in displays of fear, unwillingness to communicate and recent or sudden changes in behavior by individuals
- Lack of interventions to prevent individuals from creating an environment of fear - ANSWERS-Failure to protect from psychological harm triggers?
- Administration of medication to an individual with a known history of allergic reaction to that medication
- Lack of monitoring and identification of potential serious drug interaction, side effects, and adverse reactions
- Administration of contraindicated medications
- Pattern of repeated medication errors without intervention
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- Lack of diabetic monitoring resulting or likely to result in serious hypoglycemia or hyperglycemic reaction
- Lack of timely and appropriate monitoring required for drug titration - ANSWERS-Failure to protect from undue adverse medication consequences and/or failure to provide medications as prescribed triggers
- Food supply inadequate to meet the nutritional needs for the individual
- Failure to provide adequate nutrition and hydration resulting in malnutrition; eg severe weight loss, abnormal lab values
- withholding nutrition and hydration without advance directives
- lack of potable water supply - ANSWERS-Failure to provide adequate nutrition and hydration to support and maintain health triggers?
- pervasive improper handling of bodily fluids or substances from an individual with an infectious disease
- high number of infections or contagious diseases without appropriate reporting, intervention and care
- pattern of ineffective infection control precautions
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- incidents such as electrical shock, fires
- ungrounded/unsafe electrical equipment
- widespread lack of knowledge of emergency procedures by staff
- widespread infestation by insects/rodents
- lack of functioning ventilation, heating, or cooling system placing individuals at risk
- use of non-approved space heaters in resident or patient areas
- improper handling/disposal of hazardous materials, chemicals and waste
- locking exit doors in a manner that does not comply with NFPA 101
- obstructed hallways and exits preventing egress
- lack of maintenance of fire or life safety systems
- unsafe dietary practices resulting in high potential for food borne illnesses - ANSWERS-Failure to provide safety from fire, smoke and environment hazards and/or failure to educate staff in handling emergency situations triggers?
- ANSWERS-Failure to provide initial medical screening, stabilization of emergency medical conditions and safe transfer for individuals and women in active labor....not really applicable to the long term care side so I chose not to include it.
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END OF PAGE a situation in which the providers noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident - ANSWERS-What is the definition of Immediate Jeopardy? the WILLFUL infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish - ANSWERS-What is the definition of abuse? failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness - ANSWERS-What is the definition of neglect?
- only ONE INDIVIDUAL needs to be at risk
- SERIOUS HARM, INJURY, IMPAIRMENT, OR DEATH does NOT HAVE TO OCCURE BEFORE CONSIDERING immediate jeopardy. Requires HIGH potential for those outcomes.
- Individuals must not be subjected to abuse by ANYONE...staff, family, visitors, volunteers
- Serious harm can result from both abuse and neglect
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- protection
- reporting/response - ANSWERS-Key components to prevent abuse and neglect? Entity compliance and noncompliance
- When an entity complies with the requirements applicable to the survey conducted, the form CMS-2567 should consist of an explicit statement that the entity is in compliance.
- If an entity does not comply with one or more applicable requirements, the form CMS-2567 includes corresponding citations of noncompliance
- ANSWERS-Principles of Documentation # Using Plain Language
- The deficiency citation is written clearly, objectively and in a manner that is easily understood. - ANSWERS-Principles of Documentation # Components of a Deficiency Citation
- regulatory reference
- deficient practice statement
- relevant findings - ANSWERS-Principles of Documentation #
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END OF PAGE Relevant onsite correction of findings
- if during the survey the entity corrects the situation that resulted in the deficiency, a determination of "not met" must be documented on the
- The entity may indicate its corrections in the right-hand column of the 2567. During IJ, if the facility initiates corrective actions that abate a finding for IJ, follow the guidance in appendix Q - ANSWERS- Principles of Documentation # Interpretive Guidance
- the deficiency citation explains how the entity fails to comply with the regulatory requirements, not the interpretation of those requirements. - ANSWERS-Principles of Documentation # Citation of State or Local Code Violations
- state code are not cited on the 2567 - ANSWERS-Principles of Documentation # Cross-References
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END OF PAGE The TC must complete which tasks during offsite prep? - ANSWERS- Create/export shell from ACO Import shell into ASE-q Add team members Complete offsite prep screen Make unit assignments Make mandatory task assignments print documents Share offsite prep with team What documents are printed by the TC during offsite prep? - ANSWERS-1 matrix with instructions 1 entrance conference worksheet 3 beneficiary worksheets What is the purpose of the initial pool process? - ANSWERS-To briefly screen all residents and observe, interview and complete initial record review.
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END OF PAGE When should you share data? - ANSWERS-At the end of each day and when the team composition changes. What must be done prior to Sample Selection - ANSWERS-The completed I.P data is shared and the TC confirms that the data is complete. What are the 7 LTSCP steps? - ANSWERS-1. Offsite prep
- Facility entrance
- Initial Pool Process
- Sample Selction 5.Investigation
- Ongoing and other survey activities
- Potential Citations How wide must an exit corridor be? - ANSWERS- 8 feet
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END OF PAGE What is Extrapyramidal symptoms" (EPS)? - ANSWERS-a neurological side effect that may occur within a few day or years of treatment with antipsychotics. Includes various syndromes such as; akathisia, medication-induced Parkinsonism, and dystonia. What is akathesia? - ANSWERS-a distressing feeling of internal restlessnesss that may appear as constant motion, the inability to sit still, fidgeting, pacing or rocking. What is Medication-induced Parkinsonism? - ANSWERS-Syndrome of symptoms like Parkinson's; tremor, shuffling gait, slowness of movement, expressionless face, drooling, postural unsteadiness and rigidity of muscles. What is dystonia? - ANSWERS-acute, painful, spastic contraction of muscle groups (commonly the neck, eyes and trunk) that often occurs soon after initiating treatment. What is Neuroleptic Malignant Syndrome (NMS)? - ANSWERS- Syndrome related to the use of antispychotics that presents with a sudden onset of diffuse muscle rigidity, high fever, labile blood pressure,
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END OF PAGE tremor, and cognitive dysfunction. Potentially fatal if not treated immediatley, including stopping the offending medication. What is serotonin syndrome? - ANSWERS-Serious clinical condition resulting from overstimulation of serotonin receptors. Commonly related to the use of SSRI's, SNRI's, triptans, and antibiotics. Restlessness, hallucinations, confusion, loss of coordination, fast heartbeat, rapid changes in blood pressure, increased temperature, overactive reflexes, NV&D. What is Tradive dyskinesia? - ANSWERS-abnormal, recurrent, involuntary movements that typically present as lateral movements of the tongue or jaw, thrusting, chewing, frequent blinking, brow arching, grimacing, and lip smacking. May be irreversible Significant weight loss in 1 month? - ANSWERS-5% weight loss Severe weight loss in 1 month? - ANSWERS-greater than 5% weight loss Significant weight loss in 3 months? - ANSWERS-7.5% weight loss
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