For DON about regulations

[nursbaybie]

I live in california. our state regs are title 22. then there are the cms federal regs. so which ones are we to go by. the state? or the federal?

and in title 22, if anyone is in cali, is it just that division 5, chapter 3 (licensing is chapter 5) and chapter 3 is (snf)s.

or are there other parts of it that apply too? i was told by one nurse that the surveyors only look at these state regs in title 22, but the CMS website shows all the federal regs that they go by, and the survey process refers only to the federal regs. my boss (an administrator), always says things like "the regulation is......" or the regulation says "....." is she referring to state or federal? do they give administrators a copy of all regulations? if hte state and fed conflict, do you go by the most strict of the 2 like home health agencies do?

Please help. any online resources would help as well.

thank you.

[RedZeppelinRN]

Dear Daytonite:

Thank you so much to take the time to give me all this information.

I am quite sure the Administer is not an RN, he inherited the facility when his father died. He knows nothing about nursing, especially refusing to use 2x2s because they were so expensive. But made the nurses cut up 4x4s and use them. These are usually lying around in drawers getting dirty. He asked me why they needed 2x2s. I told him them they had to be sterile for wound care.

So obviously this "Asssist Administer" cannot perform this job. She is unlicensed, not hardly an RN.

Obviously this unlicensed person cannot do assessments and treatments. Although it sounds if she can do ADLs.

She also calls physicians for vitamins and orders for wound care and says she is "advocating " for the patient. Thanks again for your input.

[Daytonite, BSN, RN]

dear daytonite:

thank you so much to take the time to give me all this information.

i am quite sure the administer is not an rn, he inherited the facility when his father died. he knows nothing about nursing, especially refusing to use 2x2s because they were so expensive. but made the nurses cut up 4x4s and use them. these are usually lying around in drawers getting dirty. he asked me why they needed 2x2s. i told him them they had to be sterile for wound care.

so obviously this "asssist administer" cannot perform this job. she is unlicensed, not hardly an rn.

obviously this unlicensed person cannot do assessments and treatments. although it sounds if she can do adls.

she also calls physicians for vitamins and orders for wound care and says she is "advocating " for the patient. thanks again for your input.

yikes! well, ordering supplies can be done by a clerk who doesn't have to be a licensed person. and, good sense and smarts about buying isn't a licensing requirement. there may be a "grandfather" clause in the licensing laws and your current administrator may have gotten his license a long time ago knowing that he would some day be inheriting the business. there is a continuing education requirement on their license renewal, but that doesn't assure anyone's competency. back in the days, the ltc i first worked in had a little autoclave about the size of a microwave you or i would have at home and we used to wrap our own dressing packs and sterilize them in this thing because the facility wouldn't buy sterile gauze for us. i distinctly remember mixing a certain foley irrigating solution, putting it in glass bottles and sterilizing them in this autoclave. (some things about nursing just remind me so much of working in a kitchen! i always thought that central service was like a big kitchen.)

if you are concerned about this, i saw that there was a way to verify the license of an administrator on the home page for the nursing homes on the dhs site. the public can verify anyone's license. you might want to verify your administrator's license first. if you suspect something is not kosher, report them. i believe that reporting is kept confidential. in california the department of health services (dhs) is the agency that administrates the laws for ltc facilities. i would think that this stuff would get noticed during a survey though, wouldn't it?

[RedZeppelinRN]

Daytonite: You are so funny! Your big kitchen! Now I know why I was so terrified of sedation for anything because I saw a movie on Turner Classic Movies. It was in black and white about surgery, etc. I was a kid and had to have a mole removed from my face and they gave me general anesthesia. I can still smell that ether and that black rubber mask being put on my face and asked to count back.

Compared to the miracles of surgery now, that movie actually scared me.

Thanks again for the info. I will check on his license. Something is more than not "Kosher" there. They were sited for many things by the State having to come back multiple times, including landing on the National Watchlist for harm actually done to a patient. I found this out before I left there.

I will pm you more later.

[Daytonite, BSN, RN]

boxter. . .you have to have a sense of humor because of all the sad stuff you see to keep yourself sane. I also thought chemistry lab was a kitchen too!

The administrator, who was also an RN by the way, at the first nursing home I worked in, was asked to take over as the administrator of a nursing home that had just been given a failing survey and a certain number of days to clean up it's mess. She had gotten this job because the DHS had recommended her to the owner of the facility. This was back in 1978 or so. She had asked me if I would come and work there to help them as they were cleaning out the deadwood nursing staff and getting the place back up to snuff. She told me that the state wanted to close the home, but it really wasn't feasible because they would have had to relocate all the residents! Most of the residents were MediCal patients and there just weren't any open MediCal beds at the other two nursing homes in the area! I had seen years ago when patients went from being private pay (when they had all their money and assets) to MediCal (after all the money and assets were gone) and had to be moved to facilities that were 60 miles away because those facilities were the only ones with open MediCal beds. This was because I was living in one of those isolated California towns in the Mojave desert where you had to drive an hour just to go to see a movie or shop at a Vons or Safeway supermarket.

[RedZeppelinRN]

Daytonite:

When I was talking about the 2x2s and 4x4s, he was trying to save money using the 4x4s and cutting them into 4 pieces. The patient was a diabetic and it had been infected for over a year. So what was left of the 4x4s were just thrown in a drawer with other junk to gather germs. I told him he needed a 2x2 because it needed to be a sterile dressing. If we had used the whole 4x4, he would have a stroke. So we improvised with bandaids, etc.

I did try to look up to see if the administrator was an RN, but that info isn't listed and if you want to know if he is licensed as an administrator, you have to give the license number. Oh well, his time will come.