Long term care surveys

Specialties Geriatric

Published

I work with several long term care facilities in northern Indiana as a consultant and am just wondering how other states are coping with their state surveys. Indiana has gotten to the point that very few facilities are able to clear a survey. Level G deficiencies are common. I know some buildings deserve them- but some of the facilities that are getting level G F-tags really do provide excellent care. The corporation I work for fortunately has excellent programs for restraints, psycotropics, falls, etc. but still cannot please the surveyors. They seem to be so out of touch with reality. Do the other states have surveyors that insist on finding something to cite? One facility got a level G tag for one resident that was unable to walk safely without assistance. He had a bed alarm, motion detector, and low bed in his room to try to keep him safe at noc. He tried to get up and when the alarms went off- staff ran to his room but was too late. He fell and broke his hip. Siderails were not an option- he tried to crawl through and over them. Our corporation does not allow vest restraints or roll-belts or any kind of "restraint" in bed because of the dangers. I agree with our no restraint in bed policy. But-what else could we have done? The surveyor said the facility should have done something for him- but was unable to give us any other recommendations. Any ideas or comments about long term care surveys?

"Those that can...do...And those that can't...survey!!!":rolleyes:

our facility recently went bankrupt and was bought out by another co. state had to come in to clear us in order for the sale to go thruand did! place was in shambles didn't even have supplies because bills weren't paid. i was told when state comes in they know exactly what their going to do . state just popped in today but didn't come on the floor ,maybe tommorro?

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anyone go through a 2002 state survey in North Carolina. If so what was the survey focus. Last year for us it was social worker and our care plans. Including pressure ulcers and skin together for a problem. The state felt the pressure ulcers and skin care plans need to be separeted. So now it seems like we are repeating ourselves. I don't care plan though for pressure ulcers if they don't have one. But q one of our care plans has a skin care plan now. Tex

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Tex, do you mean "skin" as pressure sore prevention, and "pressure ulcers" as a care plan to deal w/ existing ulcers? I handle this by writing one problem w/ 2 goals; one goal would be to resolve existing ulcer, the other goal would be no further skin breakdown. I had a surveyor tell me that each RAP area triggered had to be a seperate care plan problem once. My facility hired a consultant who is teaching us to "lump together" related issues in one problem, but make as many goals as you need under each one. We are not sure how to take this, kind of afraid the surveyors will not like it. However, I can't find a regulation stating that we are required to care plan each RAP seperately; it is only required that each RAP be addressed in the care plan, which I feel we do a good job of. I mean, is it REALLY necessary that each care plan be 15 pages long??? I'm sure all of our STNAs and nurses have PLENTY of time to read and follow them!!

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ktwlpn, I think the reason your QA person wants you (the licensed nurse) to address restorative in your biweekly notes because one of the requirements for restorative to be counted on the MDS is that is " be reviewed periodically by a licensed nurse".

Our suveyors didn't have a problem with our review notes but the medicaid auditors wanted it to be more specific. ie name the goal, is the resident making progress, do you need to make changes.

nursekrachet- Hope the new owners make some improvements. Lots of homes are sinking under the new financial rules.

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Specializes in LTC, WCC, MDS Coordinator.

In Kansas, the surveyors are sniffing around the oral care and if it is care planned. The other main focuses are pain management with good documentation of pain assessments and weight losses. Every time they come in here they have another "sneak attack" planned.

My care plans have a main nursing diagnosis for the problem...such as Self-care Deficit...and then I have multiple goals...such as "resident will have optimal hygiene and grooming", "resident will have decreased risk of and minimal injuries from falls", and "resident will have decreased risk of new skin issues and improvement in existing skin issues". These cover a lot of RAPs triggers. My care plans, like I said elsewhere, are written on Word and have goals and interventions that can be check-marked. The surveyors haven't hated them..yet!

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I don't know what you could have done differently. We have several residents that fit in the category you describe --- we've done exactly what you describe -- bed alarms, low bed, etc. Happily our facility received a No Deficiency this year!!!!!! We are in the top 5 percent in Montana and we worked hard to get there.

I really find it hard to believe that they gave you a deficiency for that incident ---- what do they expect --- one on one nursing??? Wouldn't that be a nice dream!!!!

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Was the resident awake when bed-check was performed? ...... could he possibly have been brought out of his room?

Were all of his needs met? Would a trip to the bathroom have helped? Does he have a bag full of activities that you could have given him something to 'do' at 3 am? Was he possibly a night shift worker back 'in his days'? It is imperative that we look at the reason he was awake and wanting to get out of bed.......

Just curious, trying to place myself in his position, what could have he possibly have needed.

When the surveyors come in, they are looking for 'proof' that you are providing the care he needs and deserves.

That's where it's our position to get ahead of the surveyors & make sure we are meeting all needs. They are looking for system failures/break downs.

Do you have an active Quality Assurance team? By performing walk-throughs, and digging and delving through possible deficiencies, you can stay above. It is essential to have staff support as well, after-all 99% of the solutions to the breakdowns can and should come from staff!!

I'm surprised you don't have an MDS coordinator. Are your assessment forms 'user friendly'? The surveyors are looking for documentation...... user friendly assessment forms could assist you in that process.

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Specializes in Everything except surgery.

Umm..just curious...but what is a F or a G tag??

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The gentleman that fell was a G tag- actual harm. It was this ONE resident that got us the tag. I was suppose to go to court two days ago- but it was settled out of court. Both myself and my assistant were to testify.

I am no longer the DON- I accepted a corporate consultant position with the same company. I will admit that the facilities that I go to have more bells, buzzers and alarms than you can imagine. Everything from noise monitors (like the ones for infants) to motion detectors at bedside as well as sensor pad alarms in beds and wheelchairs.

Never a dull moment in long term care!!!

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Brownms 46 Glad to hear from someone in Texas, I was born in Corpus Christi texas..................tex

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Specializes in Everything except surgery.
Originally posted by tex

Brownms 46 Glad to hear from someone in Texas, I was born in Corpus Christi texas..................tex

Thanks Tex...:)! I really like it here...Nice folks...clean city...and great views...:cool:

But can someone tell me what is a F or G tag mean?

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the Tags are what are cited by the surveyors. they are categorized by the level of severity of the citation. Fines and penalties are levied based on the level of the tag. So an F tag means there was actual harm to resident because of something the facility did or didn't do. I believe the higher the letter the more severe the deficiency is. Further clarification, anyone????

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