What besides the obvious do state inspectors look for in LTC?

[kstec]

I recently started at a LTC facility and they just got a new administrator and are trying to clean the place up. I've only been a LPN for about 18 months and primarily worked family practice for most of it. I worked as a CNA many moons ago so I have some idea of what the obvious things they look for but are wondering about the not so obvious. The unit I've been working on is getting better but still a mess. Yesterday in between medpass I decided to go through bedside tables. I found needles (unused), syringes, all types of dressings, neb tubing, neb tx vials, a prescription med for wound care that was dispensed 4/21/2006, tubefeeding tubing and the list goes on and on. Do you think that by cleaning some of them out, I save the facility some fine money? Also the MDS coordinator told me that we got tagged for leaving a resident in her geri-chair unattended. What is that about? Why is that different than having a resident in a wheelchair? Well any helpful hints would be greatly appreciated. Like I said I think I know the obvious but not the not so obvious. Thanks in advance.

[mercy1975]

i know several of you have seen this info, but i thought it would be helpful.

survey preparation

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• here's some items that should be inserviced before your upcoming survey. these are alot of the areas the surveyors will be reviewing.
  
  
  
• all staff to wear name tags
  
• greet and smile at surveyors as appropriate. they are guests in the facility and should be treated as guests. offer water and coffee after breakfast is done.
  
• call residents by their names only
  
• nembulizers-include cleaning procedure
  
• inhalers-include cleaning procedure. remind staff to shake the inhaler in-between puffs and offer water for resident to rinse mouth out.
  
• accucheck machine-clean after every use!!
  
• eye drops-if giving multiple eye drops, know how long to go in-between giving them
  
• injections
  
• peri-care--try to have two staff go together. they can coach each other. keep residents appropriately covered during intimate procedures.
  
• emptying of foley bags
  
• tube medications-do each med separately and flush between each med
  
• med pass- remind staff to use hand gel every time after giving a resident's meds. wash hands with soap and water after every 4th resident.
  
• policy and procedure for cleaning razors
  
• positioning of residents
  
• all residents to receive appropriate cueing and assistance during meals.
  
• keep all hazardous items locked up
  
• all residents to be appropriate dressed
  
• man shaved by 10am
  
• if wheeling a resident in a w/c their leg extensions must be on and feet appropriately placed.
  
• all o2 tubing should be in a plastic bag and not laying on the floor.
  
• keep clean and dirty items separated by three feet minimum.
  
• all staff to know where the care plans are located.

#2

dec 15, 2007, 10:50 am

mercy1975 (female)

member

nursing specialty: ltc surveyor, don of ltc

years exp: 35 years

join date: aug 2007

location: fontanelle, iowa

age: 54

posts: 39

country: united states

received 12 "thank you" from 11 posts

re: survey preparation

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following is a listing of what should be included in a survey entrance manual.

this is the information the surveyors will request upon entering into your facility.this will make the entrance go very well. this also will give the don more time to be with the nursing staff instead of rushing to get the nursing information. this will save the surveyors time also which keeps them happy.surveyors have been very impressed when this information is readily available.

1. resident roster with room numbers

2. blank 24 hour report sheet with residents names (one for each surveyor)

3. list of key personnel, including the pharmacy consultant and qa person

4. copy of facility layout-(one for each surveyor)

5. resident's advocate committee names

6. hcfa form 672

7. work schedule for rn/lpn (day of entrance)

8. hcfa 802-up to date

under "wt." indicate with an arrow if weight is up or down

under "uti/ inf control/antibiotic"-note utis

under "interview able: indiv/fam" ,note with an "i" if the resident is

interview able. a list would be also be acceptable.

under "psychoactive meds" note :"p" for psychoactive, "a" for

anti-anxiety, and "h" for hypnotic.

9. policy /procedure for monitoring accidents/incidents and system to

prevent/minimize

10. immunization practices (flu and pneumococcal)

11. list of employees since last survey (list position and hire date)

12. admissions (past 30 days)

13. list of discharges (during last three months)

14. medicare residents requesting demand billing (during past 6 months)

15. resident age 55 and younger

16. meal times (of all dining rooms)

17. dining room seating chart- (one for each surveyor)

18. copy of menus (including therapeutic menus for duration of the survey)

19. list of residents on therapeutic and mechanically altered diets

20. work schedule for lpn/rn (day of entrance)

21. medication pass times for inhalers, eye drops, injections, g-tube

medications, and nembulizers.

22. emergency water supply policy and procedure (5 gallons per resident per day)

23. clia wavier certificate

24. copy of surety bond

25. resident rights

26. admission agreement

27. policies /procedures to prohibit /investigate abuse

28. activity calendar (last three months)

29. resident advocate members

30. resident council meeting minutes-(last three months)

last edited by nrskarenrn : dec 15, 2007 at 11:49 am.

[proud2b1]

The obvious,and then anything else that arrises!They are big on follow-up cahrting,pt.care,labs md notifications.They are very big on activities,postioning,and dietary.Seems each year they hit hard on any certain area.BEHAVIORS are a real biggie.Always make big issues out of any contact kind of behaviors.

[proud2b1]

Thanks for all this!We are in our window now,where I work.This is nice to go by,to hit on hot spots and the basics,that sometimes we forget!!!

[LVNwannaBE2007]

thanks for all the help..... i am a new LVN in charcge of about 48 people a day on average..... our window just opened in march and state walked into a neighboring facility 2 nights ago on 10-6 shift. anything else you all can add to this. even when we just ahve 1 or 2 state people come in like DADS i freak out and almost cry i cant help it lol...... i get so nervous and have never been through this before and am so nervous

[flashpoint]

Some quirky things facilities in our corporation have been dinged for...

"Shred" containers being too big...unless you shred documents on site (which they don't like either), the container needs to be less than 32 gallons. Big trash cans are not a good idea.

Leaving oxygen concentrators when the resident is not using them...fire hazard.

Things on care plans like "Encourage fluids." If you offer fluids and the resident declines, you need to offer again and tell them how important fluids. Use verbage that is less likely to fail...like OFFER fluids.

Make sure that resident quirks are care planned...like sleeping in clothes or wearing clothes that don't match or wearing too much makeup or having a nickname like "Ugly" or "Topsy" or "Doodie."

See if someone can give you a copy of CMS 802 and CMS 672...it shows you who the surveyors are going to look at before they even walk in the door.

The most important thing is to just have your ducks in a row all of the time...always do everything by the book and you should be good to go when the survey team shows up.

[sunny261]

We just had the state in our LTC and they focused on pressure sores, documentation, weight loss and enviromental(had nothing to do with nursing)....

[flashpoint]

We just had the state in our LTC and they focused on pressure sores, documentation, weight loss and enviromental(had nothing to do with nursing)....

That is what we are hearing in this area too...we are really lucky that we don't have any pressure sores...we keep pretty on top of weight loss...our housekeeping and maintenance staff are really on the ball...our documentation needs work, but we have a plan for improvement. I wish the would just show up and get it over with.

:)

[sunny261]

cotjockey:

I so understand where you are coming from. We don't have many pressure sores either-most are admitted with them. Documentation seems to be a hard area for nurses to grasp. you have to document residents reaction to changes in meds, behaviors on and on. I find that it seems like it really comes down to communication. For example I had a recent readmit for the hospital to my unit. They came back with a foley. I had several reasons not to d/c it but it seems no-one discusses with me to ask or talk to me about it. They had been admitted with renal failure and dehydration and they had alot of dependent edema on their return. So why would I want a foley to remain in for the first couple of days??? I think when I freaked a tad in the facility wide morning report they got the message. or finding out from the state that one of my residents had an incident with another resident and had the potential to be a victim. Not mentioned in report at all or put on the 24 hour report sheet. How can you document on anything if you don't know...

[hopenono]

first of all on rounds they also look in the rooms for simple stuff

urnial unlabed in the bathroom items too high on top of closet

tube feeding, right lable name tubing labled syringes labled hob up

rate ect cathaters leg band pvy bags

what the tubing looks like

o2 setting and what the tubing looks like and if it is dated

ice water in reach

call light in reach

if the "posions" laniseptic ect is in reach

if you use falling star program it the staff aware of what it is?

they also look at what the resident looks like over all

what the resident looks like.

they will pick the case mix based on this

they will look meal service to make sure residents get the diet ordered in the right texture

they look for temp if they are on a weight loss program is staff feeding encouraging ect by the way i have seen them time how long a staff person stays in the room to feed a hospice pt that was not eating to see if we were attempting to feed offer alt. ect

they will look and talk to the residents and they will look at the mds and care plan making sure that if they are difficult to feed it is care planed and if staff is following it they very much use the raps to see if you careplaned it and if it is being followed.

they also will look in your med room make sure no meds are out dated all stock items are labled ect

they will look to see that you are giving rt dose rout ect and they look back in the orders to make sure they are correct.

complaints are some times more work than an ann. because it is harder to clear a complaint than to write tags!

our home is new and we have a very picky group with lots of complaints

we have had LTC in our home 12 times in less than 8 months all unsup. but the hours we use to make sure no tags are written is very hard

all the "office nurses" take a hall we round every hour. awnser call lights mont meal service (we do the rounds daily anyway and mont meals all the time) we also mont to see who is on the case mix so we can see if there is a potential problem needed to be fixed. no home is perfect they will find something! but care issues are the worst and we work hard not to get this tag! peri care is one of the big ones that we have seen in the last year!

good luck on your survey! start now with rounds every day or even 3x daily. look for all the items listed give the list to your charge nurse and keep a copy follow up with rounds give a deadline to have it compleated.

mont meal service and med pass mont narc counts randomly and always check your orders!!!!