Knowledge of the Long-Term Facility, Survey Process, and Related Laws, Regulations and Guidelines
Knowledge of the Long-Term Facility, Survey Process, and Related Laws, Regulations and Guidelines refers to knowledge of pertinent sections of the Code of Federal Regulations (CFR) and the State Operations Manual (SOM) as well as an understanding of when and how to use these resources to conduct surveys. It also refers to an understanding of the steps involved in planning, conducting, and documenting a long-term care facility survey such as working knowledge of the procedural instructions outlined in Appendix P, the regulations and guidance found in Appendix PP, and an understanding of how and where to document survey observations. A non-exhaustive list of sample topics includes :
-Statues pertinent to Title XVII §1819 and Title XIX, §1919of the Social Security Act
-Code of Federal Regulations 42, CFR 483
-State Operations Manual, Appendix PP
-Other types of survey process, including complaint, re-visit and extended surveys
Knowledge of Factors affecting Environmental Quality and Sanitation
Knowledge of Factors affecting Environmental Quality and Sanitation refers to knowledge of how physical factors affect resident quality of life. This knowledge includes characteristics such as space, construction, sanitation, maintenance, ventilation, temperature, noise, and accident prevention. A non-exhaustive list of sample topics includes:
-Resident Call Systems
-Life Safety from Fire
-Emergency Power
-Space and Equipment
-Mechanical, Electrical and Patent Care Equipment
-Bathroom and Bedroom Specifications
-Building Exits
-Dining and Resident Activities
-Safe, Functional, and Sanitary Resident Environment
-Adequate Ventilation
-Pest Free Environment
Knowledge of Resident Assessment and Care Plans and Long Term Care Facility Record
Knowledge of Resident Assessment and Care Plans and Long Term Care Facility Record refers to knowledge of how to determine if the assessment and the comprehensive care plan address the needs of the resident. This includes ensuring the facility has conducted a comprehensive assessment, identified each resident's needs and developed a written plan of care based on the resident's current assessment. It also refers to knowledge of the information required in medical records and of the records used in planning, monitoring, and evaluating resident care. Included are general medical records (active and discharged), medication and treatment records, and physician orders. A non-exhaustive list of sample topics includes:
-Care planning based upon initial and on-going comprehensive assessments
-Documentation of resident participation in their assessment process
-Current, written care plan for each resident
-Ongoing assessment, valuation and updating of care plans
-Knowledge of general principles and practices of medical record systems
-Electronic Health Records (EHR)
-Discharge planning
Knowledge of Medicine, Nursing, Rehabilitation, Gerontology, Disability, and Chronic Disease
Knowledge of Medicine, Nursing, Rehabilitation, Gerontology, Disability, and Chronic Disease refers to an understanding of standards of medical, nursing, and rehabilitation practice. It also refers to a basic knowledge of residents' physical and mental abilities, potential for rehabilitation, and care requirements. A non-exhaustive list of sample topics includes:
-Baseline care planning
-Pain Management
-Adequate treatment and progress notes
-Physical, speech-language pathology, occupational and respiratory therapies
-Positioning and assistive devices
-Range of motion and mobility
-Pressure sore prevention
-Bowel/bladder programs
-Dialysis
-Promotion of independence in activities of daily living
-Functional limitations
-Prosthesis
-Common disease affecting the elderly such as Diabetes, COPD, CHIF, CVA, CAD
-Common manifestations of disease processes
-Accident hazards
-Discharge Planning and Summary
Knowledge of Resident Rights and Quality of Life Issues
Knowledge of Resident Rights and Quality of Life Issues refers to an understanding of how long term care facility programs and practices affect resident right. Also includes is knowledge of how social services and activated can protect and promote quality of life and how these programs and services should be tailored to resident cognitive abilities. A non-exhaustive list of sample topics includes:
-Self-determination and a dignified existence
-Freedom from physical, verbal, physiological, and sexual abuse
-Choice of roommate and room assignment
-Right to have access to persons and services inside and outside the facility
-Right to manage persona; finances
-Right to be informed in a language that is understood
-Resident involvement in decisions about care
-Resident security and privacy
-Respect for residents' personal property
-Freedom to exercise rights and register complaints
-Freedom from discrimination, cohesion and reprisal from voicing complaints
-Restraints
Knowledge of Nutritional and Dietary Service Principles and Practices
Knowledge of Nutritional and Dietary Service Principles and Practices refers to elements of the dietary services that affect nutritional adequacy. These elements range from staffing, menu planning, food preparation and distribution to therapeutic diets. Also includes is an understanding of how resident choices and the dining experience may impact resident quality of life. A non-exhaustive list of sample topics includes:
-Menu planning
-Food preparation
-Sufficient, skilled staff to meet resident nutritional needs
-Dietary management credentials
-Food delivery
-Therapeutic diets
-Aesthetics of food delivery
-Recognition of food choice and provision for substitutes
-Record keeping of meal consumption
-Resident supervisor and assistance, as required, with eating
Knowledge of Drug Therapies and Drug Administration Principles and Practices
Knowledge of Drug Therapies and Drug Administration Principles and Practices refers to an understanding of basic pharmacological practices including techniques of drug administration and distribution, drug classification, interactions/side effects, and basic human physiology as related to drug therapy and allergies. A non-exhaustive list of sample topics includes:
-Rules for determining medication errors as they relate to medication pass
-Physician orders v. drug and dose administered
-Significant v. non-significant errors
-Use of psychotropic medications
-Drug regimen review
-Storage of medications
-Unnecessary medications
Knowledge of Infection Control Procedures
Knowledge of Infection Control Procedures refers to knowledge of Federal regulatory standards of infection control and of principles of acceptable professional practice. Included is the ability to apply applicable standards and principles for the evaluation of areas such as building maintenance, handling of linen, management of contaminated materials, and aseptic and isolation techniques. A non-exhaustive list of sample topics includes:
-Handling storage, processing and transportation of laundry
-Preventing, identifying and reporting infections and communicable diseases
-Antibiotic stewardship
-Surveillance, Precaution and Transmission Procedures
-Standard precautions
-Infectious waste storage and disposal procedures
-Hand hygiene
-Aseptic techniques
Skill in Documentation
Skill in Documentation refers to skill in recording information factually, clearly, and objectively. Also included is skill in describing conditions and circumstances, documenting their direct relationship to a Federal regulation, and there effect on resident care. Examples of specific topics include:
-Creation of qualitative documents which answer who, what, when , where, and why questions
-Organized and logical presentation of facts
-Proper use of forms
-ensuring supporting evidence is documented clearly and accurately
Skill in Gathering and Integrating Information
Skill in Gathering and Integrating Information refers to a proficiency in gathering information from a variety of sources and using an objective, systematic approach to evaluate if and how the information collected is relevant. It also refers to proficiency in noting usual and unusual circumstances in relation to residents and their environments. Included is skill in using all senses to assimilate information. It also refers to skill in eliciting necessary information, generating responsiveness, clearly articulating ideas, and evaluating response while maintaining an environment
conducive to communicating with others. Also included is the skill required to communicate and interact with a variety of people, such as survey team members, residents' family members, facility staff, and facility administrators. A non-exhaustive list of sample topics includes:
-Integrating team members' observations and findings
-Identifying trends by combining information from interviews, record reviews, and observation
-Team leading/coordinating
-Communicating areas of concern to the team during team meetings
-Negotiating
-Establishing rapport
-Identifying pertinent information
-Achieving balance between focus and empathy
-Identifying areas to probe
-Active listening
-Nonjudgmental expression of ideas
-Professional demeanor
-Conflict resolution
-Recognizing when you need to gather additional information about a procedure/process or situation
Deficiency Determination and Scope and Severity
Deficiency Determination and Scope and Severity refers to consistent application of requirements when determining whether or not a deficiency exists , and if a deficiency does exists, what is the scope and severity of the deficiency. It also refers to the ability ti analyze the written evidence of a deficient practice in order to determine the appropriate level of harm/impact and the prevalence of the problem. Examples of specific topics include:
-Immediate jeopardy
-Actual harm
-Potential for harm that is more than minimal
-Informal Dispute Resolution (IDR)