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LTC Q & A
CMS LTC Qs & As
| Question | Answer |
|---|---|
| If a resident is declining to be weighed or has asked that weights be discontinued, will the facility incur a citation if the resident then unknowingly loses weight? | Resident declines tx, they may not be treated against their wishes, including d/c of weights. §483.10(c)(6), they must be provided w/ info, i.e., risks of d/c weights, to make informed decision & medical record should have appropriate documentation. |
| Can a facility post signs at the head of a resident's bed if they have impaired vision or hearing so staff will know? | §483.10(h) - Resident has right to personal privacy & confidentiality personal & medical records. Posting signs in rooms or in areas visible to others that include clinical/ personal info could be considered a violation of a resident’s privacy. |
| Allegations of abuse, neglect, exploitation, or mistreatment the regulation refers to reporting immediately but not later than 2 hours, is this reporting internally or externally? | 483.12 (c)(1) - Reports must be made to the facility’s administrator & to the State Survey Agency & APS where state law provides for jurisdiction in LTC facilities & to other officials in accordance with State law |
| Which cases of abuse and neglect need to be reported within 2 hours? | 1) Allegations of abuse 2) Allegations that a resident has suffered serious bodily injury due to neglect, exploitation, mistreatment, or an injury of unknown source. |
| Which cases of abuse and neglect need to be reported within 24 hours? | 1) Reasonable suspicion of a crime not involving serious bodily injury. 2) Allegation that doesn’t involve serious bodily injury of neglect, misappropriation, exploitation, mistreatment, or injury of unknown source. |
| How do you investigate abuse if you have a complaint about abuse but a resident is not named in the complaint? | The team should ensure they consider the abuse allegation during the initial pool process. If no residents in the initial pool had concerns with abuse, the TC needs to add a generic place holder so the abuse care area can still be investigated. |
| If a nurse currently working for a facility has a disciplinary action on their license is it expected termination of their employment based on the new regulation? | 42 CFR 483.12(a)(3)(iii), facility must not employ, or engage individuals, w/ a disciplinary action against a pro license from abuse, neglect, exploitation, mistreatment or misappropriation of resident property. |
| Are all bedrails considered to be physical restraints? | F604 It is considered a physical restraint if it meets all of the following criteria: • Is attached or adjacent to resident’s body; • Can't be removed easily by resident; and • Restricts resident’s freedom of movement or normal access to his/her body. |
| If bed rails are pre-installed on a bed (purchased as one unit or not easily removed), could they be disabled in some way to ensure they are not used for a resident for whom bed rails are not appropriate? (F700) | If rails aren't appropriate for resident & facility chooses to keep bed rails on in down position, raising rail for use during care, is considered noncompliance if all requirements (assessment, consent, inspection, & maintenance) are not met prior to rail |
| “Staff do not crush & combine meds & then give them all at once either orally or via feeding tube.” Does this mean the nurses need to crush each pill & mix it separately for oral administration? | F759/F760- separating crushed medications may not be appropriate for all & should not be counted as a med error unless there are instructions not to crush meds. Facilities should use a person-centered, individualized approach to administering meds. |
| “Staff do not crush & combine meds & then give them all at once either orally or via feeding tube.” Does this mean the nurses need to crush each pill & give separately for administration via feeding tube? | Separating crushed meds via feeding tube is a standard of practice according to the American Society for Parenteral & Enteral Nutrition (A.S.P.E.N.). |
| Does the pharmacist recommendation have to be placed in the residents chart, or can it be in a binder located at the nurses’ station or DON office? | §483.45(c)(4), F756- If documentation of findings is not in the active record, it's maintained within the facility & is readily available for review. Establishing a consistent location for findings & recommendations can facilitate communication. |
| Regulation F758 Unnecessary Drugs; will Compazine which residents take for nausea & vomiting on a PRN basis expire every 14 days & have to be renewed? | Compazine is considered an anti-psychotic, though it can be used to treat N/V. According to Federal requirements, a PRN order would be limited to 14 days. A new PRN order can't be renewed unless attending Dr. or practitioner first evaluates resident. |
| What constitutes an evaluation by the attending or prescribing physician? | F758- Direct examination of resident. Documentation should be: 1) Is drug still needed, 2) What is benefit of med, 3) Is there improvement? Surveyors should review medical record for evidence of required evaluation & interview staff to assess compliance. |
| What happens to a shell if a survey is postponed? | If shell is already exported from ACO, you'll want to recalculate MDS information. If start/exit dates have changed, recalculate & then share updated shell to ensure that the team has the most recent MDS information. (Step 2 of LTCSP Procedure Guide) |
| Can information given to surveyors on a matrix during a survey be pulled from the most recent MDS data? | Info to complete matrix will come from various places of each resident’s clinical record. All info entered into matrix should be verified by a staff member knowledgeable about the resident population & must be reflective of all residents as of survey. |
| What is the survey team supposed to do with the facility assessment that is requested during the entrance conference? | F838§483.70(e), If systemic care concerns are identified & are related to the facility’s planning, review facility assessment to determine if these concerns were considered as part of the facility’s assessment process. |
| How do I add residents for the Beneficiary Notices & Infection Control Tasks? | Click on Add Resident icon in the upper right corner OR if resident is already listed in the LTCSP resident list, add the resident’s ID in the Notes field using Alt+R, or the person icon. |
| If you have no issues with an observation & you mark that, do you have to document your observation in the box? | It is recommended that there is some documentation of all observations. |
| A Resident was added to the resident list in the LTCSP software application but was already in the list. Is there a way to delete the second entry? | Before adding a resident to the resident list search for the resident in the search box to make sure they are not already in the list before adding them to avoid duplication. Currently there is no way to remove a duplicate resident. |
| When do we add a resident on PASARR to the sample? | You would only add a resident for PASARR if you marked them for further investigation during the initial pool process, if you identified a concern when you reviewed the matrix or if you identified concerns during the offsite preparation. |
| Where do we indicate who the family representative is? i.e. Son, daughter, guardian, neighbor, etc.? And how often they visit? | This information may be entered into the notes section in the resident representative interview. This information would be saved for future reference. |
| How does the survey process and software handle extended survey? | go to the Navigation Menu; select Investigation/Facility tasks, & assign the Extended Survey task to the team member(s) who will be assigned to complete the task by following the Extended Survey Pathway. |
| I discharged an offsite resident with the reason (Expired, Discharged to Community or Hospitalized) but they still show up in the resident list. Why is that? | The application does not remove any residents from the resident list even if they are marked as being discharged. |
| If we have 60 rooms & each has their own medication storage & we put 60 in the number of locations, the system will ask us to complete 30 reviews, is that the expectation? | Resident rms count if they store meds vs. common storage area. Review storage in resident rooms. We will look at this for further guidance in terms of # of rooms needed & if there will be variations from current instructions to review 50% of med area. |
Created by:
Debra Bernier 1
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