CHECKLIST FOR SURVEY READINESS Business Office and Personnel 100% audit until in compliance and then 50% audit every year Issue Quarterly statements sent as per regulations Surety bond Survey data readily available State and federal contact data visable -observation/ documentation Interventions Comments Denial letters given for Medicare A TB skin tests up to date Inservices up to date NA data base data available Criminal background checks done appropriately Posting of staffing readily accessible to visitors and updated daily Medicare denial letter and expedited review letter given timely when resident discharged from Medicare A P and P for pneumoccial and influenza vaccines including follow after injection
CHECKLIST FOR NURSING Issues -observation/documentation Yearly competencies CMA Yearly competencieslicensed nurses Yearly competencies-na s Clinical issues Falls Med pass observation Med pass observation Treatment observation Documentation-NN-timed, dated and signed Care plan updated with Resident changes Incident reports complete Fall investigations complete Weekly total body checks Tube feeder-med pass observation Admission assessment complete Elopement protocol Anticoagulant use Peri care Lift use Gait belt use Dignity Handwashing Abuse Elopement Incident report Investigation Care plan update Tracking trends
Clinical issues Skin At risk assessment Prevention on bed and chair Heels floated if MDS notes 3-4 in bed mobility Dietary note monthly Vitamins Supplements Liberalize the diet Weekly sizing and staging (pressure only) Wound nurse or wound center consult if without healing in 3 months Treatment follows standards of care Recent labs MD updated Use of PUSH tool for change of position at least q2 hours Incontinence management
Clinical issuesweight loss Clinical issuesinfection control Clinical issuesbehaviors Isolation Dietary note monthly Appetite stimulant Depression issue Status of advance directive-hospice or end of life care-use of a feeding tube Type of diet Supplements Assistance in dining room % eaten Recent labs MD updated Log of issues Inservices Cultures done correctly Treatment with appropriate follow up Use of behavior sheets Monitoring for side affects Use of AIMS or DISCUS for antipsychotic use Tapering as per CMS guidelines Diagnosis to support use Social services involvement Care planned Type of isolation noted Lab data supports need for isolation Isolation techniques observed
CHECKLIST FOR DIETARY Issue - observation/documentation Intervention Comment Cleaning schedules Pests Storage Food temps-define timeframes Infection control Menus Inservices Dish washer test Equipment Floors All doors with screens Items stored off floors on palets None within 18 inches of ceiling Use of palets Hot foods hot Cold foods cold Logs available and within compliance parameters Handwashing Use of gloves Hairnets Sanitation Match MD orders Personal preferences honored Liberalized diets Documentation Be prepared to demonstrate a cycle to surveyors
CHECKLIST LAUNDRY AND HOUSEKEEPING Issue Dirty laundry storage on the unit Separation of clean and dirty Washers and dryers Clean personal items Storage areas Floor cleaning Room cleaning Staff refrigerators Resident discharge Isolation Cart Liners present Barrels cleaned daily Dirty laundry in bags (highly recommended) Minimize handling Use of gloves Handwashing In laundry areas only Chemicals dispenser OK Water temps OK Lint removed at least daily Personal clothing labelled Locked Timely and accurately Timely and accurately All items if open, covered,, labeled and dated Room cleaned timely and accurately Follows correct procedures In line of site to worker Chemicals not left unattended No personal items on cart
Issue Safety of storage Preventive maintenance documentation Water temps Life safety CHECKLIST MAINTENANCE All rooms locked Lifts Heater/air Boiler Lights Toilets Shower rooms Facility drainage Roof Down spouts Resident rooms Common areas Laundry Dietary Fire drills Wanderguards Call lights Alarm/security systems
CHECKLIST ACTIVITIES, SOCIAL SERVICES Issue Calendar Activity Care plan Posted monthly Daily announcement of activities In room activities Based on documented resident preferences (attendance in the facility or attended when in the community) Calendar includes evening and weekend activities Updated quarterly or more frequently Interventions Comments Activity Assessments Residents who spend a lot of time in their rooms Social services care plan Status of advance directive Behavior issues Room mate issues Family issues Discharge plans Initial assessment Quarterly updates Upon admit Quarterly Needs being met Care planned Personal needs met Who is the DPOA or Guardian Updated yearly In progress notes On care plan Psy involvement as necessary In notes In notes and care plan On care plan and in notes Upon admit Documented
Issue MDS Coordinator Has attended MDS training MDS schedule RAP s Care plans Transmissions Significant changes CHECKLIST MDS PROCESS Identified who is an RN Documentation in personnel folders Completed within state regulations Complete Reflect MDS and current issues Timely Reports kept on file Completes timely CHECKLIST RESIDENT INTERVIEWS (QIS tool) Issue Resident questions Resident observation Note any problem areas Report to department head or in daily stand up Compare issues observed to care plan documentation Note consistent issues between residents CHECKLIST FAMILY INTERVIEWS (QIS tool) Issue Family questions Note any problem areas Report to department head or in daily stand up Compare issues observed to care plan documentation Note consistent issues between residents CHECKLIST RESDIENT COUNCIL INTERVIEWS (QIS tool)
Issue President or designate questions Note any problem areas Report to department head or in daily stand up Educate person to be interviewed to questions to be asked