Part 6 Facility Policies: Putting The Systems Together

The facility seeking to transfer a resident must 1. record the reasons in the residents clinical record 2. give 90 days notice 3. have a good reason 4. need the bed for an other resident who is returning from the hospital

1. record the reasons in the residents clinical record

Married Couples Sharing a Room Consenting married residents have a right to share a room 1. regardless of their health conditions 2. if facility policy permits 4. when a room is conveniently available 4. when approved by the resident council

1. regardless of their health conditions

An alleged violation of neglect of a resident has been lodged. The administrator has reported this to the state, conducted an investigation the next day, and concluded no violation occurred. The administrator should 1. report results to state officials within 5 days of the alleged violation 2. document the investigation results and file it for state review at annual inspection time 3. reprimand the employee involved 4. consider the matter successfully settled

1. report results to state officials within 5 days of the alleged violation

A uniform data set describing the residents capability to perform daily life functions and functional impairments is known as 1. the uniform (minimum) (comprehensive) data set 2. comprehensive care plan 3. resident needs assessment 4. resident data assessment card

1. the uniform (minimum) (comprehensive) data set

Registered Nurse The administrator of a 50-bed facility asks the director of nursing to serve as both director of nursing and as a charge nurse on the weekend shift. 1. this is appropriate 2. minimum staffing has been met 3. minimum staffing has not been met 4. not permitted

1. this is appropriate

Furniture The administrator refuses to permit a large piece of furniture to be placed in the residents room arguing that it overly obstructs movement. The administrator is 1. within her rights 2. ignoring resident rights 3. making her own rules without regard to the resident 4. making a mistake

1. within her rights

Properly Qualified Activities Program Professional The administrator decides the trained therapeutic recreation specialist is too costly for the facility and hires instead a less expensive qualified occupational therapy assistant. This is 1. within the federal hiring guidelines 2. outside the federal hiring guidelines 3. an unfortunate decision 4. likely to not be a cost-effective decision

1. within the federal hiring guidelines

On the death of a Medicaid resident, the facility conveyed the residents funds within 14 days and promised to forward a final accounting in 3 weeks. This is 1. within the required notification periods 2. a failure to meet notification requirements 3. faster refunding and accounting than required 4. meeting minimum standards

1. within the required notification periods

In order to begin collection better data about the nursing home industry, federal legislation mandated development and use of ______ (App P & PP) 1. the comprehensive care approach 2. a minimum data set 3. changes in record keeping 4. a state-developed data collection system

2. a minimum data set

Residents Exercise of Rights Without Reprisal The resident hangs a religious ornament above her bed. Several nurses aides are offended and feel it is inappropriate. The facility administrator should 1. seek a resident council opinion 2. advise the aides that is appropriate 3. try to enforce the separation of church and state rules 4. get the facility attorney involed

2. advise the aides that this is appropriate

The facility must train _______ in emergency procedures_______ 1. all caregiver employees/when they begin to work 2. all employees/when they begin to work 3. designated employees/within 3 weeks of employment 4. new employees/within 1 week

2. all employees/when they begin to work

The resident has complained numerous times about the disruptive behavior of a nearby resident. The facility assures the resident that nothing can be done. This is 1. probably an accurate statement by the facility 2. an inadequate facility response 3. a routine occurrence 4. not addressed by federal rules

2. an inadequate facility response

A resident asks the afternoon nurse on duty to access his patient records. The nurse responds that she will have the records made available by late tomorrow morning. The nurse's response is 1. a denial of resident rights 2. appropriate 3. an unpermitted delay 4. clearly a delaying tactic

2. appropriate

When a facility notifies a resident of a transfer on February 1, to be accomplished March 1, the facility has 1. met Final Rules requirements 2. failed to meet Final Rules requirements 3. taken appropriate action when unable to meet needs 4. acted in good faith

2. failed to meet Final Rules requirements

When the nurse gives complete verbal notice of the duration of the bed-hold policy under the state plan to a resident and his family before transfer to a hospital, the facility can be said to have 1. met final rules requirements 2. failed to meet Final Rules requirements 3. exceeded Final Rules requirements 4. conformed acceptably to Final Rules requirements

2. failed to meet Final Rules requirements

A resident enters a facility continent. Due to new clinical conditions catherization becomes necessary. The facility's entire response is to provide services "to prevent urinary tract infections" and treat them if occurring. The facility has 1. met Final Rules standards 2. failed to meet Final Rules standards 3. exceeded what is required under Final Rules 4. performed good quality care

2. failed to meet Final Rules standards

The care plan team determines that although they had not anticipated it, the resident needs physical therapy. The facility should 1. assign the therapy to a qualified physical therapist either in house or from outside 2. get a physicians written order 3. get authorization from the Medicare provider 4. begin the physical therapy as soon as possible

2. get a physicians written order

The resident reports the facility to the state for releasing his medical records to the local hospital despite his refusal to release these records when he was transferred to the local hospital. The state is likely to 1. issue a fine 2. inform the resident he has no right to refuse to release his records on transfer 3. issue a citation 4. assure the resident it will not happen again

2. inform the resident he has no right to refuse to release his records on transfer

If persons with controlling interest in the facility, the company owning the facility, or the administrator or director of nursing change, the facility should 1. call and inform the state facility licensing agency 2. inform the state licensing agency in writing 3. inform the Medicare Intyermediary 4. inform the state Medicaid officials

2. inform the state licensing agency in writing

Ms. Brown alleges for the 12th documented time that she was abused by an employee. The facility 1. is justified in the documenting, but not investigating the matter 2. is negligent in protecting patients 3. should counsel with the resident 4. should consider transferring that resident to a more suitable facility

2. is negligent in protecting patients

Abuse To lessen the risk and incidence of residents abusive treatment of other residents, the facility permits a resident to remain in his room throughout the day. This is 1. good risk management 2. within the intent of the federal rules 3. abusive treatment 4. a good way to reduce incidents of residents abusing other resdients

3. abusive treatment

The resident assessment must be conducted or at least coordinated by and signed by 1. the residents physician 2. the medical director of residents physician 3. a registered nurse 4. the director of nursing

3. a registered nurse

6.1.4 Admissions Policies Orders for routine care or to improve the resident's functional abilities must be available 1. at admission 2. within 24 hours of admission 3. within 36 hours of admission 4. by the second shift after readmission

1. at admission

A person who is determined by the state mental health authority to need nursing facility service but is receiving active treatment for mental illness _________ (App P & PP) 1. can be admitted 2. must not be admitted 3. may be admitted if the medical director authorizes it 4. must go to the state mental hospital or equivalent

1. can be admitted

Organizations that actually pay the Medicare claims submitted by doctors and other medical suppliers are called _______ (App P & PP) 1. carriers 2. Medicare contractors 3. third-party payers 4. intermediaries

1. carriers

A representative of the state ombudsman office demands to see the clinical record of a Medicaid resident who had written that he wanted no one to have access to his clinical record. On receiving the request, you, the administrator, should 1. deny permission to the ombudsman 2. provide access to the record requested by the ombudsman 3. tell the ombudsman you will seek legal counsel, then respond 4. ask the ombudsman to return at a later time

1. deny permission to the ombudsman

A resident who has been determined by the courts to be incompetent decides he no longer wants the court-appointed representative to handle his personal funds and asks the facility to establish a personal funds account for him. The facility should 1. establish a personal funds account for that resident 2. seek the advice of an attorney 3. ask the court-appointed representative for permission to establish an account 4. get the advice of the facility accountant

1. establish a personal funds account for that resident

The facility administrator establishes written transfer agreements with two local hospitals, one of which is approved only for participation under the Medicare program, and the second approved only for participation under Medicaid. The administrator has 1. failed to meet transfer agreement requirements 2. accomplished the minimum required by the Federal Regulations 3. more than met the minimum required- an agreement with one of these hospitals would meet requirements 4. ensured that needed transfers can be accomplished

1. failed to meet transfer agreement requirements

Mail Rights in Sending and Receiving The resident demands computer and internet access, but the facility fails to provide this. The facility 1. is within its rights 2. is failing to meet requirements 3. behind the times 4. worried about resident privacy

1. is within its rights

If a facility provides the stated minimum number of hours per resident day of care, a state or federal inspector______ (App P & PP) 1. may still cite nursing for insufficient staffing 2. will pass the facility on staffing 3. will require the facility to maintain that ratio 4. may, at his or her discretion, reduce the staffing required

1. may still cite nursing for insufficient staffing

A resident routinely maintained $40 in her personal funds account and is upset to learn the facility has her funds in a noninterest-bearing account. Placing this residents funds in a noninterest-bearing account is 1. permitted 2. required 3. optional if the resident agrees 4. expected financial behavior

1. permitted

Freedom From Restraints The new administrator announces that after 2 weeks, no restraints will be allowed, even those required to meet the residents medical symptoms. This is 1. permitted 2. not permitted 3. a violation of federal rules 4. a misinterpretation of the rules intent

1. permitted

The resident decides to discontinue all nine drugs being administered daily. The facility staff fell this may result in a coma likely followed by death. The facility 1. can modify this decision as needed to keep the resident alive 2. must comply and maintain the resident at highest level within that decision 3. must contact and follow the physicians orders 4. should consider transferring the resident

2. must comply and maintain the resident at highest level within that decision

When the physician decides to discontinue an existing form of treatment due to adverse consequences, the facility 1. must note this in the residents care plan 2. must notify the resident and the residents representative 3. inform the pharmacy of this new information 4. order new replacement drugs

2. must notify the resident and the residents representative

Nurse's aides who have completed a training and competency evaluation program and passed the required competency test(s) _______ (App P & PP) 1. may serve at any facility 2. must still be judged by surveyors as competent to provide services 3. may, at their option, be registered with the state nurse's aide registry 4. may sit for training for nurse's aide assistant, IV

2. must still be judged by surveyors as competent to provide services

If a nursing facility has been certified by Medicare and Medicaid under Final Rules and federal requirements, in effect, it ________ (see Federal Requirements App. P & PP) 1. can be exempted from state and local licensure requirements 2. must still meet all state and local licensure requirements 3. is deemed to have met all state and local licensure requirements 4. may apply for a waiver from state requirements

2. must still meet all state and local licensure requirements

Work The resident requested work delivering newspapers throughout the facility. This is an approved part of the residents care plan. The resident receives $5.00 an hour for this work. The facility is 1. meeting work requirements 2. not meeting work requirements 3. improperly documenting the residents work 4. appropriately humoring the resident

2. not meeting work requirements

Protection of Residents Funds The facility staff suspect family members are abusing a residents funds and requires that, for the residents protection, his funds must be deposited with the facility. This is 1. a prudent step for the facility 2. not permitted 3. subject to review by the owners 4. a routine protection afforded residents by most facilities

2. not permitted

Training of Nurse's Aides The personnel director recommends a part-time nurse's aide who has worked at the facility for the past 6 months and is nearing the end of her competency evaluation program be hired as a full-time aide. The administrator should feel that the personnel director is 1. doing a good job 2. not understanding the requirements 3. smart to have a person under observation for 6 months before permanent hiring 4. functioning quite well

2. not understanding the requirements

Family Meetings Regarding group or family meetings, after providing space and privacy to resident families and any invited persons, the facility obligations are 1. met 2. partially met 3. exceeded 4. optional as to further assitance

2. partially met

The transfer agreements signed by the administrator ensure that the medical and other information needed for care and treatment of the resident is available and that a bed will be available for the resident on return from the hospital. This is the entire agreement. A visiting surveyor would 1. find this acceptable 2. require changes to the transfer agreement 3. believe residents of that facility were being adequately protected 4. feel comfortable that a residents right to return to the facility has been protected

2. require changes to the transfer agreement

Disaster and Emergency Preparedness The facility should train all employees in emergency procedures 1. by the end of the first week on the job 2. the first day on the job 3. as soon as training staff are available 4. before the employee's first day on the job

2. the first day on the job

Nursing homes are licensed by 1. the counties 2. the states 3. the federal regional government arms 4. centers for medicare and medicaid

2. the states

The discharge social worker at the hospital determines that the resident cared for under the transfer agreement should return, not to the facility, but be placed in an assisted living facility that is a less expensive setting. Normally, 1. this is inappropriate 2. this is appropriate 3. is outside the prerogative of a hospital 4. frowned on by medicare

2. this is appropriate

Under the Final Rules, the right to immediate access to any resident by representatives of the state, ombudsman, protection agencies, and advocacy agencies is 1. subject to resident approval 2. unrestricted 3. carefully set out as to time and place 4. subject to facility approval

2. unrestricted

The facility proudly installed flat-screen TVs in all residents rooms and added a small surcharge to all residents monthly charges. This freed up significant floor space in each room and improved resident morale. This approach to improving resident life 1. is appropriate 2. violates medicaid and medicaid rules 3. meets medicare rules but not those of medicaid 4. meets medicaid, but not medicare rules

2. violates medicaid and medicaid rules

A resident demands to see both the most recent survey results and the plan of correction. The facility shows the survey results, but tells the resident that the plan of correction is confidential and not available. The facility is 1. within its rights 2. violating resident rights 3. acting prudently 4. protecting sensitive information

2. violating resident rights

Resident assessments must be conducted within ________ days after admission, after a significant mental or physical change, and at least every _______ months. 1. 6/8 2. 4/6 3. 14/12 4. 4/24

3. 14/12

Having a transfer agreement with one or more hospitals is ________ (App P & PP) 1. good practice 2. a risk management measure 3. a condition of participation requirement 4. a wise step in preparation for emergency situations

3. a condition of participation requirement

Rights of residents who are adjudged incompetent by a court are exercised by 1. the locally appointed ombudsman 2. the family 3. a person appointed by the court 4. the responsible adult

3. a person appointed by the court

Restraints The administrator who learns that the director of nursing obtained physicians orders for physical restraints on three "too time-consuming 'wanderer'" residents should 1. compliment the director of nursing on solving a staffing problem 2. seek the same for additional residents 3. ask the physicians to remove the restraint orders 4. continue about her normal daily duties

3. ask the physicians to remove the restraint orders

The new resident speaks only Japanese. Before the resident was admitted, the facility advised him through his interpreter that no one in the facility spoke Japanese and that solely sign language would be used. On examining this admission condition in the residents records, the surveyor would 1. feel the facility had made a reasonable choice 2. ask to see the signage to assess its adequacy 3. cite the facility 4. suggest ways the facility might better communicate with this resident

3. cite the facility

6.1.3 Dietary If the facility does not employ a full-time qualified dietitian the facility 1. can appoint instead a full-time director of food services 2. may seek consultation from the outside 3. designates a director of food services who receives consultation from a qualified dietitian 4. employees a nutrition expert who advises the director of food services

3. designates a director of food services who receives consultation from a qualified dietitian

Social Services The recently graduated social worker job applicant for a 140-bed facility states that she has a bachelors degree in psychology and 1 years experience as supervisor of four social workers at a nearby nursing hospital. The administrator should 1. be satisfied that the applicant meets requirements for the facility 2. hire the applicant 3. explore the applicants experience in more depth 4. be pleased that the applicant has supervised four social workers

3. explore the applicants experience in more depth

The facility sets up mechanisms to listen to the views and to record grievances and recommendations of residents and families concerning a proposed policy. The facility has 1. met expectations under the federal regulation 2. exceeded what it is required to do 3. failed to meet regulations 4. set up a good feedback mechanism

3. failed to meet reguations

If the administrator of an average daily total occupancy of 80 residents requires the director of nursing to serve as charge nurse, the administrator ________ (App P & PP) 1. has met final rules requirements 2. needs to routinely report the assignment to the state 3. has failed to meet Final Rules requirements 4. has exceeded Final Rules requirements

3. has failed to meet Final Rules requirements

Resident Transfers The facility may transfer a resident 1. when beds are scarce 2. when the resident is a month late in payment of charges 3. if the facility will close within 1 year 4. if the resident is persistently disruptive to other patients comfort

3. if the facility will close within 1 year

Work A resident may perform services for the facility if the services are 1. voluntary 2. paid at or above prevailing rates 3. in the plan of care 4. light duty in nature

3. in the plan of care

Private Pay The facility is by policy a 100% private pay residents facility. The facility informs prospective residents of this both in writing and orally in a language they can understand. This 1. meets the facility's obligations 2. is permitted under special circumstances in some medicare-certified facilities 3. is not permitted 4. is a safe business practice

3. is not permitted

Notifying _______ residents when their account reaches _______ less than the _______ resource limit for one person is required. 1. medicare/$200/supplemental security income(SSI) 2. medicaid/$300/social security administration 3. medicaid/$200/SSI 4. all/$200/personal funds

3. medicaid/$200/SSI

A facility that informs each resident who is entitled to Medicaid benefits, in writing, at admission, and when changes of services that are paid for under the State plan occur, has 1. met its obligations 2. exceeded its required information 3. not fully met its notice of service obligations 4. properly interpreted the Final Rules requirement to inform

3. not fully met its notice of service obligations

Each facility must designate a physician to serve as medical director ________ (App P & PP) 1. on a part-time basis 2. on a full-time basis 3. on a part or full time basis 4. when needed

3. on a part or full-time basis

Informing a resident of his rights is required 1. within 24 hours of admission 2. prior to admission 3. prior to or at admission 4. as a courtesy to each entering resident

3. prior to or at admission

The facility is not required to use its resources effectively and efficiently to attain the highest practical 1. resident physical well-being 2. resident mental well-being 3. profitability 4. resident psychosocial well-being

3. profitability

Consultant Pharmacist The consultant pharmacist at his monthly visit requires the director of nursing to provide him with a reconciliation report for all controlled drugs signed verified by the director of nursing. The pharmacist 1. has met his obligations 2. has acted in good faith 3. should determine himself that drug records are in order 4. is meeting the expectations of Medicare and Medicaid record keeping

3. should determine himself that drug records are in order

The terms for Medicare and Medicaid participating homes used in the Final Rules effect are ________ (App P & PP) 1. nursing home and nursing facility 2. medicaid facility and medicare facility 3. skilled nursing facility and nursing facility 4. approved facility and licensed facility

3. skilled nursing facility and nursing facility

Establishing and implementing policies regarding the management of the facility are assigned to _______ (App. P & PP) 1. the administrator 2. the owner(s) 3. the governing body or persons designated as such 4. the facility staff

3. the governing body or persons designated as such

Self-Administrator of Drugs (Requirements) An individual resident can self-administer drugs if 1. the pharmacy approves 2. the attending physician approves 3. the interdisciplinary team has determined this is safe 4. the resident accepts responsibility for storing the drugs safely

3. the interdisciplinary team has determined this is safe

The facility must employ a ________ either full time, part time, or on a consultant basis. 1. director of food services 2. chef 3. sufficient dietary staff 4. qualified dietitian

4. qualified dietitian

As part of a larger chain, the local facility believes that self-insurance plus use of Federal Deposit Insurance Corporation insured accounts is a reasonable protection of resident funds. The surveyor is likely to 1. to agree 2. to want to ensure financial stability by reviewing the balance sheets for the facility 3. to issue a deficiency 4. examine the facility's financial track record

3. to issue a deficiency

Residents Right to Advance Directives and to Refuse Treatment and/or Research After the first of 10 scheduled physical therapy sessions following her surgery, the resident tells the physical therapist she is not going to keep the final nine appointments. The resident is 1. making a foolish decision 2. exceeding her rights to control her health care 3. within her rights 4. making a questionable decision

3. within her rights

Access and Visitation Rights A representative of the secretary knocks on the locked front door at 5:30am. and wants immediate admission. The charge nurse tells the representative to wait until the facility opens at 6:00am. This is 1. within the facility's discretion 2. good judgment 3. a safety and risk management behavior 4. a violation

4. a violation

Congress intends that residents have the right to inspect, on 48 hours notice, 1. their medical record 2. the plan of care 3. medication records 4. all their records

4. all their records

Perhaps the most basic purpose of the new management of personal resident funds rules is to 1. reduce resident confusion about finances 2. improve facility accounting efficiency 3. improve interest rates to residents by pooling resident funds 4. avoid commingling resident funds with facility funds

4. avoid commingling resident funds with facility funds

Responsibility for ascertaining professional performance standards for licensed, certified, or registered allied health persons used by the facility rests with the _______ ( App P & PP) 1. respective certifying or registering boards 2. resident or the residents responsible party 3. state 4. facility

4. facility

A residents clinical condition demonstrates that a nasogastric tube is unavoidable. The facility documents this and begins a permanent program designed to prevent aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers. A medicare inspector would consider the facility to have 1. met Final Rules requirements 2. exceeded Final Rules requirements 3. given excellent care 4. failed to implement the intent and spirit of Final Rules

4. failed to implement the intent and spirit of Final Rules

Regular In-Service Education At least every 12 months the facility requires all full-and part-time nurse's aides to fill in a report on the continuing education done by each aide in the facility. This report is then filed in the employee's personnel file. The facility is 1. meeting reporting requirements 2. right to keep the signed report in the employees personnel file 3. not keeping adequate records of training 4. failing to train based on outcome of these reviews

4. failing to train based on outcome of these reviews

Regulations such as those implementing Medicare and Medicaid; Requirements for Long-Term Care Facilities, are first published in the _______ (App P & PP) 1. united states code 2. national register 3. congressional record 4. federal register

4. federal register

All facilities are required to 1. have a governing body 2. have an adequately functioning administrator who reports to a corporate board 3. have a governing body or designated persons 4. have a governing body or designated persons functioning as a governing body

4. have a governing body or designated persons functioning as a governing body

Roommate and Room Changes To accommodate a resident returning from the hospital, the facility informs Mrs. Brown that in half an hour the staff will be moving in a new roommate. The facility 1. is making the right decision 2. has the right to make such needed changes 3. is meeting its obligation to residents 4. is failing to meet its obligations to residents

4. is failing to meet its obligations to residents

Allowable Charges The facility routinely charges all cosmetic and grooming items and services for private, medicare, and medicaid resdients. This charging policy 1. is permitted at facility discretion 2. meets medicare rules, but not medicaid rules 3. meets all rules 4. is not permitted for medicare and medicaid residents

4. is not permitted for medicare and medicaid residents

The comprehensive care plan does not include a(an) ______ (App P & PP) 1. attending physician 2. registered nurse caregiver 3. resident 4. medical director

4. medical director

Use of Outside Resources When the facility does not employ a qualified professional to furnish a service to be provided by the facility, the facility 1. can provide a list of suitably qualified professionals in the community 2. can seek volunteer help for unmet services 3. must use the local hospital 4. must have that service furnished

4. must have that service furnished

6.1.6 Rehabilitation Policies If mental health rehabilitative services for mental illness or mental retardation are required in the resident's plan of care, the facility 1. may seek to transfer the resident to a mental health services setting 2. must transfer the resident to a mental health services setting 3. must provide such services in house 4. must provide in house or obtain such services

4. must provide in house or obtain such services

Th administrator believes that once the obligation to meet federal state and local laws is met, the requirements applicable to the operation of the facility have been satisfied. The administrator is______ 1. following all requirements 2. by definition meeting standards 3. exceeding minimum operational standards 4. only partially correct

4. only partially correct

On discovering that the new intake social worker required the individual holding durable power of attorney for a patients funds to sign a contract guaranteeing payment from that patients funds, the administrator should 1. discourage the social worker from finding similar admissions 2. revoke the guarantee of payment document 3. discipline the social worker 4. praise the intake social worker

4. praise the intake social worker

Not Employing Certain Individuals When a facility learns a court of law has taken action against one of its employees indicating unfitness for service, the facility must 1. fire that employee immediately 2. give the employee 2 weeks notice 3. require additional in-service education for that employee 4. report the courts action to licensing authorities

4. report the courts action to licensing authorities

Residents Rights to All Records A resident ma refuse to release personal and clinical records when 1. transferred to another health care facility 2. third-party payment contracts seek it 3. required by law 4. required by the duly appointed state ombudsman

4. required by the duty appointed state ombudsman

Payments The facility requires only private paying patients to designate a third party who will pay the bills. Medicare and Medicaid patients are billed only from their own funds. This 1. is a correct interpretation the rules 2. is a necessary business practice 3. ensures a good collection rate 4. violates medicare and medicaid standards

4. violates medicare and medicaid standards

Residents Rights to Full Total Health Status Information A resident is concerned about her cognitive status and asks to see all the facility has in her records about her cognitive status including tests administered at admission 4 weeks earlier. The resident is 1. unnecessarily worried 2. inappropriate 3. asking for information the facility should withhold 4. within her rights

4. within her rights