CMS Manual System - Louisiana Department of Health and Hospitals

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Self-insurance is not an acceptable alternative to a surety bond. Likewise, funds deposited in bank accounts protected by the Federal Deposit Insurance Corporation, or similar entity, also are not acceptable alternatives. Procedures §483.10(c)(7) As part of Phase 2, if your team has any concerns about residents‘ funds, check the amount of the surety bond to make sure it is at least equal to the total amount of residents‘ funds, as of the most recent quarter. If the State survey agency determines that individual circumstances associated with a facility‘s surety bond or its alternative are such that the survey agency cannot determine whether or not the facility is in compliance with the requirements at §483.10(c)(7), then it would be appropriate to make the referral to the State‘s fiscal department. If a corporation has a surety bond that covers all of its facilities, there should be a separate review of the corporation‘s surety bond by the appropriate State agency, such as the State‘s fiscal department, to ensure that all the residents in the corporation‘s facilities within the State are covered against any losses due to acts or errors by the corporation or any of its facilities. The focus of the review should be to ensure that if the corporation were to go bankrupt or otherwise cease to operate, the funds of the residents in the corporation‘s facilities would be protected. ______________________________________________________________________ F162 §483.10(c)(8) Limitation on Charges to Personal Funds The facility may not impose a charge against the personal funds of a resident for any item or services for which payment is made under Medicaid or Medicare (except for applicable deductible and coinsurance amounts). The facility may charge the resident for requested services that are more expensive than or in excess of covered services in accordance with §489.32 of this chapter. (This does not affect the prohibition on facility charges for items and services for which Medicaid has paid. See §447.15, which limits participation in the Medicaid program to providers who accept, as payment in full, Medicaid payment plus any deductible, coinsurance, or copayment required by the plan to be paid by the individual.) (i) Services included in Medicare or Medicaid payment. During the course of a covered Medicare or Medicaid stay, facilities may not charge a resident for the following categories of items and services: (A) Nursing services as required at §483.30 of this subpart.
(B) Dietary services as required at §483.35 of this subpart. (C) An activities program as required at §483.15(f) of this subpart. (D) Room/bed maintenance services. (E) Routine personal hygiene items and services as required to meet the needs of residents, including, but not limited to, hair hygiene supplies, comb, brush, bath soap, disinfecting soaps or specialized cleansing agents when indicated to treat special skin problems or to fight infection, razor, shaving cream, toothbrush, toothpaste, denture adhesive, denture cleaner, dental floss, moisturizing lotion, tissues, cotton balls, cotton swabs, deodorant, incontinence care and supplies, sanitary napkins and related supplies, towels, washcloths, hospital gowns, over the counter drugs, hair and nail hygiene services, bathing, and basic personal laundry. (F) Medically-related social services as required at §483.15(g) of this subpart. (ii) Items and services that may be charged to residents’ funds. Listed below are general categories and examples of items and services that the facility may charge to residents’ funds if they are requested by a resident, if the facility informs the resident that there will be a charge, and if payment is not made by Medicare or Medicaid: (A) Telephone; (B) Television/radio for personal use; (C) Personal comfort items, including smoking materials, notions and novelties, and confections; (D) Cosmetic and grooming items and services in excess of those for which payment is made under Medicaid or Medicare; (E) Personal clothing; (F) Personal reading matter; (G) Gifts purchased on behalf of a resident; (H) Flowers and plants; and (I) Social events and entertainment offered outside the scope of the activities program, provided under §483.15(f) of this subpart.
Page 1 and 2: CMS Manual System Pub. 100-07 State
Page 3 and 4: State Operations Manual Appendix PP
Page 5 and 6: §483.25(n) Influenza and Pneumococ
Page 7 and 8: (including eligibility, coverage, c
Page 9 and 10: ___________________________________
Page 11 and 12: Procedures §483.10(a)(3) and (4) D
Page 13 and 14: ―Advance directive‖ means a wri
Page 15 and 16: §483.10(b)(5) -- The facility must
Page 17 and 18: Provide written information concern
Page 19 and 20: ___________________________________
Page 21 and 22: §483.10(c)(3) Deposit of Funds (i)
Page 23 and 24: Were limits placed on amounts that
Page 25: ___________________________________
Page 29 and 30: medical service that is recognized
Page 31 and 32: satisfactorily resolved by discussi
Page 33 and 34: (i) Transfer to another health care
Page 35 and 36: Interpretive Guidelines §483.10(g)
Page 37 and 38: (ii) Any representative of the Stat
Page 39 and 40: ___________________________________
Page 41 and 42: efore the resident may exercise tha
Page 43 and 44: §483.12(a) Transfer, and Discharge
Page 45 and 46: §483.10(o), Tag F177, addresses th
Page 47 and 48: Look for changes in source of payme
Page 49 and 50: How to notify the ombudsman (name,
Page 51 and 52: ___________________________________
Page 53 and 54: Interpretive Guidelines §483.12(d)
Page 55 and 56: Interpretive Guidelines §483.12(d)
Page 57 and 58: ―Convenience‖ is defined as any
Page 59 and 60: order reflecting the presence of a
Page 61 and 62: consistently implemented. Determine
Page 63 and 64: monitored separation from other Res
Page 65 and 66: to prevent occurrences, monitoring
Page 67 and 68: injurious behaviors, residents with
Page 69 and 70: A certified nurse aide found guilty
Page 71 and 72: o Day-to-day use of plastic cutlery
Page 73 and 74: for the resident‘s safety. For ex
Page 75 and 76: If a facility changes its policy to
Page 77 and 78:
___________________________________
Page 79 and 80:
Staff should strive to reasonably a
Page 81 and 82:
egarding medical information. The f
Page 83 and 84:
The report stated that, ―Resident
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If not contraindicated, modifying t
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o Visual interaction and to compens
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For residents from diverse ethnic o
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Encouraging volunteer-type work tha
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12 Christenson, M.A. (1996). Enviro
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selected this activity. The Nationa
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Interview the social services staff
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Identifies how the facility will pr
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o Determine if the facility has acc
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(ii) Has 2 years of experience in a
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Once the team has completed its inv
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___________________________________
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transportation services that are no
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F252 (Rev. 66, Issued: 10-01-10, Ef
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Although this Tag can be used for i
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___________________________________
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___________________________________
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Intent §483.20 To provide the faci
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(vii) Psychosocial well-being ―Ps
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___________________________________
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Resident‘s decision making change
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___________________________________
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(i) Admission assessment. (ii) Annu
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Completing an assessment that is no
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Interpretive Guidelines §483.20(h)
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Submitting correction(s) to informa
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If the resident has refused treatme
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. Do the dietitian and speech thera
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Are physicians‘ orders carried ou
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What types of pre-discharge prepara
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If the resident‘s PAS report indi
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Briefly review the assessment, care
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and knowledge of the resident, shou
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Determine whether the facility had
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NOTE: Guidance regarding pressure u
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The resident has the right to refus
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others being hypersensitivity, idio
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Examples of clinical resources avai
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indicators which may represent pain
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• Impact of pain on quality of li
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National Center for Complementary a
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3 National Center for Complementary
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The objective of this protocol is t
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How effective the interventions hav
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Nurse Interview. Interview a nurse
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Communicated with the health care p
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qualified persons with input from t
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of pain. First, the team must rule
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The resident experienced daily or l
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Extensive Assistance - While reside
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Procedures: §483.25(a)(1)(ii) Dete
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Identify if resident triggers CAAs
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USE OF SPEECH, LANGUAGE, OR OTHER F
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___________________________________
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Probes: §483.25(b) Identify if res
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―Debridement‖- Debridement is t
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OVERVIEW A pressure ulcer can occur
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procedures, during prolonged ambula
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Assessment of a resident‘s skin c
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Both urine and feces contain substa
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use of lifting devices for repositi
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in accord with resident‘s overall
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Whether pain, if present, is being
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Some clinicians utilize validated i
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generally impairs wound healing, se
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15 Fuhrer M., Garber S., Rintola D.
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of Localized Chronic Wound Infectio
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Previously unidentified open areas;
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complications including reassessmen
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If not, the development of the pres
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o Determine if the care plan was pe
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Examples of possible avoidable nega
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(Rev. 66, Issued: 10-01-10, Effecti
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later stages of dementia, diabetes,
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the resident‘s concerns and offer
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Functional and cognitive capabiliti
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toileting and response to specific
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cognitive deficit—provided that t
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the epidermis (comparable to a deep
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adequate. Based on the resident‘s
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Follow-Up of UTIs rectal temperatur
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9 Maki, D.G. & Tambyah, P.A. (2001)
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Whether the resident is on a schedu
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catheter/continence services. Reque
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Defines the catheter, tubing and ba
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If the attending physician is unava
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Assess, prevent (to the extent poss
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perform relevant activities of dail
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Requires immediate correction, as t
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The failures of the facility to pro
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Identify if resident triggers CAAs
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Probes: §483.25(f)(1) For sampled
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___________________________________
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Using universal precautions and cle
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Monitor the effectiveness of the
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Directs resources to address safety
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Monitoring is the process of evalua
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those (e.g., disease, environment)
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Addressing the factors for the fall
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155°F 148°F 140°F 133°F 127°F
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NOTE: The Safe Medical Devices Act
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ENDNOTES 1 Centers for Medicare & M
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Use To evaluate whether the facilit
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2. Interview The adequacy of the su
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Changes in condition such as the ab
Page 295 and 296:
Noncompliance for F323 After comple
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Once the survey team has completed
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Unsafe wandering and/or elopement t
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Severity Level 1 Considerations: No
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―Qualified dietitian‖ refers to
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Current standards of practice recom
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dry mouth, and diseases of the orop
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Based on analysis of relevant infor
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For many residents (including overw
Page 313 and 314:
In deciding whether and how to inte
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End-of-Life Resident choices and cl
Page 317 and 318:
11 Chouinard, J. (2000). Dysphagia
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Objectives Use INVESTIGATIVE PROTOC
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Nutrition interventions, such as sn
Page 323 and 324:
Whether the facility identified res
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Review of Facility Practices Relate
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42 CFR §483.20(b)(1), Tag F272, Co
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DEFICIENCY CATEGORIZATION (Part IV,
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If immediate jeopardy has been rule
Page 333 and 334:
Intent §483.25(j) The intent of th
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Is proper administration technique
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§483.25(k)(5) Standard: Tracheal S
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(v) In the presence of adverse cons
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physical actions such as: pacing, c
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o Support decisions about modifying
Page 345 and 346:
individual with dementia, to improv
Page 347 and 348:
Medication management is based in t
Page 349 and 350:
Whether the signs, symptoms, or rel
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o Pain; o Chronic psychiatric illne
Page 353 and 354:
Common Conditions/ Symptoms Example
Page 355 and 356:
Identifying the essential informati
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necessarily indicate a need for dos
Page 359 and 360:
Sometimes, the decision about wheth
Page 361 and 362:
The continued use is in accordance
Page 363 and 364:
J., & Bates, D.W. (2005). Incidence
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(NSAIDs) Medication Issues and Conc
Page 367 and 368:
Antibiotics Medication Issues and C
Page 369 and 370:
Medication Issues and Concerns prim
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Medication Issues and Concerns Mono
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chlorpropamide glyburide Antifungal
Page 375 and 376:
Medication Issues and Concerns MAO
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Medication Issues and Concerns days
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Medication Issues and Concerns Medi
Page 381 and 382:
uspirone Medication Issues and Conc
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Medication Issues and Concerns amio
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Medication Issues and Concerns Angi
Page 387 and 388:
Nitrates, e.g., Medication Issues a
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Medication Issues and Concerns Anti
Page 391 and 392:
Medication Issues and Concerns esom
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Medication Issues and Concerns laxa
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Medication Issues and Concerns Resp
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Medication Issues and Concerns hygi
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Medication Issues and Concerns All
Page 401 and 402:
iperiden trihexyphenidyl olanzapine
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NOTE: This review is not intended t
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If during the review, you identify
Page 407 and 408:
How he/she approaches the MRR proce
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o Failure to monitor a medication c
Page 411 and 412:
42 CFR 483.20(b), F272, Comprehensi
Page 413 and 414:
Complications (such as diarrhea wit
Page 415 and 416:
NOTE: If Severity Level 3 (actual h
Page 417 and 418:
―Resident Condition‖ -- The res
Page 419 and 420:
Medication Errors Due to Failure to
Page 421 and 422:
Medications Administered with Enter
Page 423 and 424:
if the facility uses the ―recap
Page 425 and 426:
technique requires a comparison of
Page 427 and 428:
eaction to the vaccine than would h
Page 429 and 430:
o Persons who are 50 years of age o
Page 431 and 432:
Sampling: To determine if education
Page 433 and 434:
Processes to address issues that ar
Page 435 and 436:
The facility failed to document tha
Page 437 and 438:
Requires immediate correction as th
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(ii) other nursing personnel. §483
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(3) The State finds that, for any p
Page 443 and 444:
(A) Has only patients whose physici
Page 445 and 446:
For SNFs and SNF/NFs which may be w
Page 447 and 448:
Assessing special nutritional needs
Page 449 and 450:
Probes: §483.35(c)(1) Are resident
Page 451 and 452:
___________________________________
Page 453 and 454:
Interpretive Guidelines: §483.35(f
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―Food Preparation‖ refers to th
Page 457 and 458:
for growth of harmful pathogens. Ba
Page 459 and 460:
Source of Primary Agents of Primary
Page 461 and 462:
Food Receiving and Storage When foo
Page 463 and 464:
specified below will either kill da
Page 465 and 466:
may consist of a combination of foo
Page 467 and 468:
at the manifold, which is the area
Page 469 and 470:
INVESTIGATIVE PROTOCOL SANITARY CON
Page 471 and 472:
2. Interview Observe that foods are
Page 473 and 474:
cooling, and ensure that PHF/TCS fo
Page 475 and 476:
2. Degree of harm (actual or potent
Page 477 and 478:
Severity Level 1 Considerations: No
Page 479 and 480:
Intent: §483.35(h) The intent of t
Page 481 and 482:
Whether they are assisting assigned
Page 483 and 484:
and drink. If concerns are identifi
Page 485 and 486:
Compliance with 42 CFR 483.35(h), F
Page 487 and 488:
eligibility to eat and drink with a
Page 489 and 490:
Examples of the facility‘s non-co
Page 491 and 492:
delegating and supervising follow-u
Page 493 and 494:
Probes: §483.40(b) Do services ord
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For what reasons are residents sent
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(2) Obtain the required services fr
Page 499 and 500:
Probes: §483.45(a)(1)(2) 1. For ph
Page 501 and 502:
a care plan must be developed, foll
Page 503 and 504:
Are residents missing teeth and may
Page 505 and 506:
Definitions are provided to clarify
Page 507 and 508:
The National Coordinating Council f
Page 509 and 510:
Establish procedures that address m
Page 511 and 512:
How the receipt of medications from
Page 513 and 514:
Documentation of actual disposition
Page 515 and 516:
the pharmaceutical services. Fourth
Page 517 and 518:
The facility‘s failure to involve
Page 519 and 520:
The facility in collaboration with
Page 521 and 522:
(2) The pharmacist must report any
Page 523 and 524:
errors, or other irregularities, an
Page 525 and 526:
NOTE: The surveyor‘s review of me
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o Seizure activity; o Spontaneous o
Page 529 and 530:
Common Medication-Medication Intera
Page 531 and 532:
The identification of any irregular
Page 533 and 534:
aspects of pharmaceutical services.
Page 535 and 536:
The pharmacist‘s MRR failed to id
Page 537 and 538:
(3) Determines that drug records ar
Page 539 and 540:
During a medication pass, medicatio
Page 541 and 542:
This requirement has several aspect
Page 543 and 544:
Determine whether the noncompliance
Page 545 and 546:
§483.65 Infection Control The faci
Page 547 and 548:
―Contact precautions‖ are measu
Page 549 and 550:
Critical aspects of the infection p
Page 551 and 552:
Conducting data analysis to help de
Page 553 and 554:
observations of staff practices and
Page 555 and 556:
Complications from invasive diagnos
Page 557 and 558:
Airborne transmission can occur by
Page 559 and 560:
After removing gloves or aprons; an
Page 561 and 562:
Depending on the situation, options
Page 563 and 564:
tears or holes be replaced. It is r
Page 565 and 566:
ENDNOTES 68 Siegel, J.D., Rhinehart
Page 567 and 568:
Guidelines for environmental infect
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INVESTIGATIVE PROTOCOL FOR INFECTIO
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Multiple use items (e.g., shower ch
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Interview the Designated Infection
Page 576 and 577:
Utilize infection precautions to mi
Page 578 and 579:
Properly implement transmission bas
Page 580 and 581:
influenza in residents on another,
Page 582 and 583:
§483.70(a)(6)(ii) The dispensers a
Page 584 and 585:
Additional guidance is available in
Page 586 and 587:
§483.70(d)(1)(i) Accommodate no mo
Page 588 and 589:
Procedures: §483.70(d)(1)(iv) Ther
Page 590 and 591:
Interpretive Guidelines: §483.70(d
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centralized nursing station, this c
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Are spaces adaptable for all intend
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defined as substandard quality of c
Page 598 and 599:
(ii) Responsible for the management
Page 600 and 601:
Probes: §483.75(e)(2 - 4) During a
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1919(e)(2)(A) of the Act the facili
Page 604 and 605:
Interpretive Guidelines: §483.75(f
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The medical director helps the faci
Page 608 and 609:
MEDICAL DIRECTION The facility is r
Page 610 and 611:
The medical director is responsible
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REFERENCES 1 Pattee JJ, Otteson OJ.
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support with ventilators, intraveno
Page 616 and 617:
The medical director provides input
Page 618 and 619:
V. DEFICIENCY CATEGORIZATION (Part
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NOTE: If immediate jeopardy has bee
Page 622 and 623:
Intent: §483.75(j)(1) The intent o
Page 624 and 625:
Probes: §483.75(j)(1)(i) - (iv) Ar
Page 626 and 627:
An inability to order radiological
Page 628 and 629:
There is a written policy, at the h
Page 630 and 631:
If there is a problem with confiden
Page 632 and 633:
(i) Residents will be transferred f
Page 634 and 635:
Preventing deviation from care proc
Page 636 and 637:
Meetings of the QAA committee must
Page 638 and 639:
INVESTIGATIVE PROTOCOL QUALITY ASSE
Page 640 and 641:
The assigned surveyor should interv
Page 642 and 643:
2. Degree of harm (actual or potent
Page 644 and 645:
The facility‘s QAA committee meet
Page 646 and 647:
R04SOM 11/12/2004 Guidance to Surve
Page 648 and 649:
e. Special Care Fl19____ Receiving
Page 650 and 651:
Form CMS-672 (10/10) ReSIDent CenSu
Page 652 and 653:
Form CMS-672 (10/10) ReSIDent CenSu
Page 654 and 655:
DEPARTMENT OF HEALTH AND HUMAN SERV
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22. Psychoactive Medications: If th
Page 658 and 659:
16. Weight Change/Nutrition/Swallow
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RESIDENT REVIEW WORKSHEET (continue
Page 662:
RESIDENT REVIEW WORKSHEET (continue
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CMS Manual System - Louisiana Department of Health and Hospitals

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