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Interpretive Guidelines §483.12(a)(2) and (3) If transfer is due to a significant change in the resident‘s condition, but not an emergency requiring an immediate transfer, then prior to any action, the facility must conduct the appropriate assessment to determine if a new care plan would allow the facility to meet the resident‘s needs. (See §483.20(b)(4)(iv), F274, for information concerning assessment upon significant change.) Conversion from a private pay rate to payment at the Medicaid rate does not constitute non-payment. Refusal of treatment would not constitute grounds for transfer, unless the facility is unable to meet the needs of the resident or protect the health and safety of others. Documentation of the transfer/discharge may be completed by a physician extender unless prohibited by State law or facility policy. Procedures §483.12(a)(2) and (3) During closed record review, determine the reasons for transfer/discharge. Do records document accurate assessments and attempts through care planning to address resident‘s needs through multi-disciplinary interventions, accommodation of individual needs and attention to the resident‘s customary routines? Did the resident‘s physician document the record if: o The resident was transferred/discharged for the sake of the resident‘s welfare and the resident‘s needs could not be met in the facility (e.g., a resident develops an acute condition requiring hospitalization)? or o The resident‘s health improved to the extent that the transferred/discharged resident no longer needed the services of the facility. Did a physician document the record if residents were transferred because the health of individuals in the facility is endangered? Do the records of residents transferred/discharged due to safety reasons reflect the process by which the facility concluded that in each instance transfer or discharge was necessary? Did the survey team observe residents with similar safety concerns in the facility? If so, determine differences between these residents and those who were transferred or discharged.
Look for changes in source of payment coinciding with transfer. If you find such transfer, determine if the transfers were triggered by one of the criteria specified in §483.12(a)(2). Ask the ombudsman if there were any complaints regarding transfer and/or discharge. If there were, what was the result of the ombudsman‘s investigation? If the entity to which the resident was discharged is another long term care facility, evaluate the extent to which the discharge summary and the resident‘s physician justify why the facility could not meet the needs of this resident. ______________________________________________________________________ F203 §483.12(a)(4) Notice Before Transfer Before a facility transfers or discharges a resident, the facility must-- (i) Notify the resident and, if known, a family member or legal representative of the resident of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand. (ii) Record the reasons in the resident’s clinical record; and (iii) Include in the notice the items described in paragraph (a)(6) of this section. §483.12(a)(5) Timing of the notice. (i) Except when specified in paragraph (a)(5)(ii) of this section, the notice of transfer or discharge required under paragraph (a)(4) of this section must be made by the facility at least 30 days before the resident is transferred or discharged. (ii) Notice may be made as soon as practicable before transfer or discharge when-- (A) The safety of the individuals in the facility would be endangered under paragraph (a)(2)(iii) of this section; (B) The health of individuals in the facility would be endangered, under (a)(2)(iv) of this section; (C) The resident’s health improves sufficiently to allow a more immediate transfer or discharge, under paragraph (a)(2)(ii) of this section; (D) An immediate transfer or discharge is required by the resident’s urgent medical needs, under paragraph (a)(2)(i) of this section; or
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 and 26: ___________________________________
Page 27 and 28: (B) Dietary services as required at
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: §483.10(o), Tag F177, addresses th
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
Page 85 and 86: If not contraindicated, modifying t
Page 87 and 88: o Visual interaction and to compens
Page 89 and 90: For residents from diverse ethnic o
Page 91 and 92: Encouraging volunteer-type work tha
Page 93 and 94: 12 Christenson, M.A. (1996). Enviro
Page 95 and 96: selected this activity. The Nationa
Page 97 and 98:
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
Page 211 and 212:
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
Page 239 and 240:
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
Page 275 and 276:
Directs resources to address safety
Page 277 and 278:
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
Page 301 and 302:
Severity Level 1 Considerations: No
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―Qualified dietitian‖ refers to
Page 305 and 306:
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
Page 325 and 326:
Review of Facility Practices Relate
Page 327 and 328:
42 CFR §483.20(b)(1), Tag F272, Co
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DEFICIENCY CATEGORIZATION (Part IV,
Page 331 and 332:
If immediate jeopardy has been rule
Page 333 and 334:
Intent §483.25(j) The intent of th
Page 335 and 336:
Is proper administration technique
Page 337 and 338:
§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
Page 351 and 352:
o Pain; o Chronic psychiatric illne
Page 353 and 354:
Common Conditions/ Symptoms Example
Page 355 and 356:
Identifying the essential informati
Page 357 and 358:
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
Page 365 and 366:
(NSAIDs) Medication Issues and Conc
Page 367 and 368:
Antibiotics Medication Issues and C
Page 369 and 370:
Medication Issues and Concerns prim
Page 371 and 372:
Medication Issues and Concerns Mono
Page 373 and 374:
chlorpropamide glyburide Antifungal
Page 375 and 376:
Medication Issues and Concerns MAO
Page 377 and 378:
Medication Issues and Concerns days
Page 379 and 380:
Medication Issues and Concerns Medi
Page 381 and 382:
uspirone Medication Issues and Conc
Page 383 and 384:
Medication Issues and Concerns amio
Page 385 and 386:
Medication Issues and Concerns Angi
Page 387 and 388:
Nitrates, e.g., Medication Issues a
Page 389 and 390:
Medication Issues and Concerns Anti
Page 391 and 392:
Medication Issues and Concerns esom
Page 393 and 394:
Medication Issues and Concerns laxa
Page 395 and 396:
Medication Issues and Concerns Resp
Page 397 and 398:
Medication Issues and Concerns hygi
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Medication Issues and Concerns All
Page 401 and 402:
iperiden trihexyphenidyl olanzapine
Page 403 and 404:
NOTE: This review is not intended t
Page 405 and 406:
If during the review, you identify
Page 407 and 408:
How he/she approaches the MRR proce
Page 409 and 410:
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
Page 439 and 440:
(ii) other nursing personnel. §483
Page 441 and 442:
(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
Page 455 and 456:
―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
Page 495 and 496:
For what reasons are residents sent
Page 497 and 498:
(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
Page 527 and 528:
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
Page 570 and 571:
INVESTIGATIVE PROTOCOL FOR INFECTIO
Page 572 and 573:
Multiple use items (e.g., shower ch
Page 574 and 575:
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
Page 592 and 593:
centralized nursing station, this c
Page 594 and 595:
Are spaces adaptable for all intend
Page 596 and 597:
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
Page 602 and 603:
1919(e)(2)(A) of the Act the facili
Page 604 and 605:
Interpretive Guidelines: §483.75(f
Page 606 and 607:
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
Page 612 and 613:
REFERENCES 1 Pattee JJ, Otteson OJ.
Page 614 and 615:
support with ventilators, intraveno
Page 616 and 617:
The medical director provides input
Page 618 and 619:
V. DEFICIENCY CATEGORIZATION (Part
Page 620 and 621:
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
Page 656 and 657:
22. Psychoactive Medications: If th
Page 658 and 659:
16. Weight Change/Nutrition/Swallow
Page 660 and 661:
RESIDENT REVIEW WORKSHEET (continue
Page 662:
RESIDENT REVIEW WORKSHEET (continue
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