312 ●

Part III Standards for Compliance admission packet;

● meal and medication pass times; ●

● ● the building layout;

facility policies related to the prevention of abuse/ neglect;

● ● a list of residents 55 or under;

residents who communicate with an alternative device or who communicate in a language not predominant in the facility;

●

QM reports (CASPER 3 and 4 reports are provided);

●

the process of how communication to residents, families, and staff during the survey will take place;

●

identification of the appropriate staff member to discuss any special care unit and services, how staff are trained to work with people with demen- tia, and how the facility monitors the use of psy- chopharmacological medications, specifically antipsychotic medications;

● ● the use of paid feeding assistants;

status of the Quality Assurance and Quality Assessment committee; and

●

identification of staff member responsible for the immunization program or the infection control program.

The initial tour is a time for review and observation of the facility, residents, and staff. Residents who were preselected for the sample are now observed to find out if they still reside in the facility and to deter- mine if they can participate in the quality- of-life assessment interview. This tour can be done with or without the accompaniment of a staff member. Observations for possible quality-of-life or quality-of-care concerns are noted, such as resident grooming and dress, staff-to-resident interactions, and sanitation/infection control issues. During the initial tour, as many residents as possible are inter- viewed and observations of care and services are made. Sub-Task 5B, Kitchen/Food Service Observation, is of particular interest to the RDN and dietary staff (11). The purpose of this initial tour is to identify any failed practices related to sanitation and cleanliness of the kitchen; the handling of potentially hazardous foods; the manner in which foods are thawed; and the cleanliness, sanitary practices, and appearance of staff. CMS Form 804, Kitchen/Food Service Observation, dated July 1995, is used to guide the surveyor in the inspection of the kitchen and other

a list of admission and discharge/transfer during the past month with the destination identified;

areas containing food or where food may be stored or served. This form is guidance for F371 Sanitary Conditions, which includes food storage, preparation, and distribution and does not include all the areas the surveyor may review. The surveyor will return at a later time for a more in-depth inspection of the kitchen and to observe any identified areas of concern from resident, family, or group interviews or areas identified during dining observation or on the initial kitchen visit to see if they are still present. (In the QIS process, the mandatory task has a more detailed outline to be used during kitchen inspection. The RDN might consider using this as a reference tool or as part of the facility’s quality improvement program even if the traditional survey process is in place.)

Sample selection is finalized after the entrance conference, the initial tour, and the review of the facili- ty’s roster/sample matrix, resident census, and condi- tions of residents that are provided from the facility. Residents identified as 55 or under and residents with communication variants will be added to the Phase 1 sample. The statute/law requires the sample be “case- mix stratified,” which CMS defines as residents who are interviewable and noninterviewable and residents who require heavy and light care. Residents reviewed during this first phase are identified as “Comprehensive or Focused.” In the comprehensive review, all areas of care are investigated, and observations, interviews, and record reviews are used to support or denounce a failed practice. The focused reviews are more specific to a focused area of concern. The Phase 2 sample is selected partway through the survey when sufficient data have been gathered on the Phase 1 sample. This sample selection may be based on new concerns and/or to continue a further investigation of concerns identi- fied in Phase 1. If an area of failed practice is identi- fied, residents with that same area of concern may be added to the sample in order to identify the scope or number of residents affected by the failure. The number of closed records to review is identified in Appendix P, Table 1, “Sample Selection” (5). Reviews of all residents in the sample include observation, interviews, and record reviews. All resi- dents are reviewed for quality of life and care as it relates to their specific needs—if the care provided has helped them reach or has maintained their highest prac- ticable physical, mental, and psychosocial needs; if their accommodation of needs has been met; and if they have been appropriately assessed using the RAI process. Residents who have had comprehensive reviews are reviewed further to include accuracy of the MDS, the completion of the CAA process, the imple- mentation and revision of the resident’s care plan goals and interventions, the relationship of the resident’s