Chapter 21 Federal Regulations

medication regimen (including psychopharmacological interventions) to his or her condition, and the use of the investigative protocol if he or she is one of the WHP residents. Observations are made of residents who voice concerns related to dining or food quality and who are at risk nutritionally. Focused reviews during Phase 2 look at areas of concern where the team requires more information to determine compliance and the scope of the problem. Resident interviews are conducted throughout the

survey process. Family members of residents who are noninterviewable are interviewed, and a group meeting is conducted for residents who are alert and capable of communicating in a group setting. Specific questions are asked of the resident and/or family members and in the group meeting related to food service and the dining experience. Staff interviews are conducted to clarify observations and care of residents and to clarify policies and procedures. A staff member may be interviewed to identify policies and procedures as they relate to nutrition and dining services. Questions include:

●

What do you do if a resident loses 5 lbs in one week?

●

If someone has weight loss, when do you contact the RDN?

●

What is your policy if someone does not con- sume a supplement?

The staff member interviewed may not be the charge nurse or someone who has in-depth answers about these policies. Conduct in-service education for all staff in order to make sure they know what to do when a concern arises.

Observations of resident care take place based on the care needs of a resident, with general observations of the resident’s grooming, hydration, positioning, room, and so on, taking place throughout the survey. Observing during dining is a perfect way to see multi- ple areas of care and quality-of-life issues for a large number of residents and to examine the meal service. In the traditional survey, team members may observe dining during any time of the survey. Medication pass is observed with a fixed number of observations required and physician orders verified to match the observed pass. Throughout the survey, the general con- dition of the facility, rooms, hallways, dining areas, therapy rooms, and so on, are observed, as well as the staff’s handling of linen, food trays, and resident care equipment.

Record review occurs for all residents in the

sample. The record review is used to gather addi- tional information and to verify that the MDS

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assessment and care planning interventions are appropriate for the resident. Weight records are a part of the review process. It is critical to the assess- ment process and to the quality care of a resident that the RDN or dietary department verify that weights are accurate. Having policies in place as to what takes place if there is a change in the weight and the accurate assessment and documentation related to care planning and interventions are critical for the care of the resident. It is important to have a referral system in place as to when someone is referred to the RDN. Conducting a complete assess- ment to identify problems and to develop or revise the plan of care will ensure the resident receives the best care and that the facility is in compliance with the regulations.

Quality Indicator Survey

The QIS consists of the following tasks (details are contained in the QIS Surveyor Training Manual) (5):

Introduction

Task 1: Off-site Survey Preparation: ●

Off-site Survey Preparation and Initial Sampling

Task 2: On-site Preparatory Activities and Entrance Conference Prior to the Entrance Conference

● ● Entrance Conference Possible Off-Hours Activities

Task 3: Initial Tour ●

Tour

Task 4: Stage I Survey Tasks ●

● ● ● Finalize Sample Selection

● Stage I: Sample Selection Procedures Stage I: Team Meetings (first meeting) Stage I: Information Gathering Stage I: Admission Sample Review ● Medical Record Review

● Stage I: Census Sample Review Resident Interviews

● ● ● ●

Resident Unavailable for Interviews Resident Observations Staff Interviews

● Medical Record Review Family Interviews

●

Task 5: Non-staged Survey Tasks ●

● Dining Observation

Resident Council President/Representative Interview