Hot Topics and Trends in LTC Stefanie Mozgai, BA, RN, CPM Assistant Commissioner NJ Department of Health Health Facility Survey & Field Operations

Disclaimer This power point presentation is an educational tool prepared by the Department of Health & Senior Services that is general in nature. It is not intended to be an exhaustive review of the Department’s administrative code & is not intended as legal advice. Materials presented should not substitute for actual statutory or regulatory language. Always refer to the current edition of a referenced statute, code &/or rule or regulation for language.

Desired Outcomes Enhance professional development Broaden knowledge of updates released by CMS and NJDOH Update awareness of current NJ survey results Share with partners

Agenda Citation Trends Plans of Correction and e-POC Implementation MDS Focused Survey Infection Control in Nursing Homes New Nursing Home Survey Process Guidance for Inmates in Long Term Care ESRD – Dialysis in Nursing Homes Upcoming DoH Training Pressure Ulcer Reduction Drug Diversion Coalition

What Surveyors See

NJ Top Ten Citations: 10/1/15- 3/1/16 F 281 Service Provided Meet Professional Standards F 323 Accident Hazard Prevention/Supervision F 371 Food Safety and Sanitation F 441 Infection Control F 309 Maintain Highest Practical Function and Well Being F 425 Pharmaceutical Services F 279 Comprehensive Care Plans F 514 Resident Records: Complete, Accurate, Accessible F 329 Drug Regimen is Free from Unnecessary Medications F465 Safe, Functional, Sanitary, Comfortable Environment F-281 - Services provided or arranged by the facility must meet professional standards of quality Does the care plan reflect who the resident is? Is it reflective of what the resident wants? Is the care plan based on a thorough assessment? Is it built on the resident’s needs and strengths? Is the family involved in the Plan? Does the Care Team, including the C.N.A. , know the Plan? Adherence to parameters of medication administration Accurate documentation on MAR, TARs, DNRs, Implementation of Physician Orders Clarification of Physician Orders Services provided by appropriate licensed and certified staff Response to Emergency situations F-371 – Food is stored prepared, distributed, and served under sanitary conditions. Food must be prepared to prevent the spread of food-borne illness since foodborne illness is often fatal to nursing home residents and must be avoided. Safe storage of refrigerated items Time temperature standards for food handling especially Potentially Hazardous Foods (PHF) Certified & trained (in-Services) Dietary Personnel Personnel hygiene Dish & pot ware cleaning & storage Dietary P & Ps and Documentation F-323 - Resident’s environment must be free of accident hazards & each resident must receive adequate supervision & assistive devices to prevent accidents Secured areas when necessary Smoking Supervision Careless Smoking Toileting Assistance Transfer Techniques Elopement F- 441 – Establish an Infection Control Program designed to provide an environment to prevent the transmission of disease. The infection control program must be effective for investigating, controlling, and preventing infections. Hand-hygiene Wound Care Equipment & supplies Contact Precautions Dressings Linen storage Glove Use Secure Storage Accountability; Narcotic Count Sheets r/t availability; Accurate Inventory Safety during Med Pass Med cart, med room, key/access status F279 – Comprehensive Care Plan Developed from results of accurate assessments to & must be reviewed & revised. Must include: measurable objectives & timetables to meet a resident’s medical, nursing, mental & psychosocial needs , and describe services to be provided to attain or maintain the resident’s highest practicable physical, mental, & psychosocial well-being. Reflects who the resident is and what the resident wants Built on needs and strengths Care Team knows the Resident and knows the Plan Revised when necessary Realistic

CMS Top Ten Citations: 10/1/14- 9/30/15 F 441 Infection Control* F 371 Food Safety and Sanitation* F 323 Accident Hazard Prevention/Supervision* F 309 Maintain Highest Practical Function and Well Being* F 431 Drug records, label/storage drugs & biologicals F 329 Drug Regimen is Free from Unnecessary Medications* F 279 Comprehensive Care Plans* F 514 Resident Records: Complete, Accurate, Accessible* F 241 Dignity and Respect of Individuality F 282 Services by Qualified Persons/Per Care Plan *Also on NJ’s Top Ten F-281 - Services provided or arranged by the facility must meet professional standards of quality Does the care plan reflect who the resident is? Is it reflective of what the resident wants? Is the care plan based on a thorough assessment? Is it built on the resident’s needs and strengths? Is the family involved in the Plan? Does the Care Team, including the C.N.A. , know the Plan? Adherence to parameters of medication administration Accurate documentation on MAR, TARs, DNRs, Implementation of Physician Orders Clarification of Physician Orders Services provided by appropriate licensed and certified staff Response to Emergency situations F-371 – Food is stored prepared, distributed, and served under sanitary conditions. Food must be prepared to prevent the spread of food-borne illness since foodborne illness is often fatal to nursing home residents and must be avoided. Safe storage of refrigerated items Time temperature standards for food handling especially Potentially Hazardous Foods (PHF) Certified & trained (in-Services) Dietary Personnel Personnel hygiene Dish & pot ware cleaning & storage Dietary P & Ps and Documentation F-323 - Resident’s environment must be free of accident hazards & each resident must receive adequate supervision & assistive devices to prevent accidents Secured areas when necessary Smoking Supervision Careless Smoking Toileting Assistance Transfer Techniques Elopement F- 441 – Establish an Infection Control Program designed to provide an environment to prevent the transmission of disease. The infection control program must be effective for investigating, controlling, and preventing infections. Hand-hygiene Wound Care Equipment & supplies Contact Precautions Dressings Linen storage Glove Use Secure Storage Accountability; Narcotic Count Sheets r/t availability; Accurate Inventory Safety during Med Pass Med cart, med room, key/access status F279 – Comprehensive Care Plan Developed from results of accurate assessments to & must be reviewed & revised. Must include: measurable objectives & timetables to meet a resident’s medical, nursing, mental & psychosocial needs , and describe services to be provided to attain or maintain the resident’s highest practicable physical, mental, & psychosocial well-being. Reflects who the resident is and what the resident wants Built on needs and strengths Care Team knows the Resident and knows the Plan Revised when necessary Realistic

Plans of Correction - Five Elements Element #1 - Address how corrective action will be accomplished for those residents found to have been affected by the deficient practice; Element #2 - Address how the facility will identify other residents having the potential to be affected by the same deficient practice. Element #3 - Address what measures will be put into place or systemic changes made to ensure that the deficient practice will not recur; Element #4 - Indicate how the facility plans to monitor its performance to make sure that solutions are sustained; and Element #5 - Dates when corrective action will be completed practice Key Points: One POC per Tag One Completion date per Tag The Statement of Deficiencies (CMS-2567) must be signed and dated by the Administrator on both the FOOO; KOOO and SOOO

Plans of Correction – Key Points One POC per Tag One Completion date per Tag The Statement of Deficiencies (CMS-2567) must be signed and dated by the Administrator on Initial Comments page of: Federal Health Report : FOOO Life Safety Code Report: KOOO State Deficiency Report: SOOO Sending e-mail to LTC POC: Include Facility’s full name on subject line Completion Dates are by tag not by elements!!! Even when there are not deficiencies.

e – POC Implementation Transition – current electronic DOH pilot to federal electronic process Initial use coincided with the recertification survey starting in Spring 2015, after which, will include Revisits, Complaints, Federal Monitoring Surveys Web-based training available now at: www.qtso.com Password required – To obtain: e-mail Debi Chapman; Subject line: “e-POC Training” The 2567 e-POC system is open - Providers may enroll now Training – Surveyors and Providers State Contacts: Debi Chapman at: Debra.Chapman@doh.state.nj.us, Pamela Gendlek at: Pamela.Gendlek@doh.state.nj.us

MDS Focused Surveys Expansion of Pilot – Process works All States participated Nursing Homes and surveys per State to be announced by CMS Approximately two days onsite per survey Conducted by two specialty trained surveyors Exit Conference to be provided Deficiencies can be issued

Infection Control in NHs CMS is in process of piloting an infection control worksheet It is not being piloted in NJ at this time

New Nursing Home Survey Process CMS is in process of piloting a new electronic survey process Currently being piloted with the CMS Regional Office staff not in NJ at this time NJ has volunteered to participate when the pilot is rolled out to States

Guidance for Inmates in LTC CMS is in the process of formulating regulatory guidance Focus may be on patient rights and facility’s ability to meet conditions for participation in Medicare program

Dialysis in LTC CMS is in the process of formulating regulatory guidance Guidance is being developed by both the CMS LTC Division as well as the ESRD Division

Upcoming Training on 8:43E The regulations in NJAC 8:43E pertain to all State Licensed facilities During Calendar Year 2016, NJDOH will work with NJHA on providing education to providers on the various sub chapters of these regulations

Pressure Ulcer Reduction NJDOH issued a memo March 2016 encouraging participation in the Nursing Home Quality Improvement Project Facilitated by HQSI and funded by CMS

Drug Diversion Coalition NJDOH is sponsoring a Drug Diversion Conference to educate providers about how to respond, detect, and prevent drug diversion in health care settings Tuesday, June 14, 2016 from 9:30am-3:30pm at Rutgers University-Busch Campus in Piscataway Questions: Contact Laura Taylor at laura.taylor@doh.nj.gov

Resources CMS Appendix P & PP S & C Letters – www.cms.gov www.pioneernetwork.net Advancing Excellence in America’s Nursing Homes Campaign - www.nhqualitycampaign.org New Jersey Alliance for Culture Change

Thank You