“LTCSP Year One: Lessons Learned and Tips for Success” Patrick Campbell RN

Let’s Learn from Each Other Survey is hard work but very important work We at Providigm work with many different State Agencies We are sometimes asked what we see that works or doesn’t I will share what our teams have experienced but please feel free to share your thoughts You all have great experiences to share with the group for us all to learn from © 2018 Providigm, LLC

Your SA Functions a Bit Different These differences play a role in length of time to complete a survey Union not Union Overtime some yes some no Paid for travel not paid for travel Survey team sizes © 2018 Providigm, LLC

Your SA Functions a Bit Different Current surveyor resources to utilize Addition of complaints and FRI’s Number of areas investigated per surveyor QIS 5.3 LTSCP 11.4 Overwhelming? © 2018 Providigm, LLC

Team Size/Initial pool/Sample 96-100 Residents Recommends team size of 4 Pool of 32 Sample of 20 care areas 170-174 Residents Pool 32 Sample of 34 care areas That’s 14 more care areas with same team size © 2018 Providigm, LLC

Ombudsman Do we contact the Ombudsman prior to entrance to the facility Yep we do. Information from the Ombudsman should be used to complete the offsite preparation. The Resident Council guidance also references inviting the ombudsman to the RC meeting © 2018 Providigm, LLC

No more offsite team meeting Team reviews offsite information Offsite Preparation screen general complaint or complaint/FRI residents assigned to you MDS Indicator Facility Rate Report Sense of how many residents and which MDS indicators are of potential concern at the facility Offsite selected residents Review the list of offsite selected residents and their MDS indicators © 2018 Providigm, LLC

Offsite Some assign offsite-selected residents off site others wait to do this onsite when they know that the MDS room numbers are accurate. Make sure you have a system to ensure the team has the facility map for offsite prep © 2018 Providigm, LLC

Entrance Conference Team Coordinator conducts an Entrance Conference…Review 1-11 Not 12-37…Admin staff can read this information No sitting and waiting/use time efficiently Immediately kitchen tour/go to assigned areas Don’t assign TC Kitchen if possible © 2018 Providigm, LLC

Work Efficiently Waiting on a team member… what can you do Do Mandatory tasks when you have any down time.  Do Medication pass Med storage Liability notice and others.  Use time efficiently.  © 2018 Providigm, LLC

Screening Residents Do not wait for the roster or matrices to begin screening residents. Screen every resident There are no initial screening questions included in the system. Conduct the screening based on your knowledge and critical thinking skills © 2018 Providigm, LLC

Screening Residents Review their MDS indicators and/or matrix information before entering the room to give you a more complete picture. Introduce yourself and briefly converse with the resident (e.g., ask how they are doing) while you complete a brief head-to-toe observation of the resident and their surroundings. If there are concerns, consider whether they should be included in the initial pool. © 2018 Providigm, LLC

Screening Residents Initial pool selection is based exclusively on surveyor-identified information Ask probing questions Determine to investigate further or no issue © 2018 Providigm, LLC

Initial Pool Do not document screening results on the RI, RO, RR screens. We do not complete the RI, RRI, RO, or RR areas when screening – these are to be completed only for residents that are included in the initial pool. Changes in August helped with this © 2018 Providigm, LLC

Don’t Forget Add the date/time by using the Insert Timestamp icon (clock) or Alt+T. Add the Resident’s ID in the notes field by clicking on the Insert Resident ID icon (the person next to the clock) in the bar above the notes field or Alt+R. No need to discharge any resident (excluding offsite selected residents) who is no longer in the facility. © 2018 Providigm, LLC

Resident Interview During Resident Interview for any resident-expressed concern, ask follow-up questions to determine if the concern warrants further investigation Ask detailed questions some areas may be able to be ruled out. Probing is critical so you only identify concerns indicative of potential non-compliance. © 2018 Providigm, LLC

Resident Representative/Family Interviews Key that they are familiar with the resident’s care Sampled residents if possible Don’t forget to capture 3 even if not able to complete till after sample is created. Sometimes they get forgotten if not done during the initial pool. © 2018 Providigm, LLC

Limited Record Review/Observations Conduct limited record review after interviews and observations are completed prior to sample selection. Conduct observation's as sometimes we rule something out with multiple observations May be in the pool but not end up in the sample © 2018 Providigm, LLC

New NA option NA option for the Dialysis, Ventilator, Hospice and Smoking care areas to help differentiate between those who have no issues and those for whom the Care Area is not applicable. System will identify if you mark someone as no concerns with smoking and then no residents are selected for the sample for smoking © 2018 Providigm, LLC

Documentation in the pool What is the expectation for documentation if THERE ARE NO CONCERNS Should we document to "prove" we did the interview or observation? Documentation is extremely important but how much Leads to an effective and efficient investigation © 2018 Providigm, LLC.

Documentation in the pool It is important to have evidence that multiple observations were made to determine if staff were consistently following the care plan. If concerns are identified those observations would need more details It is recommended that there is some documentation of all observations © 2018 Providigm, LLC

Completion of the Pool Complete all resident observations, interviews and limited record review for the initial pool residents by the end of Day 1 or beginning of Day 2. © 2018 Providigm, LLC

Creating the Sample All FI’s residents may not end up in the final sample. There may be times another resident with the same care area may be a better candidate for the sample. Use the care area and resident view Ensure enough residents in a care area to be representative of that care area….2 or 3. You can add more if needed. © 2018 Providigm, LLC

Where did they go? We may have residents with FIs marked that are not in the list of final sample candidates. Possible that the FIs marked were for care areas that are only mapped to facility tasks. Once we finalize the sample, these residents appear in the appropriate facility task list. Don’t forget to pull residents into your tasks as needed © 2018 Providigm, LLC

Sample Size If the sample size is not met, consider the criteria below to include more residents in the sample: Residents who were selected for the Unnecessary Medication review but are not a part of the sample. Residents with concerns related to QOL and resident rights Unrepresented area(s) of the building © 2018 Providigm, LLC

Investigations Investigation By Resident access care areas being investigated for that resident. This option is useful when making observations, interviewing the resident, RR or family, or reviewing the record. Investigation By Care Area –access all of your residents being investigated for that care area. This option is useful when interviewing staff © 2018 Providigm, LLC

Helpful Tools Attach documents to the survey Access body map to draw your observations of the wound. You can access a blank document to handwrite or draw Weight Calculator © 2018 Providigm, LLC

Investigations Majority of time spent observing and interviewing with relevant review of record to complete investigation Use Appendix PP and critical elements (CE) pathways…so much is new! How much documentation © 2018 Providigm, LLC

Investigations Investigation Notes field to document any information specific to the care area being investigated (e.g., observations, interviews, specific record Resident Notes may be a more efficient option to document your information during your investigation since your documentation is one continuous notes field © 2018 Providigm, LLC

Dining Observation A list of residents will be displayed on the screen if the resident had an MDS indicator or you marked further investigate for nutrition/hydration concerns. To add a resident with dining concerns to the notes section and the sample list report for the facility, click on the Add Resident icon in the upper right corner OR add the resident’s ID in the Notes field using Alt+R © 2018 Providigm, LLC

Kitchen For CE16 (unit refrigerators), either the assigned surveyor can review all unit refrigerators or the review can be shared amongst team members. Sharing some tasks is more time efficient when in a large spread out building © 2018 Providigm, LLC

Personal Funds Environment Only complete the applicable section of the pathway. Review the specific concerns the team has with the environment. It may not be necessary complete a review of the entire environment. Do not complete a review of oxygen storage, the generator, or the Emergency Preparedness if this is reviewed by life safety © 2018 Providigm, LLC

SNF Beneficiary Protection Notification Review A new pathway has been developed List of residents (home and in-facility) Randomly select three residents Facility completes new worksheet Review worksheet and notices Add those resident’s into the task © 2018 Providigm, LLC

Resident Council Meeting Group interview with active members of the council Try to keep the group small…12 Complete early to ensure investigation if concerns identified Refer to updated Pathway Guidance about ombudsman Add the residents attending © 2018 Providigm, LLC

Infection Control The residents reviewed for influenza and pneumococcal vaccinations, should be added to the resident box on the infection control screen. Add a resident to the box, click on the resident icon in the upper right corner Remember only one person has to complete the whole task © 2018 Providigm, LLC

Wrap Up What we do is important and ever changing Always read published S&C letters Network-See what your neighbors are doing Remember, Surveyors and home staff all have the same goal-taking care of our Elders! © 2018 Providigm, LLC