National Association of State Veterans Homes State Veterans Home Program Office of Geriatrics and Extended Care, Patient Care Services, Department of Veterans Affairs

2 CLINICAL & SURVEY OVERSIGHT  Current program structure –140 State Veterans Homes facilities –132 nursing home care programs beds –55 domiciliary care programs –6110 beds –1 adult day health care program 50 participant slots

3 CLINICAL & SURVEY OVERSIGHT  FY 2010 new survey implemented –Phase I consisted of 6 surveys –Phase II consisted of 91 surveys  Types of surveys –Recognition surveys = 4 –Annual surveys = 87 –For Cause surveys = 6 Totals surveys 97

4 CLINICAL & SURVEY OVERSIGHT  Survey length in days –7 surveys averaged 4 days –88 surveys averaged 3 days –1 survey averaged 2 days –1 survey averaged 1 day

5 CLINICAL & SURVEY OVERSIGHT NURSING HOME SURVEY RESULTS  Number of surveys without deficiencies 22  Number of surveys with deficiencies 75  Total number of deficiencies 381  Average number of deficiencies per survey 5.08

6 CLINICAL & SURVEY OVERSIGHT Standard #StandardFrequency aPhysical Environment: Life Safety from fire iQuality of Care: Accidents bPhysical Environment: Emergency Power b Resident Assessments: Comprehensive Assessments of residents needs Resident Assessments: Comprehensive Assessments must be developed within 7 day by an Interdisciplinary team and periodically reviewed dDietary Services: Food aResidents Behavior and Facility Practices: Restraints Resident Behavior and Facility Practices: Staff Treatment of Resident dQuality of Care: Pressure Sores12

7 CLINICAL & SURVEY OVERSIGHT Standard #StandardFrequency d Resident Assessment: Comprehensive plans need to be individualized Resident Assessment: Services provided or arranged by facility must meet professional standards of quality and provided in accordance with Residents care plan aQuality of Care: Reporting of Sentinel Events a/bQuality of Life: Dignity/ Self-determination and participation aInfection Control: Infection Control Program bInfection Control: Preventing spread of Infection fQuality of Care: Range of Motion gQuality of Life: Patient Activities j Quality of Care: Nutrition based on residents comprehensive assessment 6

8 CLINICAL & SURVEY OVERSIGHT  Deficiencies identified on 5 or fewer surveys –Administration: Clinical Records –Residents Rights: Notification of Changes –Dietary Services: Menus and nutritional adequacy –Administration: Governing body –Quality of Care: Medication Errors –Dietary Services: Frequency of meals –Dietary Services: Sanitary conditions

9 CLINICAL & SURVEY OVERSIGHT IMMEDIATE JEOPARDY / FOR CAUSE SURVEYS  Ten (10) Immediate Jeopardy determinations –Smoking while using oxygen –Modified diets, thickened liquids –Falls with significant injuries  Six (6) For Cause Surveys –Significant increase in falls - 2 –Complaints of a serious nature from residents, residents’ families and staff – 3 –Significant number of deficiencies identified during annual survey - 1

10 CLINICAL & SURVEY OVERSIGHT DOMICILIARY SURVEY RESULTS  Number of surveys without deficiencies 26  Number of surveys with deficiencies 12  Total number of deficiencies 63  Average number of deficiencies per survey 5.25

11 CLINICAL & SURVEY OVERSIGHT  Deficiencies identified on 4 surveys –Medical Care: A patient treatment plan is established and maintained for each domiciliary patient. –Medical Care: Each patient has a complete medical re-evaluation annually and as needed.  13 standards were cited as deficient on 2 surveys  29 standards were cited as deficient on 1 survey

12 CLINICAL & SURVEY OVERSIGHT QUESTIONS