1. How to Be survey Ready
How using checklists can make the difficult…simple.
By Beth Cayce CaraVita Home Care and Senior Care Consulting
For checklists caregivers/useful-links-for-caregivers/ also pls share a review

2. Learning Objectives
To understand initial, annual and complaint survey checklists
To know how policies and procedures relate to the checklist and requirements
To understand the QI principles to keep your community ready for compliance surveys
To learn to think like a surveyor

3. Initial inspections and yearly
Admission Agreement Checklist
Have each section coded in one of your agreements to make sure you have everything.
Sample language- some groups are using for the admission agreement (see Genia)60 days
Will also include some forms that the Responsible Party will have to sign like provision for emergency transportation and evacuation, house rules, evidence the resident has had opportunity to read agreement, who fills the prescriptions etc.– all detailed in the checklist
Information on Proxy caregivers and their use in the community.

5. Policies and procedures
Again have these tagged to your policies – each line should have one or several polices to correspond
We will review this with examples

8. General Tour checklist
Use this as initial and ongoing audit.
It pairs with staff checklists for pch, al, mc , proxy and coma
Keep residential profile updated
Emergency contacts on the bus
There is crossover to the resident review form when surveying
Memory care crossover
Safety and fire extinguishers and lights working & up to date
Access to show your infection control program in action with sanitation, hand wash stations have sanitizing agents, and laundry soap and kitchen chemicals, water temp, trash, first aide pest control, disposables. Carts maintained/manned or out of way, change of water etc.
Records maintained 2 years on rights and feedback but 3 yrs for legal and other
Change of condition and transfers
We will review this together

11. ALC checklist AKA Resident review
Great to have this on Profile sheet
ID-ss, veteran status, age, sex, picture
Leg rep and POA-, legal representative, Resp party, guardian, POA, next of kin- up to date
Admission, discharge log--- date, prior residence, referral source, agency contact number of referral source, date of d/c and where discharged to and phone #
Medical dx, Sex Offender, Health info and needs
Md, pharmacy agreement and Hospital noted
Care plan 3mos MC and yrly AL and change of condition
Health info
Personal info- married, veteran,
Admission Criteria and PCH, AL or MC and assistance with self preservation, Dx,
No money for transport, unless non scheduled or emergency
Valuables handled, res rights, personal needs allowance, informed consent, DNR and National sex offender registry
File kept 3 yrs
Admission agreement signed

13. Resident Review Self Adm or not and MAR
CMA’s used – they will go to your book
Quarterly Med Review
Needs assessment and care plan
Social activities/resource
Resident Room
Significant Incident reports
Change in condition
Nutrition
Family interview
Resident interview
Staff interview.

14. Staff review Job duties First Aide Cpr
Evac proc( orientation checklist)
Resident medical and social needs and special needs of dementia
Resident rights, Abuse Act and reporting
CEU’s
Physician eval TB
Finger prints of owner/mgr
Criminal record check of employees
Infection control ( orientation)
Employee history verified.

16. Additional Memory Care
Orientation prior to work
Philosophy, description of services & p and p, Egress and wandering & safety control and common behaviors/mgt techniques
First six months
Nature of dementia, stages and specific care needs
Common behavior problems and management techniques
Communication skills
Positive therapeutic interventions and activities- sensory, stimulation and ADL’s
Role of family and support
Environmental modifications to avoid problematic behavior and create therapeutic environment
ISP, who and when to update
New developments in dementia care
Skills for recognizing cognitive and physical changes
Safety skills for dementia residents.

18. Memory Care checklist
Memory care description of service and any additional p and p needed
Description signed by Responsible party
Waive the nurse if ALC and CMA able to administer medications
Physician report with Dementia dx ( 30 days) for resident and they make companion without it.
Does not need 24 skilled care
ISP
Description of resident care and social needs
Frequency of services
Resident preferences
Behaviors and interventions
ID of staff implementing the plan
Quarterly updates or on change of condition
Facility holds itself out to be specialized in care of dementia

21. Therapeutic Activities on Memory Care
Adapted for participation
Weekly
Gross motor
Self Care
Social activities
Crafts
Sensory enhancement
Outdoor Activities

22. Certified Medication Aide
Form easy to interpret
Want to have notebook
Training that meets states guidelines,
Toefl
Test grades and certificate from state
Initial and annual full skill check
Quarterly checks so that each has a med pass check 2 times a year
In their personnel file you will have proper notice of separation for individual but have blank in your book
In their personnel file you will have notification of termination related to med performance but have blank form here.

24. Complaint investigation
Also often use the resident review sheet
Once they are there it will depend on complaint, but use the other forms as a guide
For example– med error
CMA
MAR review, MD orders
Resident Record check
Staff file check
Incident reports
Staff interview
P and P

26. Emergency Preparedness
Review with your disaster plan