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

3. 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.

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

5. 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

6. What Surveyors See

7. 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 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 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

8. 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 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 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

9. 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

10. 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 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.

11. 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:
Password required – To obtain: 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:
Pamela Gendlek at:

12. 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

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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

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

21. Thank You