OBRA Flashcards
(116 cards)
0
Q
- Upon the death of a resident with personal funds deposited with the facility, the facility must convey within _____ days the resident’s funds, and a final accounting of those funds, to the individual or probate jurisdiction administering the resident’s estate.
A
30
F160
483.10(c)(6) Conveyance upon death
Upon the death of a resident with a personal fund deposited with the facility, the facility must convey within 30 days the resident’s funds, and a final accounting of those funds, to the individual or probate jurisdiction administering the resident’s estate.
1
Q
- Therapeutic diets must be prescribed by the attending physician. True or False?
A
True
F366
§483.35(d)(4)
Therapeutic diets must be prescribed by the attending physician.
2
Q
- The drug regimen of each resident must be reviewed at least _____ by a licensed pharmacist.
A
Monthly
F428
(Rev. 22, Issued: 12-15-06, Effective/Implementation: 12-18-06)
§483.60(c) Drug Regimen Review
(1) The drug regimen of each resident must be reviewed at least once a month by a licensed pharmacist.
(2) The pharmacist must report any irregularities to the attending physician, and the director of nursing, and these reports must be acted upon.
3
Q
- A resident who can eat enough alone or with assistance is not fed by naso-gastric tube unless the resident’s clinical condition demonstrates that use of a naso-gastric tube was ______.
A
Unavoidable
F321
§483.25(g)(1) A resident who has been able to eat enough alone or with assistance is not fed by naso-gastric tube unless the resident’s clinical condition demonstrates that use of a naso-gastric tube was unavoidable; and
F322
§483.25(g)(2) A resident who is fed by a naso-gastric or gastrostomy tube receives the appropriate treatment and services to prevent aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers and to restore, if possible, normal eating skills.
4
Q
- How much must a facility pay a resident who works for them?
A
Prevailing Rates
F169
§483.10(h) Work
(iii) Compensation for paid services is at or above prevailing rates;
5
Q
- Is a ‘significant change reassessment’ generally indicated if improvement is consistently noted in 2 or more areas of improvement?
A
yes
F274
§483.20(b)(2)(ii) Guidelines
The following are the criteria for significant changes:
A significant change reassessment is generally indicated if decline or improvement is consistently noted in 2 or more areas of decline or 2 or more areas of improvement:
6
Q
- SNF-Bedrooms must measure at least _______ square feet per resident in multiple resident bedrooms, and at least 100 square feet in single resident rooms.
A
80
F458
§483.70(d)(1)(ii) Measure at least 80 square feet per resident in multiple resident bedrooms, and at least 100 square feet in single resident rooms;
7
Q
- May the facility charge to resident’s funds for personal comfort items, including smoking materials, notions and novelties and confections?
A
Yes
F162
483.10(c)(8) Limitation on Charges to Personal Funds
(ii) Items and services that may be charged to residents’ funds. Listed below are general categories and examples of items and services that the facility maycharge to residents’ funds if they are requested by a resident, if the facilityinforms the resident that there will be a charge, and if payment is not made by Medicare or Medicaid:
(A) Telephone;
(B) Television/radio for personal use;
(C) Personal comfort items, including smoking materials, notions and novelties, and confections;
See F-tag for rest of list.
8
Q
- Does the comprehensive assessment for evaluating skin conditions include the RAI?
A
True
F314
§483.25(c) Pressure Sores.
The comprehensive assessment, which includes the Resident Assessment Instrument (RAI), evaluates the resident’s intrinsic risks, the resident’s skin condition, other factors (including causal factors) which place the resident at risk for developing pressure ulcers and/or experiencing delayed healing, and the nature of the pressure to which the resident may be subjected. The assessment should identify which risk factors can be removed or modified.
9
Q
- Emergency power must supply:
Hint: 4 things
A
- Lighting all entrances and exits;
- equipment to maintain the fire detection,
- alarm and extinguishing systems; and
- life support systems.
F455
§483.70(b) Emergency Power
(1) An emergency electrical power system must supply power adequate at least for lighting all entrances and exits; equipment to maintain the fire detection, alarm, and extinguishing systems; and life support systems in the event the normal electrical supply is interrupted.
10
Q
- May the administrator attend a resident group meeting without an invitation?
A
No
F243
§483.15(c) Participation in Resident and Family Groups
(4) Staff or visitors may attend meetings at the group’s invitation
11
Q
- Does the resident have the right to participate in any religious activity?
A
No, only in activities that do not interfere with the rights of other residents
F245
§483.15(d) Participation in Other Activities
A resident has the right to participate in social, religious, and community activities that do not interfere with the rights of other residents in the facility.
12
Q
- Is the facility responsible for addressing all needs and strengths of residents regardless of whether the issue is included in the MDS or RAPs?
A
Yes
F272
§483.20 Resident Assessment
The facility must conduct initially and periodically a comprehensive, accurate, standardized reproducible assessment of each resident’s functional capacity
§483.20(b) Guidelines
The information required in §483.20(b)(i-xvi) is incorporated into the MDS, which forms the core of each State’s approved RAI. Additional assessment information is also gathered using triggered RAPs.
Each facility must use its State-specified RAI (which includes both the MDS and utilization guidelines which include the RAPs) to assess newly admitted residents, conduct an annual reassessment and assess those residents who experience a significant change in status. The facility is responsible for addressing all needs and strengths of residents regardless of whether the issue is included in the MDS or RAPs. The scope of the RAI does not limit the facility’s responsibility to assess and address all care needed by the resident.
13
Q
- A resident who has been able to eat enough alone or with assistance is not fed by naso-gastric tube unless the resident’s clinical condition demonstrates that use of a naso-gastric tube was _______.
A
unavoidable
F321
§483.25(g)(1) A resident who has been able to eat enough alone or with assistance is not fed by naso-gastric tube unless the resident’s clinical condition demonstrates that use of a naso-gastric tube was unavoidable; and
F322
§483.25(g)(2) A resident who is fed by a nasogastric or gastrostomy tube receives the appropriate treatment and services to prevent aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers and to restore, if possible, normal eating skills.
14
Q
- An individual resident may self-administer drugs ______.
A
if the interdisciplinary team has determined that this practice is safe
F176
§483.10(n) Self-Administration of Drugs
An individual resident may self-administer drugs if the interdisciplinary team, as defined by §483.20(d)(2)(ii), has determined that this practice is safe.
15
Q
- Residents who use antipsychotic drugs receive ______ dose reductions.
A
Gradual
F329
(Rev. 22, Issued: 12-15-06, Effective/Implementation: 12-18-06)
§483.25(l) Unnecessary Drugs
- Antipsychotic Drugs. Based on a comprehensive assessment of a resident, the facility must ensure that:
(i) Residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a specific condition as diagnosed and documented in the clinical record; and
(ii) Residents who use antipsychotic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs.
16
Q
- ________ number of staff are required to assure the resident was provided activities based upon the comprehensive assessment and care plan.
A
Sufficient
INVESTIGATIVE PROTOCOL
ACTIVITIES
43 CFR 483.30(a), F353, Sufficient Staff
Determine if the facility had qualified staff in sufficient numbers to assure the resident was provided activities based upon the comprehensive assessment and care plan.
17
Q
- The facility must provide special eating equipment and utensils for residents who need them. True or False?
A
True
F369
§483.35(g) Assistive Devices
The facility must provide special eating equipment and utensils for residents who need them
18
Q
- Sound levels must be maintained at __________?
A
comfortable sound levels
F258
§483.15(h)(7) For the maintenance of comfortable sound levels
Interpretive Guidelines §483.15(h)(7)
“Comfortable” sound levels do not interfere with resident’s hearing and enhance privacy when privacy is desired, and encourage interaction when social participation is desired.
Of particular concern to comfortable sound levels is the resident’s control over unwanted noise.
19
Q
- Who should pay for postage, the resident or facility?
A
The resident
F171
§483.10(i)(2) Have access to stationery, postage, and writing implements at the resident’s own expense.
20
Q
- Does the resident have a right to work?
A
Yes
F169
483.10(h) Work
The resident has the right to–
(1) Refuse to perform services for the facility;
(2) Perform services for the facility, if he or she chooses, when–
(i) The facility has documented the need or desire for work in the plan of care;
(ii) The plan specifies the nature of the services performed and whether the services are voluntary or paid;
(iii) Compensation for paid services is at or above prevailing rates; and
(iv) The resident agrees to the work arrangement described in the plan of care
21
Q
- The facility must provide each resident with a nourishing, _______, well-balanced diet.
A
Palatable
F360
§483.35 Dietary Services
The facility must provide each resident with a nourishing, palatable, well-balanced diet that meets the daily nutritional and special dietary needs of each resident.
22
Q
- The facility must promote care for residents in a manner and in an environment that ______ or ________ each resident’s dignity and respect in full recognition of his or her individuality.
A
maintains or enhances
F241
§483.15(a) Dignity
The facility must promote care for residents in a manner and in an environment that maintains or enhances each resident’s dignity and respect in full recognition of his or her individuality.
23
Q
- If a specialized rehabilitative service such as speech-language pathology is required in the resident’s comprehensive plan of care, the facility must ____________ or obtain the required services from an outside source.
A
provide the services
F406
§483.45(a) Provision of Services
If specialized rehabilitative services such as, but not limited to physical therapy, speech-language pathology, occupational therapy, and mental health rehabilitative services for mental illness and mental retardation, are required in the resident’s comprehensive plan of care, the facility must–
(1) Provide the required services; or
(2) Obtain the required services from an outside resource (in accordance with §483.75(h) of this part) from a provider of specialized rehabilitative services.
24
25. What kind of housekeeping and maintenance services must a facility provide?
Hint- 3 items
Those necessary to maintain a
1. sanitary,
2. orderly, and
3. comfortable interior
SOC
F253
§483.15(h)(2)
Housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior
25
26. What are the 5 Activities of Daily Living (ADL)?
(1) bathing, dress, and groom, (2) transfer and ambulate, (3) toilet, (4)eat, and (5) use speech, language or other functional communication systems
F310
§483.25(a)(1) A resident's abilities in activities of daily living do not diminish unless circumstances of the individual's clinical condition demonstrate that diminution was unavoidable. This includes the resident's ability to --
(i) Bathe, dress, and groom;
(ii) Transfer and ambulate;
(iii) Toilet;
(iv) Eat; and
(v) Use speech, language, or other functional communication systems.
26
27. Within ____ days after a facility completes a resident's assessment, the facility must encode the Quarterly review assessments.
7
F287
§483.20(f) Automated Data Processing Requirement
§483.20(f)(1) Encoding Data. Within 7 days after a facility completes a resident's assessment, a facility must encode the following information for each resident in thefacility:
(i) Admission assessment.
(ii) Annual assessment updates.
(iii) Significant change in status assessments.
(iv) Quarterly review assessments.
(v) A subset of items upon a resident's transfer, reentry, discharge, and death.
(vi) Background (face-sheet) information, if there is no admission assessment.
27
28. Who is responsible for developing the comprehensive care plan?
interdisciplinary team
F280
§483.20(k)(2)
§483.20(k)(2) A comprehensive care plan must be-
(i) Developed within 7 days after the completion of the comprehensive assessment;
(ii) Prepared by an interdisciplinary team, that includes the attending physician, a registered nurse with responsibility for the resident, and other appropriate staff in disciplines as determined by the resident's needs, and, to the extent practicable, the participation of the resident, the resident's family or the resident's legal representative; and
(iii) Periodically reviewed and revised by a team of qualified persons after each assessment.
28
29. The resident or his or her legal representative has the right upon an oral or written request, to access all records pertaining to himself or herself including clinical records within _____ hours.
24 (excluding weekends and holidays)
F153
§483.10(b)(2) --
The resident or his or her legal representative has the
right--
(i) Upon an oral or written request, to access all records pertaining to himself or herself including current clinical records within 24 hours (excluding weekends and holidays); and
(ii) After receipt of his or her records for inspection, to purchase at a cost not to exceed the community standard photocopies of the records or any portions of them upon request and 2 working days advance notice to the facility.
29
30. May the Ombudsman review a record without consent?
No
F173
§483.10(j)(3) -- The facility must allow representatives of the State Ombudsman, described in paragraph (j)(1)(iv) of this section, to examine a resident's clinical records with the permission of the resident or the resident's legal representative, and consistent with State law.
30
31. Must the facility provide written information regarding the bed-hold policy prior to a transfer?
Yes
F205
§483.12(b) Notice of Bed-Hold Policy and Readmission
§483.12(b)(1) Notice before transfer. Before a nursing facility transfers a resident to a hospital or allows a resident to go on therapeutic leave, the nursing facility must provide written information to the resident and a family member or legal
representative that specifies--
(i) The duration of the bed-hold policy under the State plan, if any, during which the resident is permitted to return and resume residence in the nursing facility; and
(ii) The nursing facility's policies regarding bed-hold periods, which must be consistent with paragraph (b)(3) of this section, permitting a resident to return.
31
32. The facility must designate a registered nurse to serve as the director of nursing on a ______.
Full-time basis
F354
§483.30(b) Registered Nurse
§483.30(b)(2) Except when waived under paragraph (c) or (d) of this section, the facility must designate a registered nurse to serve as the director of nursing on a full-time basis.
32
33. A resident should not experience a reduction in range of motion unless the resident's clinical condition demonstrates that it was ________.
unavoidable
F317
§483.25(e)(1) A resident who enters the facility without a limited range of motion does not experience reduction in range of motion unless the resident's clinical condition demonstrates that a reduction in range of motion is unavoidable; and
F318
§483.25(e)(2) A resident with a limited range of motion receives appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion
33
34. Can a person be considered a qualified social worker with a degree in chemistry?
No
F251
§483.15(g)(3)
(3) Qualifications of a social worker. A qualified social worker is an individual with-
(i) A bachelor's degree in social work or a bachelor's degree in a human services field including but not limited to sociology, special education, rehabilitation counseling, and psychology; and
(ii) One year of supervised social work experience in a health care setting working directly with individuals
34
35. Is a revision of the care plan required after a significant change of condition?
Yes
F274
§483.20(b)(2)(ii)
(ii) Within 14 days after the facility determines, or should have determined, that there has been a significant change in the resident's physical or mental condition. (For purpose of this section, a "significant change" means a major
decline or improvement in the resident's status that will not normally resolve itself without further intervention by staff or by implementing standard diseaserelated clinical interventions, that has an impact on more than one area of the resident's health status, and requires interdisciplinary review or revision of the care plan, or both.)
35
36. Are injections part of Special Needs?
Yes
F328
§483.25(k) Special Needs
The facility must ensure that residents receive proper treatment and care for the following special services
§483.25(k)(1) Injections
36
37. The facility must have evidence that all alleged violations are _____ investigated, and must prevent further potential abuse while the investigation is in progress.
Thoroughly
F225
§483.13(c)(3)
The facility must have evidence that all alleged violations are thoroughly investigated, and must prevent further potential abuse while the
investigation is in progress.
37
38. Can the facility require the resident to deposit their personal funds with the facility?
No
F158
§483.10(c)(1) Protection of Resident Funds
The resident has the right to manage his or her financial affairs, and the facility may not require residents to deposit their personal funds with the facility.
38
39. The resident has the right to be free from any _____ or _____ restraints imposed for purposes of discipline or convenience, and not required to treat the resident's medical symptoms.
Physical or Chemical
F222
§483.13(a) Restraints
The resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident's medical symptoms.
39
40. The resident has a right to a _______ _______, _______-_________, and communication with and access to persons and services inside and outside the facility.
Dignified existence, self-determination
F150
§483.10 Resident Rights
The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility.
40
41. The qualified social worker is an individual with a _____ degree.
Bachelor's
F251
§483.15(g)(3)
(3) Qualifications of a social worker. A qualified social worker is an individual with-
(i) A bachelor's degree in social work or a bachelor's degree in a human services field including but not limited to sociology, special education, rehabilitation counseling, and psychology; and
(ii) One year of supervised social work experience in a health care setting working directly with individuals
41
42. A facility must maintain all resident assessments completed within the previous ______ months in the resident's active record.
15
F286
§483.20(d) Use
A facility must maintain all resident assessments completed within the previous 15 months in the resident's active record.
42
43. Can the facility charge a resident for copies of his/her record if the written or oral request was made by the resident?
Yes
F153
§483.10(b)(2) -- The resident or his or her legal representative has the right--
(i) Upon an oral or written request, to access all records pertaining to himself or herself including current clinical records within 24 hours (excluding weekends and holidays); and
(ii) After receipt of his or her records for inspection, to purchase at a cost not to exceed the community standard photocopies of the records or any portions of them upon request and 2 working days advance notice to the facility.
43
44. A post-discharge plan of care that is developed with the participation of the resident and his or her family, which will assist the resident to adjust to his or her new living environment. True or False?
True
F284
§483.20(l)(3) A post-discharge plan of care that is developed with the participation of the resident and his or her family, which will assist the resident to adjust to his or her new living environment.
44
45. How soon must a facility resolve grievances?
Promptly
F166
A resident has the right to--
§483.10(f)(2) -- Prompt efforts by the facility to resolve grievances the resident may have, including those with respect to the behavior of other residents.
45
46. A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent ______ _______ from ________.
new sores from developing
F314
§483.25(c) Pressure Sores
Based on the comprehensive Assessment of a resident, the facility must ensure that--
(1) A resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable; and
(2) A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing.
46
47. What condition must linens be in?
Good condition
F254
§483.15(h)(3) Clean bed and bath linens that are in good condition;
47
48. The activities program must be directed by a qualified professional.True or False?
True
F249
§483.15(f)(2) The activities program must be directed by a qualified professional who--
(i) Is a qualified therapeutic recreation specialist or an activities professional who--
(A) Is licensed or registered, if applicable, by the State in which practicing; and
(B) Is eligible for certification as a therapeutic recreation specialist or as an activities professional by a recognized accrediting body on or after October 1, 1990; or
(ii) Has 2 years of experience in a social or recreational program within the last 5 years, 1 of which was full-time in a patient activities program in a health care setting; or
(iii) Is a qualified occupational therapist or occupational therapy assistant; or
(iv) Has completed a training course approved by the State
48
49. A resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function __ __________.
As possible
F315
§483.25(d) Urinary Incontinence
Based on the resident's comprehensive assessment, the facility must ensure that --
§483.25(d) (2) A resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible.
49
50. Each resident's drug regimen must be free from _____ drugs.
Unnecessary
F329
§483.25(l) Unnecessary Drugs
1. General. Each resident's drug regimen must be free from unnecessary drugs. An unnecessary drug is any drug when used:
(i) In excessive dose (including duplicate therapy); or
(ii) For excessive duration; or
(iii) Without adequate monitoring; or
(iv) Without adequate indications for its use; or
(v) In the presence of adverse consequences which indicate the dose should be
reduced or discontinued; or
(vi) Any combinations of the reasons above.
50
51. Must the facility designate a staff person responsible for providing assistance and responding to written requests that result from the group meetings?
Yes
F243
§483.15(c) Participation in Resident and Family Groups
(5) The facility must provide a designated staff person responsible for providing assistance and responding to written requests that result form group meeting
51
52. The facility must ensure that the residents are free of any significant medication errors. True or False?
True
F332 and F333
§483.25(m) Medication Errors
The facility must ensure that--
[F332] §483.25(m)(1) It is free of medication error rates of 5 percent or greater; and
[F333] §483.25(m)(2) Residents are free of any significant medication errors.
52
53. A comprehensive care plan must be developed within _____ days after the completion of the comprehensive assessment.
7
F280
§483.20(k)(2)
A comprehensive care plan must be-
(i) Developed within 7 days after the completion of the comprehensive assessment;
(ii) Prepared by an interdisciplinary team, that includes the attending physician, a registered nurse with responsibility for the resident, and other appropriate staff in disciplines as determined by the resident's needs, and, to the extent practicable, the participation of the resident, the resident's family or the resident's legal representative; and
(iii) Periodically reviewed and revised by a team of qualified persons after each assessment.
53
54. The facility must encode the information within ___ days after a facility completes a resident's assessment information.
7
F287
§483.20(f) Automated Data Processing Requirement
§483.20(f)(1) Encoding Data. Within 7 days after a facility completes a resident's assessment, a facility must encode the following information for each resident in the facility:
(i) Admission assessment.
(ii) Annual assessment updates.
(iii) Significant change in status assessments.
(iv) Quarterly review assessments.
(v) A subset of items upon a resident's transfer, reentry, discharge, and death.
(vi) Background (face-sheet) information, if there is no admission assessment.
54
55. The facility must purchase a surety bond. True or False?
True
F161
483.10(c)(7) Assurance of Financial Security
The facility must purchase a surety bond, or otherwise provide assurance satisfactory to the Secretary, to assure the security of all personal funds of residents deposited with the facility.
55
56. When the resident is admitted, the facility must have ___________ orders for the resident's immediate care.
Physician
F271
§483.20(a) Admission Orders
At the time each resident is admitted, the facility must have physician orders for the resident's immediate care.
56
57. Can the facility require a third party guarantee?
No
F208 Admissions Policy
§483.12(d)(2)
The facility must not require a third party guarantee of payment to the facility as a condition of admission or expedited admission, or continued stay in the facility. However, the facility may require an individual who has legal access to a resident's income or resources available to pay for facility care to sign a contract, without incurring personal financial liability, to provide facility payment from the resident's income or resources.
57
58. A facility with more than ______ beds must employ a qualified social worker on a full time basis.
120
F251
§483.15(g)(2) and (3)
(2) A facility with more than 120 beds must employ a qualified social worker on a full-time basis.
58
59. Must the facility have consent from both married residents before they room together?
Yes
F175
§483.10(m) Married Couples
The resident has the right to share a room with his or her spouse when married residents live in the same facility and both spouses consent to the arrangement
59
60. What kind of an environment must a facility provide?
Hint: 4 items
A
1. safe,
2. clean,
3. comfortable, and
4. homelike environment
F252
§483.15(h) Environment
The facility must provide-
§483.15(h)(1) A safe, clean, comfortable and homelike environment, allowing the resident to use his or her personal belongings to the extent possible;
60
61. OBRA- How much space for property must a facility afford a resident?
As Space Permits
§483.10(l) Personal Property
The resident has the right to retain and use personal possessions, including some furnishings, and appropriate clothing, as space permits, unless to do so would infringe upon the rights or health and safety of other residents
61
62. A resident who enters the facility without an indwelling catheter is not catheterized unless the resident's clinical condition demonstrates that catheterization was _____.
Necessary
F315
§483.25(d) Urinary Incontinence
Based on the resident's comprehensive assessment, the facility must ensure that --
§483.25(d) (1) A resident who enters the facility without an indwelling catheter is not catheterized unless the resident's clinical condition demonstrates that catheterization was necessary.
62
63. The facility must inform the resident in _________ that the resident understands of his or her rights.
language
63
64. Does the resident have the right to organize and participate in resident groups in the facility?
Yes
F243
§483.15(c) Participation in Resident and Family Groups
(1) A resident has the right to organize and participate in resident groups in the facility;
64
65. What sort of access must residents have to telephones?
Reasonable
F174
§483.10(k) Telephone
The resident has the right to have reasonable access to the use of a telephone where calls can be made without being overheard.
65
66. Do residents have the right to refuse treatment?
Yes
F155
§483.10(b)(4) --
The resident has the right to refuse treatment, to refuse to participate in experimental research, and to formulate an advance directive as specified in paragraph (8) of this section
66
67. Facilities are afforded ______ percent for signifcant medication errors.
0
F332 and F333
§483.25(m) Medication Errors
The facility must ensure that--
[F332] §483.25(m)(1) It is free of medication error rates of 5 percent or greater; and
[F333] §483.25(m)(2) Residents are free of any significant medication errors.
67
68. The facility must develop a comprehensive care plan for each resident that must include: ________ objectives and __________.
Measurable objectives and timetables
F279
§483.20(d) (A facility must..) use the results of the assessment to develop, review and revise the resident's comprehensive plan of care.
§483.20(k) Comprehensive Care Plans
(1) The facility must develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive
assessment. The care plan must describe the following:
(i) The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being as required under §483.25; and
(ii) Any services that would otherwise be required under §483.25 but are not provided due to the resident's exercise of rights under §483.10, including the right to refuse treatment under §483.10(b)(4).
68
69. The facility must ensure that the resident environment remains as free of accident hazards __ __ ________.
as is possible
F323
(Rev. 27; Issued: 08-17-07; Effective/Implementation: 08-17-07)
§483.25(h) Accidents.
The facility must ensure that
(1) The resident environment remains as free from accident hazards as is possible; and
(2) Each resident receives adequate supervision and assistance devices to prevent accidents.
69
70. The resident has the right to be free of interference, coercion, ________, and reprisal from the facility in exercising his or her rights.
discrimination
F151
§483.10(a) Exercise of Rights
§483.10(a)(1) The resident has the right to exercise his or her rights as a resident of the facility and as a citizen or resident of the United States.
§483.10(a)(2) The resident has the right to be free of interference, coercion, discrimination, and reprisal from the facility in exercising his or her rights.
70
71. OBRA- An unnecessary drug is any drug when used: ______.
4 items
In excessive dose or duration, without adequate monitoring, without adequate indications for its use, in the presence of adverse consequences (ADR) which indicate the dose should be reduced or discontinued
F329
(Rev. 22, Issued: 12-15-06, Effective/Implementation: 12-18-06)
§483.25(l) Unnecessary Drugs
1. General. Each resident's drug regimen must be free from unnecessary drugs.
An unnecessary drug is any drug when used:
(i) In excessive dose (including duplicate therapy); or
(ii) For excessive duration; or
(iii) Without adequate monitoring; or
(iv) Without adequate indications for its use; or
(v) In the presence of adverse consequences which indicate the dose should be
reduced or discontinued; or
(vi) Any combinations of the reasons above.
71
72. OBRA- What kind of light must be provided?
Adequate and comfortable lighting
F256
§483.15(h)(5) Adequate and comfortable lighting levels in all areas
72
73. If the facility does not employ a full-time qualified dietician, what additional dietary oversight is required?
Director of Food Service must have frequent scheduled consultations from a qualified dietician
F361
§483.35(a) Staffing
The facility must employ a qualified dietitian either full-time, part-time, or on a consultant basis.
§483.35(a)(1) If a qualified dietitian is not employed full-time, the facility must designate a person to serve as the director of food service who receives frequently scheduled consultation from a qualified dietitian.
§483.35(a)(2) A qualified dietitian is one who is qualified based upon either registration by the Commission on Dietetic Registration of the American Dietetic Association, or on the basis of education, training, or experience in identification of dietary needs, planning, and implementation of dietary programs.
73
74. Who should choose the personal attending physician?
The Resident
F163
483.10(d)(1) -- Choose a personal attending physician
74
75. May the facility deny access to the Ombudsman by a resident?
No
F172
§483.10(j) Access and Visitation Rights
The resident has the right and the facility must provide immediate access to any resident by the following:
(i) Any representative of the Secretary;
(ii) Any representative of the State;
(iii) The resident's individual physician;
(iv) The State long term care ombudsman (established under section 307 (a)(12)
of the Older Americans Act of 1965);
(v) The agency responsible for the protection and advocacy system for developmentally disabled individuals (established under part C of the
Developmental Disabilities Assistance and Bill of Rights Act);(vi) The agency responsible for the
protection and advocacy system for mentally
ill individuals (established under the Protection and Advocacy for Mentally Ill Individuals Act);
See rest of list in F-Tag.
75
76. Mail delivered to the resident should be ______.
unopened
F170
§483.10(i)(1) Send and promptly receive mail that is unopened
76
77. Must the facility inform the resident's legal representative when there is a change in the roommate?
Yes
F157
483.10(b)(11)-- Notification of changes.
(ii) The facility must also promptly notify the resident and, if known, the resident's legal representative or interested family member when there is--
(A) A change in room or roommate assignment as specified in §483.15(e)(2);
77
78. Which resident capacity must be conducted initially and periodically ?
Functional
F272
§483.20 Resident Assessment
The facility must conduct initially and periodically a comprehensive, accurate, standardized reproducible assessment of each resident's functional capacity.
78
79. OBRA- The facility must provide for an ongoing program of activities designed to meet, in accordance with the _______.
Comprehensive Assessment, the interests and the physical, mental, and psychosocial well-being of each resident.
F248
§483.15(f) Activities
§483.15(f)(1) The facility must provide for an ongoing program of activities designed to meet, in accordance with the comprehensive assessment, the interests and the physical, mental, and psychosocial well-being of each resident.
79
80. For what reason must a facility coordinate assessments with the pre-admission screening and resident review program under Medicaid in part 483, subpart C to the maximum extent practicable?
To avoid duplicative testing and effort.
F285
§483.20(e) Coordination
A facility must coordinate assessments with the pre-admission screening and resident review program under Medicaid in part 483, subpart C to the maximum extent practicable to avoid duplicative testing and effort.
80
81. Is involuntary seclusion a form of abuse?
Yes
81
82. Within ____ days the facility should determine, or should have determined, that there has been a significant change in the resident's physical or mental condition.
14
F274
§483.20(b)(2)(ii)
(ii) Within 14 days after the facility determines, or should have determined, that there has been a significant change in the resident's physical or mental condition. (For purpose of this section, a "significant change" means a major decline or improvement in the resident's status that will not normally resolve itself without further intervention by staff or by implementing standard diseaserelated clinical interventions, that has an impact on more than one area of the resident's health status, and requires interdisciplinary review or revision of the care plan, or both.)
82
83. The facility must establish and maintain an infection control program designed to provide a _________, ________, and ____________
environment and to help prevent the development and transmission of disease and infection.
Safe, sanitary, and comfortable
F441
§483.65 Infection Control
The facility must establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection.
83
84. A resident has the right to reside and receive services in the facility with _____ accommodations.
reasonable
F246
§483.15(e) Accommodation of Needs
A resident has a right to --
§483.15(e)(1) Reside and receive services in the facility with reasonable accommodations of individual needs and preferences, except when the health or safety of the individual or other residents would be endangered
84
85. OBRA- The facility must use the services of a registered nurse for at least _______.
8 consecutive hours a day, 7 days a week
F354
§483.30(b) Registered Nurse
§483.30(b)(1) Except when waived under paragraph (c) or (d) of this section, the facility must use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week.
85
86. Must the reasons for a transfer be documented?
Yes
F177
§483.12(a) Transfer, and Discharge
Moreover, before the transfer or discharge occurs, the law requires that the facility notify the resident and, if known, the family member, surrogate, or representative of the transfer and the reasons for the transfer, and record the reasons in the clinical record. The facility's notice must include an explanation of the right to appeal the transfer to the State as well as the name, address, and phone number of the State long-term care ombudsman.
In the case of a developmentally disabled individual, the notice must include the name, address and phone number of the agency responsible for advocating for the developmentally disabled, and in the case of a mentally ill individual, the name, address and phone number of the agency responsible for advocating for mentally ill individuals.
86
87. When cannot a resident refuse to release clinical records?
When the resident is transferred to another health care institution or when it is required by law
F164
483.10(e) Privacy and Confidentiality
(3) The resident's right to refuse release of personal and clinical records does not apply when--
(i) The resident is transferred to another health care institution; or
(ii) Record release is required by law
87
88. May the facility require a resident to waive their rights concerning Medicare or Medicaid?
No
F208
§483.12(d) Admissions Policy
(1) The facility must--
(i) Not require residents or potential residents to waive their rights to Medicare or Medicaid; and
(ii) Not require oral or written assurance that residents or potential residents are not eligible for, or will not apply for, Medicare or Medicaid benefits.
88
89. Generally, there must be no more than _____ hours between a substantial evening meal and breakfast the following day.
14
F368
§483.35(f) Frequency of Meals
(1) Each resident receives and the facility provides at least three meals daily, at regular times comparable to normal mealtimes in the community.
(2) There must be no more than 14 hours between a substantial evening meal and breakfast the following day, except as provided in (4) below.
(3) The facility must offer snacks at bedtime daily.
(4) When a nourishing snack is provided at bedtime, up to 16 hours may elapse between a substantial evening meal and breakfast the following day if a resident group agrees to this meal span, and a nourishing snack is served.
89
90. OBRA- Lighting must be ______ and ______.
adequate and comfortable
F464
These rooms must-
§483.70(g)(1) Be well lighted;
Interpretive Guidelines: §483.70(g)(1)
"Well lighted" is defined as levels of illumination that are suitable to tasks performed by a resident.
Probes: §483.70(g)(1)
Are there adequate and comfortable lighting levels?
Are illumination levels appropriate to tasks with little glare?
Does lighting support maintenance of independent functioning and task performance?
90
91. OBRA- The resident has a right to choose activities, schedules, and health care consistent with his or her interests, assessments, and _________ of ______.
plans of care
§483.15(b) Self-Determination and Participation
The resident has the right to--
(1) Choose activities, schedules, and health care consistent with his or her interests, assessments, and plans of care;
(2) Interact with members of the community both inside and outside the facility; and
(3) Make choices about aspects of his or her life in the facility that are significant to the resident.
91
92. Must the facility provide the resident group with private space?
Yes
F243
§483.15(c) Participation in Resident and Family Groups
(3) The facility must provide a resident or family group, if one exists, with private space;
92
93. May the notice to discharge be less than 30 days if the resident's health sufficiently improves?
Yes
F177
§483.12(a) Transfer, and Discharge
Generally, this notice must be provided at least 30 days prior to the transfer. Exceptions to the 30-day requirement apply when the transfer is effected because of:
� Endangerment to the health or safety of others in the facility;
� When a resident's health has imGenerally, this notice must be provided at least 30 days prior to the transfer.
Exceptions to the 30-day requirement apply when the transfer is effected because of:
� Endangerment to the health or safety of others in the facility;
� When a resident's health has improved to allow a more immediate transfer or discharge;
� When a resident's urgent medical needs require more immediate transfer; and
� When a resident has not resided in the facility for 30 days.
In these cases, the notice must be provided as soon as practicable before the discharge.
93
94. The comprehensive care plan must describe the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental and psychosocial ______ ______.
well being
F279
§483.20(d) (A facility must..) use the results of the assessment to develop, review and revise the resident's comprehensive plan of care.
§483.20(k) Comprehensive Care Plans
(1) The facility must develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive
assessment. The care plan must describe the following:
(i) The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being as required under §483.25;
94
95. The facility may or may not impose a charge against the personal funds of a resident for any item or services for which payment is made under Medicaid or Medicare?
May Not
F162
483.10(c)(8) Limitation on Charges to Personal Funds
The facility may not impose a charge against the personal funds of a resident for any item or services for which payment is made under Medicaid or Medicare (except for applicable deductible and coinsurance amounts).
95
96. How often must the facility record and update the address and phone number of the resident's legal representative or interested family member?
Periodically
F157
483.10(b)(11)-- Notification of changes.
(iii) The facility must record and periodically update the address and phone number of the resident's legal representative or interested family member.
96
97. Does the resident have the right to receive notice before the resident's roommate in the facility is changed?
Yes
F247
A resident has a right to-
§483.15(e)(2) Receive notice before the resident's room or roommate in the facility is changed.
97
98. During the course of a covered Medicare or Medicaid stay, facilities may not charge a resident for the following: _______.
Hint: 6 things
```
(A) nursing services,
(B) dietary services,
(C) an activities program,
(D) room/bed maintenance services,
(E) routine personal hygiene items and services, and
(F) medically-related social services
```
F162
483.10(c)(8) Limitation on Charges to Personal Funds
98
99. The facility must ensure that a resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they were ______.
Unavoidable
F314
§483.25(c) Pressure Sores
Based on the comprehensive Assessment of a resident, the facility must ensure that--
(1) A resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable; and
(2) A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing.
99
100. What is the definition of urinary incontinence?
Involuntary loss or leakage of urine
F315
§483.25(d) Urinary Incontinence
"Urinary Incontinence" is the involuntary loss or leakage of urine. There are several types of urinary incontinence, and the individual resident may experience more than one type at a time.
100
101. Can a facility hire someone accused of abuse?
Yes (must be convicted not to hire)
F225
The facility must-
§483.13(c)(1)(ii)
Not employ individuals who have been-
(A) Found guilty of abusing, neglecting, or mistreating residents by a court of law; or
(B) Have had a finding entered into the State nurse aide registry concerning abuse, neglect, mistreatment of residents or misappropriation of their property; and
(iii) Report any knowledge it has of actions by a court of law against an employee, which would indicate unfitness for service as a nurse aide or other facility staff to the State nurse aide registry or licensing authorities
101
102. Does a resident or responsible party's verbal or signed consent forms eliminate a facility's responsibility to protect the resident from an avoidable accident?
No
F323
§483.25(h) Accidents.
Consent by resident or responsible party alone does not relieve the provider of its responsibility to assure the health, safety, and welfare of its residents, including protecting them from avoidable accidents. While Federal regulations affirm the
resident's right to participate in care planning and to refuse treatment, the regulations do not create the right for a resident, legal surrogate, or representative to demand the facility use specific medical interventions or treatments that the facility deems inappropriate. The regulations hold the facility ultimately accountable for the resident's
care and safety. Verbal consent or signed consent forms do not eliminate a facility's
responsibility to protect a resident from an avoidable accident.
102
103. The facility must provide _______-_________ social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.
Medically-related
F250
§483.15(g)(1)
The facility must provide medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.
103
104. Each resident must receive and the facility must provide the necessary care and services to _____ or _____ the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.
attain or maintain
F309
§483.25 Quality of Care
Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.
104
105. Does the discharge summary include financial information?
No
F283
§483.20(l) Discharge Summary
When the facility anticipates discharge a resident must have a discharge summary that includes:
(1) A recapitulation of the resident's stay;
(2) A final summary of the resident's status to include items in paragraph (b)(2) of this section, at the time of the discharge that is available for release to authorized persons and agencies, with the consent of the resident or legal representative; and
105
106. How much fluid should a facility provide each resident?
Sufficient
F327
§483.25(j) Hydration
§483.25(j) Hydration. The facility must provide each resident with sufficient fluid intake to maintain proper hydration and health
106
107. Who approves whether a resident may self administer medications?
The interdisciplinary team
F176
§483.10(n) Self-Administration of Drugs
An individual resident may self-administer drugs if the interdisciplinary team, as defined by §483.20(d)(2)(ii), has determined that this practice is safe
107
108. The facility must ensure that each resident receives _______ supervision and assistance devices to prevent accidents.
adequate
F323
(Rev. 27; Issued: 08-17-07; Effective/Implementation: 08-17-07)
§483.25(h) Accidents.
The facility must ensure that
(1) The resident environment remains as free from accident hazards as is possible; and
(2) Each resident receives adequate supervision and assistance devices to prevent accidents.
108
109. Name one resident right regarding self-determination.
Interact with members of the community both inside and outside the facility
F242
§483.15(b) Self-Determination and Participation
The resident has the right to--
(1) Choose activities, schedules, and health care consistent with his or her interests, assessments, and plans of care;
(2) Interact with members of the community both inside and outside the facility; and
(3) Make choices about aspects of his or her life in the facility that are significant to the resident.
109
110. The facility must ensure that it is free of medication error rates of ____ percent or greater.
Five
F332 and F333
§483.25(m) Medication Errors
The facility must ensure that--
[F332] §483.25(m)(1) It is free of medication error rates of 5 percent or greater; and
110
111. Within how many days must the results of abuse investigations be reported to the State?
5 working days
F225
§483.13(c)(4)
The results of all investigations must be reported to the administrator or his designated representative and to other officials in accordance with State law
(including to the State survey and certification agency) within 5 working days of the incident, and if the alleged violation is verified appropriate corrective action must be taken
111
112. How should linen be stored, handled, processed and transported?
So as to prevent the spread of infection
F445
§483.65(c) Linen
Personnel must handle, store, process, and transport linens so as to prevent the spread of infection
112
113. Does the comprehensive assessment of a resident assess mental/ psychosocial adjustment difficulties?
Yes
F318
§483.25(f) Mental and Psychosocial Functioning
Based on the comprehensive assessment of a resident, the facility must ensure that-
F319
§483.25(f)(1) A resident who displays mental or psychosocial adjustment difficulty, receives appropriate treatment and services to correct the assessed problem; and
Intent §483.25(f)
The intent of this regulation is that the resident receives care and services to assist him or her to reach and maintain the highest level of mental and psychosocial functioning.
113
114. Are physical functioning and structural problems a part of the RAI?
Yes
F272
§483.20 Resident Assessment
The facility must conduct initially and periodically a comprehensive, accurate, standardized reproducible assessment of each resident's functional capacity.
§483.20(b) Comprehensive Assessments
§483.20(b)(1) Resident Assessment Instrument. A facility must make
a
comprehensive assessment of a resident's needs, using the RAI specified by the
State. The assessment must include at least the following:
(i) Indentification and demographic information
(ii) Customary routine.
(iii) Cognitive patterns.
(iv) Communication.
(v) Vision.
(vi) Mood and behavior patterns.
(vii) Psychological well-being.
(viii) Physical functioning and structural problems.
See regulations for complete list
114
115. Under OBRA which of the following is not a resident right?? F151, F153, F155, F157
1. to be free of interference, coercion, discrimination, and reprisal from the facility in exercising his/her rights
2. to purchase at a cost, not to exceed the community standard, photocopies of the records upon request, and with 24 hour advance notice to the facility
3. to refuse treatment
4. promptly notify the resident of a change in roommate
2. to purchase at a cost, not to exceed the community standard, photocopies of the records upon request, and with 24 hour advance notice to the facility
2 working days advanced notice!
115
116. In a Medicare certified facility, within how many days must the results of all investigations of abuse be reported to the (district) administrator? F225
1. 2 days
2. 3 days
3. 5 days
4. does not need to be reported
3. 5 (working) days
