The Fundamentals of Quality for Long Term Care

The Fundamentals of Quality for Long Term Care Part 1

PreviewResidents Rights – 483.10 Summary Highlights

Federal and State laws mandate that all residents residing in Skilled Nursing Facility/Nursing Facility have rights guaranteed to them. It is the responsibility of the facility (Administrator & Staff) to promote and ensure that the resident exercise his/her rights, even if the resident has communication barriers or cognition limits. It is important for all staff to recognize and be aware that the resident has choice to the extent possible, about quality of life and quality of care. Furthermore facilities must also be aware that the facility policies and procedures cannot violate the intent of the regulatory requirement. In the event a resident cannot legally exercise his/her rights, the resident’s representative can exercise his/her rights for him/her.

This section of regulations also place the responsibility on the facility to verify that the surrogate or representative have the authority to act on behalf of the resident. Staff must also be aware that, although a resident may have a legal surrogate or representative; this does not automatically relieve a facility from its duty to protect and promote the resident’s interest.

Another element of Residents Rights is the presence of advance directive. Does the facility have policies and procedures to implement advance directives? Is the staff aware of the policies and procedures? During medical records review, the surveyor will determine compliance with the extent at which the facility provides education to residents and their families regarding advance directives.

Residents finances not only covers accounting of residents personal allowances, but it also covers information given to residents and their families about services covered by Medicare and Medicaid. Does the Business Office or the Social Worker communicate to the residents about Medicaid limitations? Does the Business Office secure authorization from the resident or family in order to handle their funds, and do they do quarterly accounting of those funds to the residents?

Residents’ privacy, dignity, self respect – very important component of residents rights. “Knock and ask for permission before entering resident’s room. Only authorized staff directly involved in treatment should be present when treatments are given. People not involved in the care of the individual should not be present without the individual’s consent while he/she is being examined or treated.

As an administrator who routinely spent part of her day with the front-line staff when she operated her nursing centers, Nora Wellington appreciates the hard work of the front- line staff, as well as the importance of the IDT. Alicia Creighton-Allen brought her clinical skills as an Intensive Care Nurse into her Long Term Care (LTC) nursing experience, to co-author the Fundamentals of Quality series (Part I, Part II, Part III). Parts of these tools have been used by staff in some of the nursing centers where Wellington was an administrator, and those staff members have encouraged her to share her hands-on practical monitoring tools with the LTC community. These tools will help you be ready for annual surveys, and also to make you “survey-ready 365 days a year.”

Visit for more information about workshops, training, and other related LTC resources.This is the first book in a three-part series.


Long Term Care Monitoring Tools Resident Meal Time and Dining Experience Kitchen and Food Service

The Monitoring Tools - Resident Meal Time & Dining Experience and Kitchen & Food Service are designed in an easy-to-read and easy-to- follow format. The moniotoring tools reflect the current Federal Long Term Care Regulations and the Interpretive Guidelines. Staff can utilize these tools to help prepare for survey and to help with the task of ongoing monitoring for compliance. These tools are appropriate to help with all facilities whether the facility is a Traditional Survey afcility or a Quality Indicator Survey facility.

Having interdisciplinary teams work together to observe resident meal times is helpful. The team can observe what happens when food carts are delivered to the floors or the units. They can observe whether the staffs make themselves available to serve the residents their meals, or whether the food stays unattended in the food service delivery cart for a while. They can also observe staffs interaction with the residents during meal time. If the facility has paid feeding assistants, are the paid feeding assistants working under the supervision of a Licensed Practical Nurse or a Registered Nurse? I need to state here that the facility will decide if they want to use teams to do the internal observation/monitoring or if they prefer individual staff members to do the observation or monitoring. It is the administrator's, DON's, or QA Director's choice if they use teams or individual staff persons.

The same goes for the kitchen. The facility can put their own internal teams together or have individuals to observe the kitchen and the food service staff for compliance. In addition to these monitoring tools the teams must also have available the State Dietary Manual, and other State requirements for food service. The staffs doing the internal monitoring must check freezer and refigerators temperatures to ensure that the food is maintained at the proper temperatures. All areas of the kitchen must be observed for compliance. Are leftover foods labeled and dated before they are placed in the refgrigerator? Are food cooked to the proper temperature? Is the cold food kept at the proper temperature in the refrigerator? Is the kitchen floor clean? They can also check the dishwasher temperature for washing and rinsing cycles.