1. Spring 2017 Kelley Mitchell, RNC, MSN
ADPH REPORT
Spring 2017
Kelley Mitchell, RNC, MSN

2. Diane.Mann @adph.state.al.us
Bureau of Health Providers
Newsletter

3. Licensure Action Taken
Survey Statistics
Surveys
Emergency Closure
Licensure Action Taken
ALF 28 2
SCALF 19
Total 47 4

4. Questions & Answers

5. How should facilities dispose of empty medication packages and cards?

6. When a resident in a SCALF requires dialysis, has a port, or has a shunt, are they still appropriate to remain in the facility?

7. If a wing of ALF beds is re-certified as independent, can the ALF residents and the independent living residents intermingle, especially at meals?

8. In an effort to provide a home-like environment and person centered care for our residents, would it be possible to use a non-specific medication time? Non-specific medication times have been successful in some facilities around the state. What is the state’s position on this?

9. When a CRNP does a medical plan of care, should it or must it be co-signed by a doctor if schedule two or three medications are involved?

10. Can we retain a resident who needs a pureed diet because of dental or chewing issues?

11. 420-5-4-.07 Food Service (1) General.
(a) Direction and Supervision. The services of a Dietitian shall be made available to any resident of an assisted living facility who requires a therapeutic diet.

12. What is the facility responsibility to actions regarding the hospital RN writing verbal orders that are not signed by the physician?

13. Residents are required to have a TB check prior to admission
Residents are required to have a TB check prior to admission. Does this include re- admission from the hospital or skilled nursing?

14. When can we begin using the portable DNR?

15. How many falls is too many? Do all falls require an investigation?

16. Where in the rules does it state how long a facility can go without a licensed administrator on-site if the administrator quits, or loses, or does not renew their license?

17. (3)(a)
2. There must be an individual authorized in writing to act for the administrator during absences.

18. (1)(a)
…The governing authority shall be responsible for implementing policies for the management and operation of the facility, and for appointing and supervising the administrator who is responsible for overall management and the day-to-day operation of the facility. …

19. 135-X-10-.01 Emergency Permits
1) In the event an assisted living administrator dies, unexpectedly resigns, becomes incapacitated, or has his/her license revoked, the person or persons then responsible for the management of the assisted living facility shall notify the Board within fifteen (15) days and the agency issuing the assisted living license and shall be allowed a reasonable period of time, not to exceed 120 days from the date of death, unexpected resignation, incapacitation, or revocation of license of the assisted living administrator, in which to replace said administrator. Such assisted living facility must apply to the Board for an emergency permit for the person who will actually administer the assisted living until a licensed assisted living administrator can be employed. Such application shall state the acting administrator’s qualifications, the circumstances creating the need for an emergency permit, and the period of time for which the emergency permit is needed, and said application shall be verified by the acting administrator and the owner of, or manager of the assisted living facility. The acting administrator must be able and willing to comply with State Board of Health rules governing assisted living facilities and must meet the following minimum qualifications: …

20. For semi-annual fire/sprinkler inspections, what are the State’s guidelines for facility year versus rolling year?

21. The Role of the Registered Nurse
Nursing in SCALF
The Role of the Registered Nurse

22. 420-5-20-.04 (9) Registered Professional Nurse.
Each facility shall have at least one registered professional nurse (RN) to assess the residents in the specialty care assisted living facility.
(2)
(c) Assessment. The RN shall perform a comprehensive assessment of each resident…
(d)An RN shall identify resident care problem
Areas … An RN shall perform a monthly assessment of each resident …
(6) (a-b)Screening. Cognitive Assessment Requirements … Each resident shall be carefully evaluated by an RN …

23. (3)
(d) Plan of Care.
Based on the individual resident assessment, an RN, in conjunction with the facility staff and the resident's sponsor or responsible family member, shall develop appropriate written plans of care to address the specific problems identified. The nurse shall evaluate both the facility's implementation and the resident's response to the plan of care. The plan of care shall be modified when necessary to meet the needs of the resident, and the resident's sponsor or responsible family member shall be notified of such changes.

24. 420-5-20-.06(2) (d) Resident Care Problem Areas.
An RN shall identify resident care problem areas and formulate written interventions to address those problems, and to evaluate if the planned interventions were successful.

25. (2)
(b) An RN shall consult with the administrator on all issues of resident safety and health and well being.
(e) An RN shall assess and communicate with the resident's attending physician and with the resident's sponsor or responsible family member if the resident experiences any of the following significant status changes …

26. (11)
(b) All staff who have contact with residents, including the administrator, shall have initial training prior to resident contact. Initial training shall be followed up with refresher training as necessary. An RN shall identify staff refresher training needs and shall provide or arrange for needed training. …

27. What is the timeframe for a comprehensive assessment (RN) to be completed if a community does not employ an RN on a daily basis?

28. Define: assessment

29. 610-x-2-.06 Standards of Nursing Practice
(2) Assessment, Comprehensive: the systematic collection and analysis of data including the physical, psychological, social, cultural and spiritual aspects of the patient by the registered nurse for the purpose of judging a patient’s health and illness status and actual or potential health needs. Comprehensive assessment includes patient history, physical examination, analysis of the data collected, development of the patient plan of care, implementation and evaluation of the plan of care.
(3) Assessment, Focused: An appraisal of a patient’s status and specific complaint through observation and collection of objective and subjective data by the registered nurse or licensed practical nurse. Focused assessment involves identification of normal and abnormal findings, anticipation and recognition of changes or potential changes in patient’s health status, and may contribute to a comprehensive assessment performed by the registered nurse

30. (3)
(d)1. The facility shall assess residents on a monthly basis and more often when necessary to identify significant changes in health status or behavior

31. Define: Care Plan
Care plans are written directions for individualized resident care. Purpose To provide comprehensive continuity of resident care

32. Define: Care Plan
Identification of specific problem or need based in assessment
Care interventions-actions or services provided to meet the resident’s individual needs
Identification of staff responsible to provide the specific service
When the services should be provided
Evaluated for effectiveness
Update when necessary

33. Can you give some examples of what surveyors look for in a care plan?

34. What do surveyors look for in a care plan
Identification of specific problem or need based in assessment
Care interventions-actions or services provided to meet the resident’s individual needs
Identification of staff responsible to provide the specific service
When the services should be provided
Evaluated for effectiveness
Update when necessary

35. Why can’t nurses employed in ALFs and SCALFs provide all of the nursing services they have been trained and licensed to perform?

36. 10-x-6 Standards of Nursing Practice
(3) The scope of an individual registered nurse’s level of practice includes, …
(f) Limitations on scope, as determined by facility policy and procedure
(3) The scope of an individual licensed practical nurse’s level of practice includes, …
(e) Limitations on scope, as determined by facility policy and procedure.

37. What should a provider do if they have a resident near the end of 90 days of skilled nursing if the wound is actively healing, but may take an additional 30 days? Is a discharge necessary, or is there an extension from the state that can be obtained?

38. In an assisted living facility, can non- licensed staff press an injection of an insulin pen under the direction of a resident?

39. (4)
(e) Assistance with self-administration of medications shall under no circumstances include any of the following practices:
1. Giving a resident injections of any kind
Provided, that a resident who is capable of maintaining possession and control of his or her own medications, who does maintain possession and control of his or her medications, and who would be capable of self- administration of his or her own medications but for limitations of mobility or dexterity, may be assisted with eye drops, ear drops, or nose drops by unlicensed facility staff so long as the assistance provided is under the total control and direction of the resident.

40. Can you share some deficiencies that have been observed in the industry related to resident care, incident reporting, or care planning?

41. What should we expect and how should we prepare for upcoming surveys, including Life Safety Issues?

42. Will there be any changes to the rules and regulations regarding medication awareness criteria?
Would it be possible to consider a revision of the rules regarding medication awareness for the facilities that train and employ only licensed nurses to assist with medications (except where self- medication orders apply)?