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The survey process can be overwhelming. Surveyors arrive and begin evaluating whether the facility has met specific quality standards. Often, even the prospect of an impending survey leads to anxiety and fear for facility leaders and staff. Being aware of common citations and proactively putting plans in place to avoid those findings can help lessen the anxiety. Knowing the most-cited deficiencies and being survey ready at all times can help reduce the number of and lower the scope and severity of common citations.
Over the years, the top ten survey deficiencies have remained relatively constant, but the reasons that facilities receive a specific citation do vary across the country. Let’s look at the most-cited deficiencies across the nation since January 2019 and delve further into common reasons for the top two citations.
Once providers conceptually understand trauma-informed care, they often get stuck navigating what to do next. Steps that can help directors of nursing services (DNSs) and other members of the management team begin to operationalize trauma-informed care include the following:
Avoid a checklist mentality
“It sounds cliché, but trauma-informed care is a process, not a destination,” says Kathleen Weissberg, OTD, OTR/L, CMDCP, education director at Select Rehabilitation in Glenview, IL. “Every time I teach, I’m asked, ‘Where is my checklist? How can I make sure we are doing everything that we are supposed to do?’”
September marks my first full year as your chief staff executive. And what a year it was to step into this role! As I write this, we are less than two weeks from implementation of a new reimbursement model for skilled nursing facilities. PDPM’s impending arrival has resulted in unprecedented growth in our membership, conference attendance, and utilization of AAPACN’s education programs and tools.
Therapy utilization will no longer be a payment driver under the Patient-Driven Payment Model (PDPM) in the Skilled Nursing Facility Prospective Payment System (SNF PPS), but skilled therapy services still have a key role to play. Liz Barlow, RN, CRRN, RAC-CT, DNS-CT, senior director of quality for RehabCare in Louisville, KY, offers five ways that directors of nursing services (DNSs) can work with the interdisciplinary team to get the most bang for their buck with therapy:
The July 2019 Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency Proposed Rule would give Medicare- and Medicaid-certified nursing homes a break by postponing the Requirements of Participation’s Phase 3 rollout of the training requirements at §483.95(d) in the Code of Federal Regulations (CFR), which is F944 (QAPI Training), as well as §483.95(f)(1) and (2), which is F946 (Compliance and Ethics Training). However, this November 28, providers still must have staff training in place to meet multiple new F-tag requirements under CFR §483.95 (Training Requirements):
F940 (Training Requirements – General);
F941 (Communication Training);
F942 (Resident’s Rights Training);
F945 (Infection Control Training);
F947 (Required Inservice Training for Nurse Aides). Note: While most of F947 has already been implemented, the component related to §483.95(g)(3) will implement in Phase 3. This requires that inservice training for nurse aides “address areas of weakness as determined in nurse aides' performance reviews and facility assessment at §483.70(e) and may address the special needs of residents as determined by the facility staff”; and
F949 (Behavioral Health Training).
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