the physical plant - ANSWER-all designed, constructed, equipped, and maintained to protect health and safety of residents, personnel, public
Life
... [Show More] Safety Code (LSC) - ANSWER-Entire construction plan and materials meet LSC standards|||CMS requires unless have waiver or exception. CMS grants waivers on SNFs; states on NFs
(NFPA) - ANSWER-National Fire Protection Association ||established LSC
Purpose of LSC - ANSWER-to provide reasonable degree of safety from fire.
Waivers for Life Safety Code - ANSWER-If CMS finds a state fire and safety code adequately protects residents and personnel thenLSC does not apply. OLder facilities may obtain a waiver if they are and have been in compliance with an older addition of LSC as specified by CMS.||Before a nursing home may be built it must present architectural plant to State Medicaid or designated agency that approves construction. All major renovations, such as additional beds, change in utilization of space, and so on must receive approval. The state provides guidelines on what must be a approved. Upkeep and repairs do not require prior approaval.
Blue Prints - ANSWER-keep as-built plans available for surveyors who do LSC inspection as well as for repair persons who may need prints for big jobs.
LSC and other standards - ANSWER-Building and contact standards are set by LSC, CMS, ANSI/ADAAG - (dependent on which the state chooses) and state and local codes. ||- for handicapped|-follow which on specific state requires (ANSI/ADAAG)
LSC and ANSI/ADAAG - ANSWER-LSC accepts both standards so they are essentially all LSC standards. Administrator does not need to know EVERY standard, but must keep a copy of the "LSC Handbook" as reference. The architect who designs the facility must know and incorporate all LSC and other standards, but it is advisable for the NHA to check his building to ensure compliance.
LSC, ANSI/ADAAG, and CMS - ANSWER-**- building materials - fire-rate according to number of stories. 2 hour and 1 hour rating|**- sprinklers - new buildings have automatically activated by smoke/heat|- exits - no room more than 100 feet from exit. Lighted exit signs of specific size. |- walls extend continuously to roof deck of next floor. wall finish must meet flame-spread requirements ( have certificate of this)|- furnishings - curtains and carpet must meet fire rating|- rooms - CMS requirements - 4 residents to room MAX. 80 sq ft/resident (multi-resident room), 100 sq ft for single occupancy.
requirement for rooms| - ANSWER-- direct access to corridor|- outside window (CMS) or door (LSC)|- privacy|- furnishing| separate bed, proper size and height| bedding appropriate to climate| individual closet space| bedside table| comfortable chair| enough overbid tables to meet needs of rsidents|- toilets (CMS, ANSI, ADA)|- bathing facilities (CMS)|- resident call system (CMS, LSC) 24/7 - back up system available|- temperature range (71-81 degree F) (three feet above floor), states set actual, A/C not required
Doors - ANSWER-All 44" or more in new construction (41.5 opening)|outside doors open egress.|no locks on resident door except staff has key (LSC)||Bathroom door 32" (ANSI/ADAAG)||Fire Doors with automatic hold-open devices required in corridors||(over bed tables not required for patient)
corridors - ANSWER-no dead-ends (LSC)||8 feet wide (CMS)
Floors - ANSWER-at or above ground level. (LSC) |Fire rating if carpeted. (LSC)|Non-slip bath/toilet (ANSI, LSC)|Asphalt tile best
Fire alarms - ANSWER-flashing and audible. |connect with local fire dept, if possible|must have NFPA 71 certification of fire alarm service|
smoke detectors - ANSWER-approved detectors requried
smoking - ANSWER-written regulations, enforced. |smoking ares with non-combustible ashtrays, metal containers with self-closing lids.|Prohibited areas include resident rooms and beds, oxygen, flammable liquid storage.|proper signs posted.|supervise non-responsible.
ANSI/ADAAG(Americans with Disabilties Act Accessibility Guidelines) - ANSWER-Make building available to and usable by physically handicapped, no mental (blind, deaf, non-ambulatory, semi-ambulatory, uncoordinated). ADAAG = MAKE BUILDINGS AVAILABLE TO ADA'S. |State decides whether to apply ANSI or ADAAG standards to nursing homes
accessible route - ANSWER-no incline more than 10%
Wheelchair passage - ANSWER-32" bathroom doors||36" elsewhere
parking - ANSWER-13 FEET||cannot block sidewalk; alley for 2 cars.|The number of handicap parking places is determined from a grid issued by ANSI. It MUST BE NOTED THAT FOR EVERY EIGHT (8) HANDICAP PARKING SLOTS, ONE MUST BE VAN ACCESSIBLE.||If the facility only has one handicapped place, it must be van accessible.
ramps - ANSWER-maximum rise 30". Slope not more than 1:10
What items must be accessible to wheelchair residents?| - ANSWER-WATER FOUNTAINS, telephones (non-Braille), light switches
Toilets and handrails - height - ANSWER-toilets (Also ADA for staff) seat **17" to 19" height;||hand rails/grab bars 33" to 36". |5% or more meet standards as determined by state and CMS||(easier to replace with handicapped toilet)
Handrails - ANSWER-outside ramp, stairwell, bathroom required by ANSI, and specific height.||CMS requires in corridors.||ADAAG specifies all 34" to 38" in public places. |On stairwell must be 32" and MUST EXTEND 12" beyond last step. (ANSI|
Monitored - ANSWER-monitored nationally the Office of Civil Rights monitors ANSI. States may assign to Fire Marshall, Medicaid Agency, other. |ADAAG is monitored by State Agency handling LSC and ANSI.
Alarms - ANSWER-flashing alarms for deaf, sound alarms for blind, tactile warnings for blind to identify danger areas.
Grating - ANSWER-No greater than one-half inch; openings perpendicular to travel rout, if elongated.
Threshold - ANSWER-no more than 1/2 inch on entrance and exit doors, except exterior sliding door can be 3/4 inch in height
GROUNDS and parking - ANSWER-Maintenance cost-mowing biggest. State decides on number of parking spaces per bed.
Water - ANSWER-water must have backup source of supply. Temperature established by state. Automatic Control Valves. (surveyors will ask for contract) (110 degrees in GA)
Ventilation - ANSWER-All areas ventilated to outside - window, mechanical ventilation, or combination. | a. good movement (state determines| b. acceptable humidity/temperature levels (state determines)| c. surveyor rating:| A= Good movement; acceptable temp/humidity/odor levels| B= Little movement; temp/humidity/odor levels less acceptable.| C= No movement; temp/humidity/odor levels unacceptable. Residents and staff apprea distressed due to levels.
Pest control - ANSWER-PREVENTION PROGRAM BEST; use contractor and staff||no traps, poisons, sticky fly paper.||advantage - to use pest control service:||licensed and trained in use of all pesticides, how to rotate chemicals to prevent buildup of resistance. ||(close garbage bin: attracts pests)
Space and Equipment - ANSWER-Facility must provide sufficient space and equipment for dining, healthcare services, recreation and rehabilitation. ||Sufficient means enough to enable staff to provide residents with needed services as identified in the plan of care.| - space large enough to accommodate usual number that use it; must be accessible.| - accommodate wheelchairs, walkers, other ambulatory devices.| - rehab areas have exercise equipment, storage for supplies and equipment.
Monitoring - ANSWER-States decide who will monitor LSC and ANSI/ADAAG standards. the monitor may be the State Medicaid Agency, State Fire Marshall, or other. If it is an agency other than State Medicaid, the monitoring agency must coordinate its findings with the Medicaid agency.
Preventative Maintenance definition. - ANSWER-checking all systems, including roof, on regular basis and documenting.||roof protects all other assets. (log or cards)
3 points of Preventative Maintenance - ANSWER-1. Value:| Everything safe and operative for resident care (#1)| saves downtime| small reparis cost less than complete breakdown| equipment and systems last longer|2. personnel - major error in hiring|3. work orders
environmental quality - clean, attractive, home. - ANSWER-1. housekeeping - procedures for floors, rooms, aseptic cleaning, storage of materials, ODOR CONTROL, role in infection control, equipment care, safety|2. homelike - residents brings own belongings as long as it does not interfere with staff work or infringe on other residents' rights. de-emphasize institutional look. | a. sound - comfortable, does not interefre with hearing. background noise under resident control. Level not require staff to raise voices. consider differences in room assignments.| b. lighting - adequate for resident/staff to perform. comfortable - minimize glare, GIVE RESIDENT CONTROL.
environmental design - ANSWER-now part of all new construction. Must be designed to provide most attractive, comfortable, usable environment. | a. landscaping - all grounds, nursing home sign.| b. choice of colors.| c. room size- too small?, adequately designed?| d. medical records storage| e. parking - inconspicuous| f. functional equipment - not just fancy.
linen supply and laundry - ANSWER-clean linens in good condition, not ragged, stained. what resident clothing will launder?| a. monitoring costs - bulk soap, temperatures, overloading/under loading, overydrying, filters| GUIDELINES- after 10 years of use, maintenance cost usually justify replacement of equipment| b. Theft|
Occupational Safety and Health Administration (OSHA) - ANSWER-programs OSHA falls under U.S. Department of Labor
safety and infection control program - - ANSWER-complete procedures for all staff to follow best infection control. committee may be desirable.
universal precautions - ANSWER-checked by OSHA; includes|-CDC HAND WASHING procedures. NOW recommend use of alcohol-based solution to cleanse hands (except dietary employees)|-SOILED LINENS and bedclothes means used linens.|-Contaminated linen is soiled by blood or other potentially infectious materials. Mishandling is most frequent exposure to communicable materials. OSHA requires contaminated to be containerized at location. aseptic cleaning of isolation area. |OSHA APPROVED SPILL KITT***
CMS STANDARDS for infection control - ANSWER-investigate, control, prevent infections|set up procedure for entire program|document incidents and correctivev action|isolate infected resident|no employee with communicable diseases or skin lesions can have contact with food or residents|hand washing after each direct resident contact|handle, process, store, and transport linens in manner to prevent spread of infection
blood born pathogens (BBP) - ANSWER-focused on AIDS and Hepatitis B. (OSHA)
Training for BBP - ANSWER-all staff trained in how to handle| 1. blood spills and materials that may be infected, and | 2. exposure incidents
PERSONAL PROTETIVE EEQUIPMENT (PPE) - ANSWER-FACILITY MUST PROVIDE GLOVES, GOWNS, LAB COATS, FACE SHIELDS, EYE PROTECTION, MOUT PIECES, AND RESUSCITATION BAS, POCKET MASKS, OR OTHER VENTILATION DEVICES. TRAINED TO USE
Disposal - ANSWER-of sharps and other contaminated materials (OSHA) must have container in nursing, laundry, etc. and policy on emptying container (med carts: check levels)|
regulated waste - ANSWER-contaminated sharps, blood, pathological waste, etc. Have written procedures for handling.
Needlestick Safety and Prevention Act - ANSWER-follow OSHA standards|engineering controls - shield, retracting needles, shielded catheters, needles housed in protective covering, and jet injections. NOW required to USE SAFETY SYRINGES.|Law requires employee input on what works best.
isolation room procedures - ANSWER-single occupancy|toilet|hand washing faciltities|vented to outside|sign when in use|
HBV requirements - ANSWER-vaccine offered free to all employees (OSHA)
Employee with lesions - ANSWER-never works in kitchen or patient care area
post-exposure procedures - ANSWER-must have written plan for evaluation and follow-up. individuals involved tested (consent may be gained-OSHA says not required)-test blood of exposed person
documentation - ANSWER-every exposure incident. facility should have "OSHA Compliance and Exposure Control Plan Checklist" in order to know if incompliance
reporting communicable diseases to: - ANSWER-state agency
SAFETY mandated by CMS, OSHA: Goals - ANSWER-1. reduce work-related illness, injury, death in staff.|2. reduce accidents, injuries among resident, families, visitors.
programs - ANSWER-procedures to cover preventive measures, investigating of accidents, documentation, corrective action, reporting. committee may be useful - not required
identify potential hazards - ANSWER-BED RAILS, wheelchairs, walkers (misuse or poor maintenance|WET FLOORS mopping, spills|HOT WATER-temperature set by state. Automatic control valves|extension cords|frayed electrical wires|unattended cleaning carts (medication carts)|restraints|adapters (cheaters)
accidents - ANSWER-unintentional damage to object or injury to person. two causes: |(1) unsafe behavior|(2) unsafe working or living conditions
investigate - ANSWER-every accident, document, corrective measures - identify patterns, discuss with dept. head.
document - ANSWER-on OSHA forms log (FORM 300***) only inventory staff, not residents. need copy of "what every employer needs to know about OSHA Record-keeping . keep records for 5 years.
non-recordable- - ANSWER-if only first aid unconscious
reportable - ANSWER-accidental death, and 5 or more hospitalized (within 8 hours report)
POSTER - ANSWER-required by OSHA
HCP - ANSWER-Hazard Communication Program ||Mandated by OSHA
Purpose of HCP - ANSWER-all chemicals are evaluated and information concerning hazard communicated to employer and employees.
HCP Program written: - ANSWER-a. list of all hazardous chemicals (anything with a warning label)|b. label all chemical containers|c. prepare and distribute MSDS (any chemical)|d. develop and implement employee training
label must: - ANSWER-a. identify product|b. identify hazardous chemicals|c. contain appropriate warning|d. show name and address of manufacturer|e. sometimes pH content-7 is norm
Includes - ANSWER-cleaning compounds, clorox, furniture polish, pine oil, detergents, etc. Anything with WARNING label on it.
lockout/tagout - ANSWER-control hazardous energy.||
purpose of lockout/tagout - ANSWER-to require employers to establish program using lockout or tagout devices on energy isolating devices and to disable equipment and machines to prevent unexpected energizing, start-up, or release of store energy in order to prevent injury.
lockout device - ANSWER-lock (key or combination) that will hold device in safe position so it will not energize. where to keep key? maintenance person
tagout device - ANSWER-used when evergy source cannot be locked out - tag or warning device NOT to use.
Right to know laws RE: - ANSWER-hazardous materials in some states. OSHA recognizes only in sates with OSHA approved programs
OSHA penalties - ANSWER-OSHA can FINE facilities|amounts based on severity of the deficiencies, GIVE CITATIONS and IMPRISON|CONSULTANTS - OSHA does trial run - no penalties
SMDA - ANSWER-Safe Medical Devices Act of 1990
Medical devices - ANSWER-Medical devices - "Any apparatus, implement, chanine, implant, or related article intended for use in diagnosing, treating, curing, or preventing disease or intended to affect the body's function or structure, which achieves its intended purposes without chemical or metabolic action within the body.||i.e. catheters, thermometer, pacemakers, contact lenses, hearing aides, restraints, blood glucose monitors, WCs, gerchairs, beds, infusion and feeding pumps, whirlpool suction machines.
policies and procedures - ANSWER-facility required to establish policies/procedures for programs of staff training, of reporting incidents, illnesses, and injuries, and of action taken.
monitoring - ANSWER-the Food and Drug Administartion (FDA) monitors
reportable incidents - ANSWER-events that reasonable suggest a medical device caused or contributed to a serious illness or injury, or to the deat of a resident - includes user error.
serious illness or injury: - ANSWER-a. life threatening|b. results in permanent impairment to body structure or functioning|c. needs immediate medical or surgical intervention to prevent permanent illness or injury. ||extent determined by a physician [Show Less]