NAB NHA Exam Compiled Cards:Human Resources, Leadership and Management Physical, Environmental, and Atmosphere Resident Care Management and Quality of
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the physical plant
all designed, constructed, equipped, and maintained to protect health and safety of
residents, personnel, public
Life Safety Code (LSC)
Entire construction plan and materials meet LSC standards|||CMS requires unless
have waiver or exception. CMS grants waivers on SNFs; states on NFs
(NFPA)
National Fire Protection Association ||established LSC
Purpose of LSC
to provide reasonable degree of safety from fire.
Waivers for Life Safety Code
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
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
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
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
*- 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|
- 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
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
no dead-ends (LSC)||8 feet wide (CMS)
Floors
at or above ground level. (LSC) |Fire rating if carpeted. (LSC)|Non-slip bath/toilet
(ANSI, LSC)|Asphalt tile best
Fire alarms
flashing and audible. |connect with local fire dept, if possible|must have NFPA 71
certification of fire alarm service|
smoke detectors
approved detectors requried
smoking
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)
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
no incline more than 10%
Wheelchair passage
32" bathroom doors||36" elsewhere
parking
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
maximum rise 30". Slope not more than 1:10
What items must be accessible to wheelchair residents?|
WATER FOUNTAINS, telephones (non-Braille), light switches
Toilets and handrails - height
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
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
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
flashing alarms for deaf, sound alarms for blind, tactile warnings for blind to
identify danger areas.
Grating
No greater than one-half inch; openings perpendicular to travel rout, if elongated.
Threshold
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
Maintenance cost-mowing biggest. State decides on number of parking spaces per
bed.
Water
water must have backup source of supply. Temperature established by state.
Automatic Control Valves. (surveyors will ask for contract) (110 degrees in GA)
Ventilation
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
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
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
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.
checking all systems, including roof, on regular basis and documenting.||roof
protects all other assets. (log or cards)
3 points of Preventative Maintenance
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.
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
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
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)
programs OSHA falls under U.S. Department of Labor
safety and infection control program -
complete procedures for all staff to follow best infection control. committee may
be desirable.
universal precautions
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
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)
focused on AIDS and Hepatitis B. (OSHA)
Training for BBP
all staff trained in how to handle| 1. blood spills and materials that may be infected,
and | 2. exposure incidents
PERSONAL PROTETIVE EEQUIPMENT (PPE)
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
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
contaminated sharps, blood, pathological waste, etc. Have written procedures for
handling.
Needlestick Safety and Prevention Act
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
single occupancy|toilet|hand washing faciltities|vented to outside|sign when in use|
HBV requirements
vaccine offered free to all employees (OSHA)
Employee with lesions
never works in kitchen or patient care area
post-exposure procedures
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
every exposure incident. facility should have "OSHA Compliance and Exposure
Control Plan Checklist" in order to know if incompliance
reporting communicable diseases to:
state agency
SAFETY mandated by CMS, OSHA: Goals
1. reduce work-related illness, injury, death in staff.|2. reduce accidents, injuries
among resident, families, visitors.
programs
procedures to cover preventive measures, investigating of accidents,
documentation, corrective action, reporting. committee may be useful - not
required
identify potential hazards
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
unintentional damage to object or injury to person. two causes: |(1) unsafe
behavior|(2) unsafe working or living conditions
investigate
every accident, document, corrective measures - identify patterns, discuss with
dept. head.
document
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-recordableif only first aid unconscious
reportable
accidental death, and 5 or more hospitalized (within 8 hours report)
POSTER
required by OSHA
HCP
Hazard Communication Program ||Mandated by OSHA
Purpose of HCP
all chemicals are evaluated and information concerning hazard communicated to
employer and employees.
HCP Program written:
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:
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
cleaning compounds, clorox, furniture polish, pine oil, detergents, etc. Anything
with WARNING label on it.
lockout/tagout
control hazardous energy.||
purpose of lockout/tagout
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
lock (key or combination) that will hold device in safe position so it will not
energize. where to keep key? maintenance person
tagout device
used when evergy source cannot be locked out - tag or warning device NOT to use.
Right to know laws RE:
hazardous materials in some states. OSHA recognizes only in sates with OSHA
approved programs
OSHA penalties
OSHA can FINE facilities|amounts based on severity of the deficiencies, GIVE
CITATIONS and IMPRISON|CONSULTANTS - OSHA does trial run - no
penalties
SMDA
Safe Medical Devices Act of 1990
Medical devices
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. [Show Less]