Brandie Elizaitis, MS, CDP, CDS, Director of Operations ... Ftag of the Week – F760 Residents Are Free of Significant Med Errors (Pt. •Resident Council Meeting •Kitchen observation •Medication administration and storage •Sufficient and competent nurse staffing •QAA/QAPI . ¾Sampling –Three residents per triggered Care Area plus surveyor-initiated residents (e.g., complaints) ¾Investigation – Specific or general CriticalSpecific or general Critical Element pathway or facility task pathway and interpretive guidelines ¾Synthesis –Determine compliance with each Critical Element, document noncompliance at the Other Survey Activities Specialized Rehabilitative or Restorative Services Critical Element Pathway ... Use this pathway for a resident to ensure the facility obtains and provides necessary rehabilitative or restorative services. 4/16/2018 . Behavioral and Emotional Status Critical Element Pathway If No, cite F742 NA, the resident does not display or is not diagnosed with a mental or psychosocial adjustment difficulty, or does not have a history of trauma and/or PTSD. process of the Critical Element Pathway Discuss the difference in the use of the Guidance to Surveyors and Critical Element Pathway Identify residents and care areas for inclusion in the Stage 2 investigation Select resident sample for Stage 2 investigation 6.0 hours TG Lecture Discussion Review of QIS Matrix Review of Stage 2 Cite the process recommendations to avoid the citation of FTAG 880 for Infection Control errors. Form CMS-20074 Death (1/2018) Nutrition Critical Element Pathway. Use the Activities Critical Element pathway and the guidance above to investigate concerns related to activities which are based on the resident’s comprehensive assessment and care plan, and meet the resident’s interests and preferences, and support his or her physical, mental, and psychosocial well-being. For this purpose, the surveyors will use the March 8, 2017 revised Operations Manual (SOM) Appendix PP and the revised Quality Indicator Survey’s (QIS) established “Critical Elements” (CE) pathways. If feasible, observe initial pool residents with weight loss If concerns identified, will observe another meal Utilize SOM Appendix PP and Critical Element Pathway for Dining (CMS-20053) Dining task is completed outside any resident specific … Preadmission Screening and Resident Review Critical Element Pathway Form CMS-20090 (5/2017) Page 3 3) If the Level I pre-screening of the resident, either prior to admission or within 30 days, in accordance with the state PASARR process, identified Talk with residents for whom they are providing assistance rather than conducting social conversations with . During this part of the survey, the survey team members will conduct 9 mandatory tasks as well as the required closed record reviews. Resident council president interview Dining observation Kitchen/food service observation Infection control/immunization policies and practices ... Critical Element Pathways Facility-Level Triggered Investigations Environmental Observation Resident Funds Admission, Transfer, and Discharge Review Quality Indicator Survey is a computer assisted long term care survey process used by selected State Survey Agencies and CMS to determine if Medicare and Medicaid certified nursing homes meet federal guidelines for nursing home care. 2) Contact Info. During this part of the survey, the survey team members will conduct 9 mandatory tasks as well as the required closed record reviews. Address: 68 S Service Road Ste 100 Melville, NY 11747 Ph: (631) 692-4422 Infection Prevention, Control & Immunizations, Critical Element Pathway, CMS-20054 . CMS-20065 Activities critical pathways. LTCSP Resident Observations Care Areas and Probes. Activities Critical Element Path-way (CEP) 10:30 - 10:45 AM Break 10:45 - 11:15 AM • Discussion of related Critical Element Pathways for Sufficient and Competent Staff, Resident Council, Behavior and Emotion-al Status, Care of the Resident with Dementia, Reduction of Antipsychotic Medication and related F-tag areas as they apply General Critical Element Pathway. Critical Element Pathways. TROUBLING TAGS . •Critical element pathways will guide investigations ... Resident Council Meeting 39 CMS Documents. LTCSP Resident Observations Care Areas and Probes. CMS-20057 is … Allow residents adequate time to complete their meal. ... • Surveyors will utilize Critical Elements pathways built into the program • There will not be a formal tour. The resident council meeting minutes must be protected to ensure resident confidentiality and should indicate that resident complaints are followed up over a reason-able time period. When investigations are complete, the team makes citation, severity, and scope decisions for every tag identified by each surveyor. • If a specific care area is identified, it will be Pathways include: SNF Beneficiary Protection Notification Review Dining Observation Infection Prevention, Control & Immunizations Kitchen Observation Medication Administration Observation An Use Appendix PP and critical elements (CE) pathways Other Survey Activities Closed Record Reviews Complete timely during the investigation portion of survey Unexpected death, hospitalization, and community discharge last 90 days ... Resident Council Meeting Group interview with active members of the council To accompany the updates to the Resident Assessment requirements, a new Critical Element (CE) Pathway has been developed. This new CE Pathway will focus on the accuracy of the MDS, the timeliness of the completion of assessments, and the timeliness of the transmission of assessments Regulatory Changes in Resident Assessment cont. Person-centered care. Use Appendix PP and critical elements (CE) pathways Other Survey Activities Closed Record Reviews Complete timely during the investigation portion of survey Unexpected death, hospitalization, and community discharge last 90 days ... Resident Council Meeting Group interview with active members of the council The pathways include guidance on the areas (e.g., MDS, physician’s orders and care plan) that should be reviewed initially to help guide your observations and interviews. Use this pathway for a resident with concerns related to ROM, mobility, and/or positioning. CRITICAL ELEMEMT PATHWAYS Critical Element Pathways provide a more structured process and guides investigations and interviews. confidentiality. Form CMS 20131 (5/2017) Page 1. other staff. Review the following in Advance to Guide Observations and Interviews: process of the Critical Element Pathway Discuss the difference in the use of the Guidance to Surveyors and Critical Element Pathway Identify residents and care areas for inclusion in the Stage 2 investigation Select resident sample for Stage 2 investigation 6.0 hours TG Lecture Discussion Review of QIS Matrix Review of Stage 2 LTCSP Resident Record Review Care Areas and Probes. Use the Activities Critical Element pathway and the guidance above to investigate concerns related to activities which are based on the resident’s comprehensive assessment and care plan, and meet the resident’s interests and preferences, and support his or her physical, mental, and psychosocial well-being. CRITICAL ELEMENT PATHWAYS MANDATORY TASK Mandatory facility task assignments: 1) Dining Observation 2) Infection Control and Immunizations CMS-20054 3) Kitchen/Food Service Observation CMS-20055 ... Resident Council Meeting CMS-20057 9) Sufficient and Competent Nurse Staffing CMS-20062 CMS-20089 CMS-20053 . CMS 20057 Resident Council Interview 142-145 CMS 20062 Sufficient & Competent Nurse Staffing 146-153 First Impressions Checklist 154 Administration Checklist 155 Contract Book Checklist 156 Personnel File Checklist 157 Critical Element Pathways CMS-20059 Abuse 158-169 CMS-20063 Personal Funds 170-173 CMS-20091 Extended Survey 174-177 MISSOURI TOP TEN MOST FREQUENTLY CITED HEALTH DEFICIENCIES CMS QCOR CALENDAR YEAR 2018-FEBRUARY . Care Plan Implementation by Qualified Persons . FORM CMS-20072 (2/2017) Page 1. A presentation introducing the critical element pathways at the Long-Term Care IP Boot Camp held June 6, 2019, which was organized by the Wisconsin Department of Health Services HAI Prevention Program and MetaStar, Inc. • Investigation using CE (Critical Element) Pathways: Once the resident sample group has been selected, surveyors will initiate an investigation based upon a relevant record review of identified medical issues for each resident in the sample, using the CE Pathways investigative protocol specific to each resident’s condition. The ANCC Pathway to Excellence Framework depicts the six standards that are essential elements in developing a positive practice environment for nursing across a variety of healthcare settings including acute care and long-term care. to plan activities that are important to them. LESSONS FROM THE FIELD . •The software incorporates the Critical Element Pathways New Survey Process. Elected representatives, serving two-year positions, attend all GME Committee meetings and sit on selected sub-committees. The Developmental Disabilities Administration - DDA administers PASRR, a federally mandated program, for individuals with intellectual disabilities or related conditions (ID/RC) who have been referred for nursing facility (NF) care. LTCSP Resident Record Review Care Areas and Probes. If No, cite F743 NA, the resident’s assessment revealed or the resident has a diagnosis of a mental Critical element pathways. The survey team will use CMS developed Critical Element (CE) Pathways as well as Appendix PP of the State Operations Manual (SOM) to assess compliance with current Requirements of Participation (ROPs). Form CMS-20073 Hospice and End of Life (5/2017) Death Critical Element Pathway. Form CMS-20076 Pain Mgt (5/2017) Physical Restraints Critical Element Pathway. The survey process, which combines elements of the traditional survey and the QIS survey, includes a long list of Critical Element Pathways to help surveyors. CMS-20065 Activities critical pathways. You will use critical element, or CE, pathways to help guide your investigation. What is the resident’s response to interventions? In the case of improvements or renovations, a well laid plan is always best. 10 FACILITY TASK INVESTIGATIONS Mandatory tasks: Dining Infection Control SNF Beneficiary Kitchen Medication a. CMS-20067-Behavioral-Emotional critical pathways. Infection Prevention, Control & Immunizations, Critical Element Pathway, CMS-20054 5 Surveillance Log (master line list of all infections) • Resident number or medical record number • Location in facility • Date of current admission • Date each symptom began Is the care plan comprehensive? Use the Physical Restraints Critical Element (CE) Pathway, along with the above Guidance: •When a resident’s clinical record reflects the use of a physical restraint; ... CMS - 20090 Preadmission Screening and Resident Review Critical Element Pathway. Nutrition Critical Element Pathway Form CMS-20075 (5/2017) Page 2 Resident, Resident Representative, or Family Interview: How did the facility involve you in the development of your care plan and goals? Identify the facility task investigations, for which the surveyor will utilize the Critical Element Pathways. Speak with residents politely, respectfully, and communicate personal information in a way that maintains. Residents vote to choose the President and Vice President (or Chairperson and Vice Chairperson). •Caring for residents with mental and psychosocial disorders, as well as residents with a history of trauma and/or post-traumatic stress disorder, that have been identified in the facility assessment and •as linked to history of trauma and/or post-traumatic stress disorder, will be implemented beginning November 28, 2019 (Phase 3) Council minutes Within 24 hours: 671/672 Completed Beneficiary Notice.-Residents DC’d within last 6 months INITIAL POOL PROCESS ... Critical Element (CE) pathways 27 RESIDENT INVESTIGATION –GENERAL GUIDELINES. The overall goal of nursing home care is to assist individual residents to attain or maintain their highest practicable physical, mental, and psychosocial well-being. Resident Council President/Representative Interview ... Investigation – Specific or general Critical Element pathway or facility task pathway and interpretive guidelines Synthesis – Determine compliance with each Critical Element, document noncompliance at the applicable F tags, determine severity and scope 27 . Res. Resident Council CE #08 Do you feel a resident or the group can complain about care without worrying that someone will ‘get back’ at them? Activities Critical Element Pathway o The resident’s desired daily routine and availability for activities; and o The resident's choices for group, one-to-one, or self-directed activities. the Critical Element Pathways can guide you in defining opportunities for quality and process improvement. Implementation of Phase 2 - November 28, 2017 • F-Tag Renumbering F540-F949 • Providers must be in compliance with Phase 2 regulations • Interpretive Guidance- focus on Person Centered Care 33 Data Dissemination Methods Once you determine what information they need, you Does it address identified needs, measureable goals, resident involvement, preferences, and choices? General Critical Element Pathway Does staff consistently implement the care-planned interventions? That CE Pathway is found at: ... Once in the Survey Resources file, select Survey Forms then CE Pathways Facility Tasks, also a zip file. Resident Council Interview Quality Assessment and Assurance (QAA) and Quality Assurance and Performance Improvement (QAPI) Plan ... Preadmission Screening and Resident Review Critical Element Pathway Extended Survey Hydration Critical Element Pathway Tube Feeding Status Critical Element Pathway Utilize SOM Appendix PP and Cr itical Element Pathway for Dining (CMS-20053) ... • Probes help determine whether the critical elements of care are in place 42. o CNAs were engaged in a new program for CNAs that identified the food preferences of residents. LTCSP Resident Interview Care Areas and Probes. furnish services to residents only as paid feeding assistants as defined in §488.301 of this chapter. Each care area has its own threshold designed to trigger investigation when frequency surpasses the CMS-determined acceptable level. C U S T O M E R D R I V E N. B U S I N E S S M I N D E D. •Appendix P is no longer in use ... •Resident Council Meeting •Medication Storage •Beneficiary Protection Notification Review 6. • Specific Critical Element Pathways • General Critical Element Pathway • Guidance to Surveyors from State Operations Manual • Triggered Facility Tasks 23 Critical Element Pathways • Determine if Critical Elements of Care are met: Comprehensive Assessment (F272) Care Planning (F279) Care Plan Implementation by Qualified Persons Additionally, CMS updated the Critical Element Pathway for Resident Council – CMS-20057. This is a mandatory task, and the reference is the revised Facility Task Pathway. Recertification Surveys Is the resident’s response as intended? Resident Council Meeting . CMS-20057 Resident Council critical pathways. CMS-20057 Resident Council President/Representative Interview CMS-20058 Quality Assurance & Assessment Review Task 5 Triggered Task Worksheets ... Critical Element Pathways (CEs) and Unnecessary Drug Review Worksheet Task 6 and 7 Worksheets CMS … The Graduate Medical Education Resident Council was established in 2007 to increase representation of Baylor house staff on the Graduate Medical Education Committee. o A subcommittee of the Resident Council was established to assist in selecting favorite A Model Resident Council • Residents run the council Review the Following in Advance to Guide Observations and Interviews: CMS Documents. Tag # Tag Description # Citations F0880 Infection Prevention & Control 15 CMS - 20057 Resident Council Interview. Are residents’ choices honored and their dignity maintained? DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES. 06/17/2018 16 Critical Element Pathways (CE) • Components: – Assessment – Care Planning • Develop • Revise – Provision of Care ... Resident Council Meeting • Completed with 12 or so residents • Staff can not attend • Questions for meeting about: – How often meet If you identify gaps in your program, we encourage you to use the information included in this webinar ... the resident’s current conditions, cognitive patterns, mood, behavior, Functional Status, Diagnosis, and treatment. Quality of Life (§483.25) • Based on the comprehensive assessment of a resident, we are requiring facilities to ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person- centered care plan, and the residents’ choices. CMS-20067-Behavioral-Emotional critical pathways. Have you lost weight in the facility? •Name of Resident Council President Entrance Conference •Census number •Complete matrix for new admissions w/in last 30 days who still reside in facility •Alphabetical list of all residents (note any resident out of facility) •List of residents who smoke, designated smoking times and locations Info to be provided immediately upon entrance Use this pathway for the following: a) when MDS concerns are noted but you are not using a care area pathway (i.e., the care area did not require further investigation), or b) for concerns about … If so, why do you think you’ve lost weight (e.g., taste, nausea, dental, grief, or depression issues)? 10/10/2017 22 Updated CE Pathways 43 44. Critical Element Pathway CMS – 20054 (May 2017) • “Staff” includes employees, consultants, contractors, volunteers, and others who provide care and services to residents on behalf of facility. For example: • Do residents remain unkempt or unclean for extended periods of time (e.g., after sleeping or eating); or • Are residents woken up and assisted with activities, such as eating, bathing, or dressing at times that is convenient for staff (e.g., during shift By using the interview tools and Critical Element Pathways, a nursing home team can implement the care area investigative protocols that guide surveyors in completing their reviews. Selecting a nursing home can be a difficult task. CMS-20075 Nutrition Critical Element Pathway; CMS-20078 Pressure Ulcer Pathway; CMS-20093 Tube Feeding Pathway; CMS 20092-Hydration Pathway; Indiana Diet Manual Electronic Version Signature Form; Charting Tools. The Behavioral Health Administration - BHA) administers PASRR for people with serious mental illness (SMI). Group interview with active members of the council; Complete early to ensure investigation if concerns identified; Refer to updated Pathway ; Sufficient and Competent Nurse Staffing Review . LTCSP Resident Interview Care Areas and Probes. Resident Assessment Critical Element Pathway. We all know there are times when a resident requires a room move due to circumstances involving facility improvements or maintenance issues. The Critical Element (CE) Pathway and FIC protocol will remain available in the Survey Resource Folder States that fail to perform these survey activities timely and completely could forfeit up to 5% of their Coronavirus Aid, Relief, and Economic Security (CARES) Act allocation, annually. CEP CMS Nutrition Critical Element Pathway Dining CEP Kitchen CEP Resident Council CEP QAA & QAPI CEP Dental CEP Dialysis CEP Pressure Ulcer CEP Hydration CEP Tube Feeding CEP Hospitalization Rehospitalization CEP Competencies for … For purposes of this subpart, person-centered care means to focus on the resident as the locus of control and support the resident in making their own choices and having control over their daily lives. Identify the process for investigation with the Critical Element (CE) Pathways, for areas such as pressure ulcers and dialysis. CMS-20057 Resident Council critical pathways. Requires direct observation and communication with the resident, as well as with licensed and unlicensed direct care staff on all shifts Inclusion of the requirement that the facility use the results of the resident’s assessments to develop, review and revise the resident’s comprehensive care plan Resident Assessment Critical Element (CE) Pathway Resident Council Interview • Group interview with active members of the Resident Council • Early in the survey • Focus is on specific areas related to the functioning of the council and a few resident specific areas, such as abuse and sufficient staffing • The surveyors will ask the group Updated Survey Resources Posted for LTCSP (9/14/2021) 16 Sep 2021. Use this pathway for a resident who requires supervision and/or assistive devices to prevent accidents and to ensure the environment is free from accident hazards as is possible. LTC Provider Meeting, Fall 2017 19 Resident councils are structured in various ways, but usually every resident living in a facility is an automatic member of the council. 10 CMS QTSO Website Critical Element Pathways Critical Element (CE) Pathways •Abuse •Unnecessary Medications, Psychotropic Medications,& Medication Regimen Review •Behavioral and Emotional Status •Dementia Care •Preadmission Screening and Resident Review •Activities •Communication and Sensory Problems •Dental Status and Services •Dialysis