Improving the Quality of Care in Nursing Homes (1986) / Chapter Skim
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Appendix B: Existing SNF Conditions of Participation and ICF Standards
Appendix B: Existing SNF Conditions of Participation and ICF Standards
Pages 254-314
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From page 254... ...
CONDITION OF PARTICIPATION -- COMPLIANCE WITH FEDERAL, STATE, AND LOCAL LAWS. The skilled nursing facility is in compliance with applicable Federal, State, and local laws and regulations.
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From page 255... ...
CONDITION OF PARTICIPATION -- GOVERNING BODY AND MANAGEMENT. The skilled nursing facility has an effective governing body, or designated persons so functioning, with full legal authority and responsibility for the operation of the facility.
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From page 256... ...
The skilled nursing facility, under the direction of the governing body, prepares an overall plan and budget which provides for an annual operating budget and a capital expenditure plan.
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From page 257... ...
Expenditures directly or indirectly related to capital expenditures, such as grading, paving, broker commissions, taxes assessed during the construction period, and costs involved in demolishing or razing structures on land are also included. Transactions which are separated in time but are components of an overall plan or patient care objective are viewed in their entirety without regard to their timing.
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From page 258... ...
The overall plan and budget is prepared under the direction of the governing body of the skilled nursing facility by a committee consisting of representatives of the governing body, the administrative staff, and the medical staff (or chief medical officer, or patient care policies advisory group as described in 405.1122(a)
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From page 259... ...
The facility has appropriate written policies and procedures relating to notification of the patient's attending physician and other responsible persons in the event of an accident involving the patient, or other significant change in the patient's physical, mental, or emotional status, or patient charges, billings, and related administrative matters. Except in a medical emergency, a patient is not transferred or discharged, nor is treatment altered radically, without consultation with the patient or, if he is incompetent, without prior notification of next of kin or sponsor.
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From page 260... ...
Is fully informed, by a physician, of his medical condition unless medically contraindicated (as documented, by a physician, in his medical record) , and is afforded the opportunity to participate in the planning of his medical treatment and to refuse to participate in experimental research; (4)
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From page 261... ...
physical restraints except as authorized in writing by a physician for a specified and limited period of time, or when necessary to protect the patient from injury to himself or to others; (8) Is assured confidential treatment of his personal and medical records, and may approve or refuse their release to any individual outside the facility, except, in case of his transfer to another health care institution, or as required by law or third-party payment contract; (9)
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From page 262... ...
The skilled nursing facility has written patient care policies to govern the continuing skilled nursing care and related medical or other services provided.
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From page 263... ...
Medical records and minutes of staff and committee meetings reflect that patient care is being rendered in accordance with the written patient care policies, and that utilization review committee recommendations regarding the policies are reviewed and necessary steps taken to ensure compliance.
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From page 264... ...
The facility's obligation, upon written authorization by the patient, to hold, safeguard, and account for the patient's personal funds in accordance with this paragraph.
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From page 265... ...
Identification number and location of any account in which that patient's personal funds have been deposited; (v) Ending balance; and (vi)
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From page 266... ...
The facility must, upon request or upon the patient's transfer or discharge, return to the patient, the legal guardian, or the representative payee all or any part of the patient's personal funds that the facility has received for holding, safeguarding, and accounting, and that are maintained in a petty cash fund.
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From page 267... ...
Unless precluded by State law, the facility must provide the executor or administrator of a patient's estate with a written accounting of the patient's personal funds within 10 business days of a patient's death. If the deceased patient's estate has no executor or administrator, the facility must provide the accounting to: (i)
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From page 268... ...
Unless precluded by State law, the costs of instituting the proceeding and administering the patient's estate may be charged against the patient's estate; or, (iii) In the time period between notification to the appropriate agencies, institution of formal guardianship proceedings, or notification to the local SSA office and the actual appointment of a guardian or representative payee, the facility must serve as temporary representative payee for the patient.
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From page 269... ...
Medical direction and coordination of medical care in the facility are provided by a medical director. The medical director is responsible for the development of written bylaws, rules, and regulations which are approved by the governing body and include delineation of the responsibilities of attending physicians.
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From page 270... ...
The facility has a policy that the health care of every patient must be under the supervision of a physician who, based on a medical evaluation of the patient's immediate and long-term needs, prescribes a planned regimen of total patient care. Each attending physician is required to make arrangements for the medical care of his patients in his absence.
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From page 271... ...
CONDITION OF PARTICIPATION -- NURSING SERVICES. The skilled nursing facility provides 24-hour service by licensed nurses, including the services of a registered nurse at least during the day tour of duty 7 days a week.
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From page 272... ...
The facility provides 24-hour nursing services which are sufficient to meet total nursing needs and which are in accordance with the patient care policies developed as provided in 405.1121~1~. The policies are designed to ensure that each patient receives treatments, medications, and diet as prescribed, and rehabilitative nursing care as needed; receives proper care to prevent decul~itus ulcers and deformities, and is kept comfortal~le, clean, well-groomed, and protected from
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From page 273... ...
In coordination with the other patient care services to be provided, a written patient care plan for each patient is developed and maintained by the nursing service consonant with the attending physician's plan of medical care, and is implemented upon admission. The plan indicates care to be given and goals to be accomplished and which professional service is responsible for each element of care.
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From page 274... ...
The attending physician is notified of an automatic stop order prior to the last dose so that he may decide if the administration of the drug or biological is to be continued or altered.
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From page 275... ...
CONDITION OF PARTICIPATION -- DIETETIC SERVICES. The skilled nursing facility provides a hygienic dietetic service that meets the daily nutritional needs of patients, ensures that special dietary needs are met, and provides palatable and attractive meals.
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From page 276... ...
A current therapeutic diet manual approved by the dietitian is readily available to attending physicians and nursing and dietetic service personnel.
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From page 277... ...
Written administrative and patient care policies and procedures are developed for rehabilitative services by appropriate therapists and representatives of the medical, administrative, and nursing staffs.
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From page 278... ...
CONDITION OF PARTICIPATION -- PHARMACEUTICAL SERVICES. The skilled nursing facility provides appropriate methods and procedures for the dispensing and administering of drugs and biologicals.
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From page 279... ...
CONDITION OF PARTICIPATION -- LABORATORY AND RADIOLOGIC SERVICES. The skilled nursing facility has provision for promptly obtaining required laboratory, X-ray, and other diagnostic services.
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From page 280... ...
.) (The basic Hospital Insurance Program does not cover the services of a dentist in a skilled nursing facility in connection with the care, treatment, filling, removal, or replacement of teeth or structures supporting the teeth; and only certain oral surgery is included in the Supplemental Medical insurance Program.)
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From page 281... ...
It is not mandatory that the skilled nursing facility itself provide social services in order to participate in the program. If the facility does not provide social services, it has written procedures for referring patients in need of social services to appropriate social agencies.
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From page 282... ...
CONDITION OF PARTICIPATION -- PATIENT ACTIVITIES. The skilled nursing facility provides for an activities program, appropriate to the needs and interests of each patient, to encourage self care, resumption of normal activities, and maintenance of an optimal level of psychosocial functioning.
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From page 283... ...
The medical record contains sufficient information to identify the patient clearly, to justify the diagnosis and treatment, and to document the results accurately. All medical records contain the following general categories of data: Documented evidence of assessment of the needs of the patient, of establishment of an appropriate plan of treatment, and of the care and services provided; authentication of hospital diagnoses (discharge summary, report from patient's attending physician, or transfer form)
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From page 284... ...
Transfer of patients will be effected between the hospital and the skilled nursing facility, ensuring timely admission, whenever such transfer is medically appropriate as determined by the attending physician, and (2) There will be interchange of medical and other information necessary or useful in the care and treatment of individuals transferred between the institutions, or in determining whether such
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From page 285... ...
The skilled nursing facility meets such provisions of the Life Safety Code of the National Fire Protection Association (21st Edition, 1967) as are applicable to nursing homes; except that, in consideration of a recommendation by the State survey agency, the Secretary may waive, for such periods as deemed appropriate, specific provisions of such Code which, if rigidly applied, would result in unreasonable hardship upon a skilled nursing facility, but only if such waiver will not adversely affect the health and safety of the patients; and except that the provisions of such Code shall not apply in any State if the Secretary finds, in accordance with applicable provisions of section 1861(j)
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From page 286... ...
Nonflammable medical gas systems, such as oxygen and nitrous oxide, installed in the facility comply with applicable provisions of National Fire Protection Association Standard No. 56B (Standard for the Use of Inhalation Therapy)
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From page 287... ...
The Secretary (or in the case of a facility participating as a skilled nursing facility under title XIX only, the survey agency -- see 42 CFR 449.33(a)
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From page 288... ...
The facility establishes a written preventive maintenance program to ensure that equipment is operative and that the interior and exterior of the building are clean and orderly. All essential mechanical, electrical, and patient care equipment is maintained in safe operating condition.
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From page 289... ...
CONDITION OF PARTICIPATION -- INFECTION CONTROL. The skilled nursing facility establishes an infection control committee of representative professional staff with responsibility for overall infection control in the facility.
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From page 290... ...
CONDITION OF PARTICIPATION -- UTILIZATION REVIEW. The skilled nursing facility carries out utilization review of the services provided in the facility at least to inpatients who are entitled to benefits under the programs)
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From page 291... ...
(1) The utilization review function is conducted by a staff committee of the skilled nursing facility composed of two or more physicians, with participation of other professional personnel, or by a group outside the facility which is similarly composed and which is established by the local medical or osteopathic society and some or all of the hospitals and skilled nursing facilities in the locality, or by a group established and organized in a manner approved by the Secretary that is capable of performing such a function.
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From page 292... ...
(3) Review by the committee or group may not be conducted by any person who is employed by or who is financially interested in any skilled nursing facility or by any person who was professionally involved in the care of the patient whose case is being reviewed.
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From page 293... ...
(1) Periodic review is made of each current inpatient skilled nursing facility beneficiary case of continuous extended duration, the length of which is defined in the utilization review plan, to determine whether further inpatient stay is necessary.
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From page 294... ...
(1) A final determination of the committee or group that an admission or continued stay is not medically necessary is made by at least two physician members of the committee or groups, except that the final determination may be made by one physician member where the attending physician, when given an opportunity to express his views, does not do so, or does not contest the finding that the admission or continued stay is not medically necessary.
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From page 295... ...
If the final determination of the committee or group is that further stay is no longer medically necessary, written notification of the finding is given to the facility, the attending physician, and the individual (or where appropriate, his next of kin) no later than two days after such final determination is made and, in no event in the case of an extended duration case, later than 3 working days after the end of the extended duration period specified pursuant to paragraph (d)
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From page 296... ...
local resources available to the facility, the patient, and the attending physician to assist in developing and implementing individual discharge plans; and (v) provisions for periodic review and reevaluation of the facility's discharge planning program.
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From page 297... ...
Notwithstanding the preceding paragraphs of this section, if the Secretary determines that the utilization review procedures established by a State pursuant to Title XIX of the Social Security Act are superior in their effectiveness to the procedures required under this section, any provision of the State plan for which the waiver of the requirements set forth in this section for utilization review in skilled nursing facilities is granted shall, to the extent deemed appropriate by the Secretary, be utilized by skilled nursing facilities in that State, instead of the procedures specified in this section.
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From page 298... ...
The ICF must have written policies and procedures that insure that: (a) It transfers a resident promptly to a hospital, skilled nursing facility, or other appropriate facility,
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From page 299... ...
Consults the resident, his next of kin, the attending physician, and the responsible agency, if any, at least 5 days before a transfer or discharge; and (2) Uses casework services or other means to insure that adequate arrangements are made to meet the resident's needs through other resources.
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From page 300... ...
Be fully informed by a physician of his health and medical condition unless the physician decides that informing the resident is medically contraindicated; (ii) Be given the opportunity to participate in planning his total care and medical treatment; (iii)
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From page 301... ...
(B) The use is authorized by a professional staff member identified in the written policies and procedures of the facility as having the authority to do so.
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From page 302... ...
(a) The ICF must have written policies and procedures that provide that all rights and responsibilities of a resident pass to the resident's guardian, next of kin, or sponsoring agency or agencies if the resident: (1)
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From page 303... ...
of this section, as long as the survey agency finds that it is in the public interest and
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From page 304... ...
Description of treatments and services provided and medications administered; and (6) All indications of illness or injury including the date, theme, and action taken regarding each.
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From page 305... ...
The State survey agency may apply the lodgings or rooming houses section of the residential occupancy requirements of the Life Safety Code of the National Fire Protection Association, 1967 edition, instead of the institutional
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From page 306... ...
(a) The State survey agency may waive specific provisions of the Life Safety Code required by 442.321, for as long as it considers appropriate, if: (1)
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From page 307... ...
(b) For an existing building, the State survey agency may waive the space and occupancy requirements of paragraphs (a)
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From page 308... ...
(b) The State survey agency may waive, for as long as it considers appropriate, provisions of ANSI standard No.
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From page 309... ...
Have the menus for those residents planned by a professionally qualified dietitian, or reviewed and approved by the attending physician; and (2) Supervise the preparation and serving of meals to insure that the resident accepts the special diet.
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From page 310... ...
The ICF must have written policies and procedures for controlling medication dosage, by automatic stop orders or other methods, when the physician does not include in the order a specific limit on the time or number of doses. These procedures must include notice to the attending physician that the medication is being stopped as of a certain date or after a certain number of doses.
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From page 311... ...
(e) The ICF may employ as charge nurse an individual who is licensed by the State in a category other than registered nurse or licensed practical or vocational nurse if: (1)
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From page 312... ...
(c) The rehabilitative services must be designed to: (1)
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From page 313... ...
Developed in consultation with the attending physician and, if necessary, an appropriate therapist; and (2) Based on the attending physician's orders and an assessment of the resident's needs.
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From page 314... ...
(7) Section 442.343, rehabilitative services.
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