Facility Self-Assessment (Mock Survey) Tool - Nursing Home Help

QUALITY OF CARE
Use probes regarding Anticoagulants, blood glucose, pain, falls, smoking, change of condition, pressure ulcers &
abuse investigation to guide information gathering.
Compare any negative answers to the intent of the regulation.
Deficiencies should be cited only if the intent of the regulation is not met.
Missing standard components addressed only under “standards not in compliance” section of FQR Score.
F309 Anticoagulants:
The lab work for residents on Coumadin is completed as ordered?
Documentation of Physician notification and assessment complete for abnormal INR/PT results?
F309 Blood Glucose:
Are Blood Glucose levels obtained as ordered?
Is assessment of resident with abnormal levels present?
F309 Pain
Pain assessment, interventions and follow-up documentation are clearly evident?
F323 Falls:
Post falls assessment completed and appropriate?
Interventions on plan of care are evident on physical review of resident? Care plan
appropriate to falls?
F323 Smoking:
Are smoking safety assessments completed on all residents who smoke?
When observing the resident that smoke is it evident that the safety interventions identified are in place?
F309/F157 Change of Condition:
Timely assessment and physician notification is evident on any acute change of condition episodes.
F314 Skin/Pressure Ulcers:
Residents with pressure ulcers have had timely accurate assessment of wound?
When resident with pressure ulcers are observed are all interventions identified on the care plan observed to be in place?
F225 Verification of Investigation:
All incidents are thoroughly investigated and documentation includes evidence of determining causal factors and
recommendations to prevent reoccurrence?
Recommendations to prevent reoccurrence identified o the investigations are observed on visual checks of resident or
environment.
5.65