D. Office management: 1. Does the administrator use commonly accepted/approved Yes forms?__. No ( ) (a) Does the administrator have a brochure explaining ( ) ( ) こここ (c) Does the administrator have permission from the pa- ( ) (d) Does the administrator use an acceptable bookkeep- ( ) 2. Administrator relationships: (a) Is the family or some responsible person kept in- ( ) (b) Is the relationship among administrator, patient/ (c) Is there good administrator-personnel relationship?_ ( ) 3. Insurance: こここここ (a) Does the administrator/owner carry professional (b) Does the administrator/owner carry premise lia- A. Does the record show that each patient admitted to the nursing 1. Does the physician make periodic visits, at least once 2. Does the physician enter progress notes on record at B. Does the nursing home have a principal staff physician or A. Does individual record for each patient include: 2. Identification, such as social security number, color, 3. Physicians' progress notes-. 4. Physicians' orders?. 5. Reports and medication records?__. ( ( ( ( 6. Are nursing notes kept daily and signed by the nurses?_ ( B. Is patient roster complete and adequate for statistical and legal requirements?_. () IV. NURSING CARE A. Is there a registered nurse in charge of patient care (minimum 5 days, 40 hours per week)?_. B. Is there a licensed practical nurse in charge of patient care (minimum 5 days, 40 hours per week)?_. C. Is there a practical nurse in charge of patient care (minimum 5 days, 40 hours per week)? D. Is there a consulting registered nurse (minimum 8 hours in 1 week)? (Where consulting registered nurse is employed, dated record must be kept of all recommendations.) – E. Is there a night nurse on duty, awake and fully dressed?__ ( F. Are there written policies, procedures, and guides available to the nursing staff?. V. RESTORATIVE MEASURES A. Are restorative procedures maintained in accordance with the Yes determination of the attending physician?_ B. Are there special restorative programs under the supervision of a professional therapist?. C. Has the nursing staff been given special instruction in such a program?__ D. Are there provisions for this service from the appropriate community facilities and agencies when such services are not available at the nursing home?_. E. Have the nurses received special instruction or training in procedures leading to maximum self-care, and do they practice them?_. No ( ) ( ) ( ) () () () () () ( () VI. DIVERSIONAL ACTIVITIES A. Are facilities/equipment available for— (1) Reading material?_ (2) Letter writing?__ (3) Religious services?. (5) Radio?___ (7) Other? (specify) B. Are recreational activities encouraged and supervised?__. D. Are there adequate visiting hours?_ A. Medication: VII. ESSENTIAL SERVICES 1. Are there provisions for the safe sorting and proper 2. Are other drugs properly safeguarded and records?___ B. Dietary: 1. Is there a variety of good quality foods served at each 2. Is the food prepared and served in a form to suit the 3. Food supplies: (a) Is there a 1-week supply of staple foods?. (b) Is there a 1-day supply of perishable foods?_ 5. Are refrigeration and storage adequate?_. 6. Menus: (a) Are menus planned and on file?. (b) Is the menu varied sufficiently?. 7. If required, are food handler's permits current?. 9. Are there provisions for serving special diets?__-- 11. Are 3 meals served per day with supplementary feed- 12. Are patients weighed monthly, with weight recorded C. Housekeeping: 1. Is the general housekeeping of nursing home good?_ (c) Is there (1) A dining room?_ (2) Recreation room, patio, sunroom, or () 1. Are there written evacuation plans in home?_ ( ) () () VIII. SUMMARY AND RECOMMENDATIONS Include an objective listing of the deficiencies found. This should make mention of those points in which the facility excels. There is also room here for the subjective appraisal by the surveyors of the facility. The utility of this summary and recommendations will depend in part on the skill and perspicacity of the surveyors. Recommendations where a specific deficiency exists should be clearly made, offering the administrator/owner a chance for self-improvement. It is recognized that collateral information may be obtained by the surveyors which might be helpful in the overall evaluation of the facility. SURVEYOR'S MANUAL FOR EVALUATION OF NURSING HOMES I. ADMINISTRATION A. Physical plant: As State licensing requirements and fire safety regulations change from time to time, it is anticipated that this will be answered on the basis of the requirements in effect at the time of the survey. B. Administrator: 1. Qualifications: (a) A factual chronological recitation of the administrator/owner's formal education, training, and experience is to be included here. (b) Attention also should be given to the degree of integrity, devotion, and dedication of the administrator/owner. (c) Evidence that the administrator/owner, if not qualified, purchase the necessary services for the discharge of administrative duties? 2. Professional advancement: (a) It is felt that the progressive administrator/owner, the one who is truly interested in the advancement of his facility, will want to avail himself of the opportunity of allying with people who have a similar interest. (b) The attendance at meetings that advance the training and skill of the administrator is important. More and more emphasis is placed on restorative procedures and knowledge concerning these is available at various workshops and training courses. Current attendance at these indicates again that the administrator/owner is interested in increasing his knowledge and skill. C. Personnel policies: 1. Personnel policies should be written, kept up to date, and readily available for references. 2. The explanation of personnel policies should not be static; it should come from two sources-counseling at the time of employment, and amplifying throughout employment. For the clear understanding of all concerned, it is felt advisable that personnel policies be readily available. 3. Each employee will function most efficiently when he understands completely the extent of his duties. 4. It is felt advisable that each facility have a clearly understood and smoothly practiced evacuation and disaster plan commensurate with the size of the facility. Naturally, a paperwork evacuation plan is of little or no value at a time of emergency unless it is periodically reviewed by all personnel. Personnel and the administrator/owner must function efficiently and effectively in maintaining the safety of the patient and guests. 5. Preemployment and annual health examinations protect both the personnel and the patients. It is felt that whenever possible, the 14- by 17-inch chest film is desirable. In those areas where it is impractical or impossible to obtain a large X-ray, the minifilms as taken by the mobile chest units, such as those of the National Tuberculosis Association, will be acceptable. This section includes the administrator/owner under the general terms of "personnel." 6. All facilities should have on-the-job training in an attempt to raise the level of service performed by the employees. Outlines of lectures and demonstrations given should be kept on file, together with signed attendance records of employees present. 7. Reference material, such as medical dictionary, practical nursing textbook, PDR (physicians' desk reference) manual for diabetic food interchange, etc., should be available at all times for staff. 8. References of all applicants should be checked. D. Office management: 1. Does the administrator/owner use commonly accepted/approved forms? (a) All policies regarding admission, discharge, and refund policy should not only be in writing, but the person or patient himself should clearly understand same before admission. (b) Those possessions or valuables left in care of the administrator/owner should be receipted and a copy furnished the family/responsible person. (c) It is recognized that there may be those, who, for religious reasons prefer not to summon a physician in time of need. Arranging for this permission before admission, as well as calling another doctor if patient's own physician is not available in case of an emergency, will greatly expedite the situation. (d) The bookeeping and record systems will reflect, generally speaking, the efficiency and attention to details of the organization. 2. (a) Most of the families show a genuine interest in the welfare of their relatives, so that, for the most part, elaborate systems of contact are unnecessary. In those instances where, by virtue of indifference, apathy, inaccessibility, or for a variety of other reasons, the relatives do not visit regularly, it is felt that the relatives (nearest of kin) should be informed at not less than monthly intervals. When a considerable change takes place, particularly a sudden deterioration, communications should be as frequent as necessary. (b) This, again, is rather subjective and is perhaps most easily ascertained by the general interpersonal relationship which pervades the establishment. It might be well to make part of the evaluation during the normal visiting hours so that the visitors can be observed. II. MEDICAL CARE A. In concurrence with the American Medical Association Council of the American Nursing Home Association, and the American Medical Association and American Nursing Home Association Liaison Committee, each patient should be given the privilege of choosing his own physician. B, C. The staff physician or medical liaison committee of the county medical society could be utilized for consultation of medical care of patient. Also, they would be available for emergency calls when the patient's regular physician is unavailable. III. MEDICAL RECORDS A. Individual record folders for each patient includes: 1. Admission record and diagnosis. 2. Proper identification. 3. Orders. 4. Progress notes. 5. Reports and medication records. 6. All daily nursing notes on each patient. B. A roster should be maintained of all patients admitted and discharged in the nursing home. IV. NURSING A, B, C, D, E. The minimum nursing personnel and supervision are delineated by each individual State standard. V. RESTORATIVE MEASURES A. Written orders from the attending physician should be obtained for all restorative procedures performed in nursing home. B. Larger facilities may employ a professional physical and occupational therapist to manage this department. Smaller facilities may have a visiting physical and occupational therapist. C. Provision should be made by the administrator/owner for instruction of the nursing staff in restorative procedures. Examples of how this might be accomplished are: visiting physical and occupational therapists, workshops, county medical society liaison committees, and personal example. D. Larger communities will undoubtedly offer a restorative program. Adequate use of these should be made wherever possible. E. Relates to B. VI. DIVERSIONAL ACTIVITIES A. Diversional activities may vary from the simplest (reading material and letter writing) to organized group activities. This will depend upon the size of the facility, as well as on the interest and skill of the supervisor and nursing staff. It is not anticipated that a chapel for religious services will be considered a part of a nursing home. Services may be held or transportation arrangements with local churches and synagogues. B. The older patients, particularly those who are senile, will require considerable encouragement and supervision. There is a tendency of many older people to insulate themselves from the activities which surround them. A skillful nurse or aid can sometimes motivate the older patient to join in group activities. C. Volunteers include the American Red Cross Gray Ladies and Transportation Service, the women's auxiliary to the medical societies, the Friendy Visitors' Service, women's organizations of the various churches and clubs, etc. D. There are many services given for the patients which cannot be performed during visiting hours and for this reason unrestricted visiting may pose problems. However, visiting hours should be adequate. Visiting by friends and relatives should be encouraged. VII. ESSENTIAL SERVICES It will be noted that this entire section has received an asterisk because herein lies the heart of all problems-that is, the provision of service to the elderly, where a qualitative difference separates the truly superior home from the average or substandard home. It is recognized that excellent service can be provided in an average physical plant, and certainly the reverse thereof is also true. A. Medication: 1. Self-explanatory. 2. Self-explanatory. 3. Here, the type of facility must be given prime consideration. In the facility rendering nursing care, no medications are permitted at the bedside table. In the home for the aged, certain innocuous medications may be left at the bedside table. B. Dietary: 1. Each patient should be provided daily with the kind and amount of food according to dietary allowances currently recommended by the Food and Nutrition Board, National Research Council, Washington, D.C. (a) One pint or more of milk, including fresh milk or its equivalent in evaporated or dry milk solids. (b) Orange, grapefruit, tomato, or other vitamin C foods (fresh, frozen, or canned): one or more servings (approximately one-half cup) daily. (c) Green or yellow vegetables (fresh, frozen, or canned): one or more servings. (d) Potatoes, other vegetable, and fruit (fresh, frozen, canned, or dried): two or more servings. (e) Lean meat, poultry, fish, or eggs: two or more servings. (Dried peas, beans, or peanut butter may be used as an additional serving.) |