This was sent to me from a colleague who participated in the Texas Medicaid Coalition (TMC) call last week. An Administrator describes the Dementia focused survey. I have removed any reference to the facility or the administrator, but he or she freely described the survey during the call with all Texas providers on the TMC.
A facility in Dallas had the first Texas Dementia Focused Survey this week. During my monthly TMC conference call today, [redacted' Administrator, shared [his or her] experience. The building has a census of 86 – 20 have dementia. Administrator said this was explained to him/her as a full book survey of only dementia patients. The final count was at least 7 tags. Administrator stated that 50% of the survey was directed at Activities, 35% directed at Social Services and the rest was nursing.
10 surveyors entered the building at 8 am on Monday morning. 5 were from CMS (federal) and 5 were from DADS. {Texas survey agency] Of the 10, 6 were there for observation/training only. They arrived at 8 am and left at 7 pm the first day. They arrived at 8 am the second day and exited at 3 pm.
On entry, they requested:
- a list of all dementia patients with their diagnosis
- 802/672
- bath times
- meal times
- care plans
- ADL plan of care (did the CNAs know which residents had dementia? Heavy focus on whether residents were having BM's)
- med pass times
- P & P as it relates to dementia residents
- Social Worker files
- Activity Director files and activity calendars
- Surveyors requested the facility set up a care plan meeting with at least one resident identified as having dementia – They wanted the medical director or resident's MD, psychologist, psychiatrist, pharmacy consultant, family, housekeeping, dietary, maintenance, nurse aides,,,, as many as possible in attendance
- Proof of Dementia training for staff
- Requested QA sign in page to see who attends the meetings
While they were there, they:
- Watched baths, med pass, and the dining room. Do they resist care while bathing - how do the CNAs handle it? Do they go to the dining room to eat? Do the CNAs communicate with the resident in the dining room – do they tell them why they are in the dining room. One of the CNAs did not explain to the resident why they were being taken to the dining room and they were cited.
- Reviewed psych consents and behavior monitoring sheets – an issue was not all (both psych consents and behavior monitoring sheets) had the exact behaviors that were monitored, forms not completely filled out. They wanted to know if we knew the resident's behaviors.
- Reviewed proof that someone (not just the Pharm consultant) is tracking the antipsychotics and there is a process for identifying opportunities for reduction. They wanted to see tracking and trending
- Based on their census of 20, were there enough staff (nurses and activity staff) to provide care?
- Reviewed the Social Services behavior assessments
- Reviewed weight loss
- Heavy focus on In-room activities – are the in-room activities specifically mentioned in the care plan? They had a room with 3 females with dementia and the Activity Director was playing music in the room. The surveyor asked what was going on – The AD stated she was doing in-room activities. The AD was asked if it was care planned for the three residents and because it was only care planned for two of them, they were cited.
- Activities not performed as scheduled. One program was not provided and they were cited.
- Home like environment – in one room there were no pictures on the wall. Also, the resident's room mate had just been sent to the hospital. The room-mate was on an alternating pressure mattress and the DMI company had picked it up. No pictures and no mattress on the bed equalled lack of home like environment. They were cited.
- Watched peri-care – one resident mentioned pain while the CNA was doing peri-care and the CNA did not immediately notify the nurse. Another resident had been in bed for 3 hours and the CNA provided peri-care before getting the resident ready for meal time. When the CNA got the resident up she forgot to put a cushion in the wheelchair. They were cited under Quality of Care-pressure ulcers and provision of services.
- Reviewed every MDS and closely monitored if the diagnosis in the chart (within the last 60 days) matched the diagnosis on the MDS
- They interviewed the Administrator and the DON – Adm described it as intense and in-depth.
- Four surveyors interview the Administrator.They wanted to know how you developed your policies and procedures. What type of guidelines do you use.? The ADM said they strongly favored the Alzheimers as being the guidelines used. How do you know your dementia residents are being cared for adequately.
- Ten surveyors interviewed the DON. They asked specifically about each of the 20 patients regarding the care provided, pressure ulcers, peri care ADL's, meds, how do the CNAs communicate with the residents, etc.
Tags:
Activities – F-248 – not providing activities as stated - one program not performed as stated on calendar
Homelike environment F252
Dignity F-241 Dining Room incident
Unnecessary Drugs F-329
Performance of Services
SW not actively pursing guardianship – F-250
Quality of Care – pressure ulcers F314
Care Plans F-280
15 facilities in Texas have already been pre-chosen for the Dementia Focused Surveys.
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