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As a new activity director, I am looking at the ways that the previous activity director organized her paperwork. I talked to others in the area and they were using other paperwork than I was. My question is: What is the paperwork that state expects to see for documentation and where do I get this paperwork? I am in the state of Texas. I do not know if this makes a difference or not. Thanks... :)

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State gets the paper (info) work from the residents charts & from you.

The progress notes, MDS, Care Plans etc. are on the residents chart.

You need to provide them with the following;

A binder that has past 3 months of particpation records (current month you have in seperate binder but don't give this to them unless they ask for it)

Same thing as above but for the One-on-one's & the Resident council mins. (be sure that the resident council mins do not have the residents name in there!)

You should take the binders & put them in the room that they will be working in as soon as they enter the building. If they need anything else they will find you and ask for it.

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State gets the paper (info) work from the residents charts & from you.

The progress notes, MDS, Care Plans etc. are on the residents chart.

You need to provide them with the following;

A binder that has past 3 months of particpation records (current month you have in seperate binder but don't give this to them unless they ask for it)

Same thing as above but for the One-on-one's & the Resident council mins. (be sure that the resident council mins do not have the residents name in there!)

You should take the binders & put them in the room that they will be working in as soon as they enter the building. If they need anything else they will find you and ask for it.

 

 

Wait, so you're telling me that I have to keep a copy of all the participation records?

And the Resident Council minutes can't have their names in them?

Do these rules change for the state of FL or am I just living under a rock?

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Your paperwork is the only record that the surveyors have to gather information about the care you provide your residents. Even though they are called State Surveyors, they are still armed with Federal Regulations, applicable in all states, even Florida. Your resident council is the only place residents have to go and voice their concerns, in confidence. Its your job to make sure that their rights to privacy are upheld, you should record the minutes but dont take names and dont share any of the concerns except with the proper channels. "Resident Rights"

 

You should keep the participation records to verify that the "Plan of Action" that you have careplanned in the charts is actually being carried out and you are taking notes monitoring the progress. A surveyor should be able to walk into a facility, pick 3 resident names out of a hat, and, from the paperwork provided, follow the day by day care of each resident.

 

the Assessment the official get to know interview, what the residents likes and dislikes, hobbies, interests etc, and then on to your careplan.. any concerns or strengths to plan for, your action and your expected Goals .. your progress notes and participation records show the progression of your plan. Good documentation is key to avoiding deficencies.

 

An AD spends a huge amout of time on documetation, planning, meetings (corp & family) so make sure you have a good working volunteer dept, capable assistants, self directed resident volunteers

 

Your assistants can keep participation notes on scheduled and non-scheduled activities, so make sure they have good forms. Create them with a pencil and a Xerox machine if needed.

 

Just make sure if your facilty is regulated by Medicare and Medicaid State and Federal Regulations that you keep up-to-date and proper paper work dating back 120 days, close at hand, or you could be tagged.

Edited by DjHAWKY
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Your paperwork is the only record that the surveyors have to gather information about the care you provide your residents. Even though they are called State Surveyors, they are still armed with Federal Regulations, applicable in all states, even Florida. Your resident council is the only place residents have to go and voice their concerns, in confidence. Its your job to make sure that their rights to privacy are upheld, you should record the minutes but dont take names and dont share any of the concerns except with the proper channels. "Resident Rights"

 

You should keep the participation records to verify that the "Plan of Action" that you have careplanned in the charts is actually being carried out and you are taking notes monitoring the progress. A surveyor should be able to walk into a facility, pick 3 resident names out of a hat, and, from the paperwork provided, follow the day by day care of each resident.

 

the Assessment the official get to know interview, what the residents likes and dislikes, hobbies, interests etc, and then on to your careplan.. any concerns or strengths to plan for, your action and your expected Goals .. your progress notes and participation records show the progression of your plan. Good documentation is key to avoiding deficencies.

 

An AD spends a huge amout of time on documetation, planning, meetings (corp & family) so make sure you have a good working volunteer dept, capable assistants, self directed resident volunteers

 

Your assistants can keep participation notes on scheduled and non-scheduled activities, so make sure they have good forms. Create them with a pencil and a Xerox machine if needed.

 

Just make sure if your facilty is regulated by Medicare and Medicaid State and Federal Regulations that you keep up-to-date and proper paper work dating back 120 days, close at hand, or you could be tagged.

 

 

Wow...

I am unaware of most of this. My facility has told me that I do not need to care plan a resident unless a resident is triggered, and the resident council minutes have had the residents names on them for over 4 years?!

Is there a website I can go to with all of the activity guidelines provided by the state?

Thanks

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Amanda, I care plan every Resident.

My MDS coordinator has care plans in the computer for every department. When we meet for care plans she will ask me what I would like for Activities. If she doesn't have one in the computer that I need she will put one in. We then personalize the care plan to fit the Resident's needs or strengths.

If an activity care plan is not done I do get written for not having one.

I don't know if Florida has the same Regs, but our consultants fly in from Florida to do our mock survey.

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I am so glad to get so many replies. I am in Texas and I also am looking back at past resident council meetings for the past 8 years and they have the residents last name on them. I would like to know that best place, book, etc. to get the most recent information on documentation, resident councils, etc.

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Each States Survey Team will ask for something different when they conduct their survey. Yes, they are ALL armed with the Federal Regulations (F-Tags) and we all know, or should know them inside and out! As far as what the surveyors need/get when they walk into a facility; that depends on the survey team and the state. I am in Michigan and have been at my facility for 9 years. When the team arrives, I give them the past three months Activity Calendars and my Resident Council Binder that holds the Minutes for the current year and the past year. As the survey progresses, if the surveyors want participation logs or one-to-one visit documentation, they are usually interested in certain residents and ask for those records, which I provide.

 

As far as my Resident Council minutes go, I do have Residents full names in the minutes. I have never had a problem with this with any of our survey teams. This may be related to a form we have in the front of the medical chart which gives permission for pictures to be taken and displayed in the facility and for newspaper articles including names, names to be posted on residents doors etc. If the resident disagrees, signs they do not want the above, then their name is left out of the minutes and their room number is used.

 

As I mentioned, each state is different so if you are not sure, don't be afraid to ask. The surveyors are a wealth of knowledge and are just people like you and me. It is better to ask when you don't know than to be hung with a citation!

 

Ella

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Each States Survey Team will ask for something different when they conduct their survey. Yes, they are ALL armed with the Federal Regulations (F-Tags) and we all know, or should know them inside and out! As far as what the surveyors need/get when they walk into a facility; that depends on the survey team and the state. I am in Michigan and have been at my facility for 9 years. When the team arrives, I give them the past three months Activity Calendars and my Resident Council Binder that holds the Minutes for the current year and the past year. As the survey progresses, if the surveyors want participation logs or one-to-one visit documentation, they are usually interested in certain residents and ask for those records, which I provide.

 

As far as my Resident Council minutes go, I do have Residents full names in the minutes. I have never had a problem with this with any of our survey teams. This may be related to a form we have in the front of the medical chart which gives permission for pictures to be taken and displayed in the facility and for newspaper articles including names, names to be posted on residents doors etc. If the resident disagrees, signs they do not want the above, then their name is left out of the minutes and their room number is used.

 

As I mentioned, each state is different so if you are not sure, don't be afraid to ask. The surveyors are a wealth of knowledge and are just people like you and me. It is better to ask when you don't know than to be hung with a citation!

 

Ella

 

 

I would like to have everything prepared before being in that situation, though.

Wow, I feel like an idiot... but even more than that I feel like perhaps my facility is really clueless as to what is required from the Activities department.

Like I said before, does anyone have a link where I could get the exact guidelines for Florida? This would be a great help....

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Amanda, I am also in Texas and our "Mock" survey team just exited yesterday. My Resident's names are all through the Resident Council minutes. Believe me when I tell you they went over the minutes very thoroughly!

They never mentioned not using the Resident's names.

What they did tell me was to make a separate folder for the current months Resident Council minutes to give to the State instead of handing them the whole book, and if they want more to have it available for them.

They also came down on some of the other Dept Heads for not responding to Resident Council.(including my Administrator) Ha! Ha! We had responses by the end of the day.

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Amanda, I am also in Texas and our "Mock" survey team just exited yesterday. My Resident's names are all through the Resident Council minutes. Believe me when I tell you they went over the minutes very thoroughly!

They never mentioned not using the Resident's names.

What they did tell me was to make a separate folder for the current months Resident Council minutes to give to the State instead of handing them the whole book, and if they want more to have it available for them.

They also came down on some of the other Dept Heads for not responding to Resident Council.(including my Administrator) Ha! Ha! We had responses by the end of the day.

 

 

Haha... of course you did!

What kind of template do you use for your Resident Council minutes? Do you think we could trade documents? I would like any pointers that you could give me on mine....

Thanks!

My email is Amartin@cchpf.net

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Haha... of course you did!

What kind of template do you use for your Resident Council minutes? Do you think we could trade documents? I would like any pointers that you could give me on mine....

Thanks!

My email is Amartin@cchpf.net

 

Hi all.. the regulations for the Resident Council dont spell out the withholding of the resident names, it is company or personal policy and procedure. As a troubleshooter I always taught my facilities to use a three part system One form for minutes, one form for attendance and one form for actions / concerns.

~^~^~^~^~

You can download a copy in the Download Area on http://www.activitydirector.net/Activity_Downloads

~^~^~^~^~

 

the Ftag 164 gives the resident Rights of Privacy .. anything photo, communication (audible/visual), clinical.. etc.

so in fact each resident should sign a release to have their names published quoting something he/she said

 

ftag 164 sub section (f) "Grievances" gives the resident the rights to voice disapproval

 

ftag 165 residents have the right to voice grievances without discrimination or reprisal. Such grievances include those with respect to treatment which has been furnished as well as that which has not been furnished.

as the AD you cant determine discrimination or reprisal, so as a friend to an extended family you should protect their privacy, they depend on you. the 3 forms system helps you maintain a line of privacy.

 

ftag 166

prompt efforts by the facility to resolve grievances the resident may have. Including those with the respect to the behavior of other residents

 

Also read the article on HIPAA Activity Article on HIPAA

Chris Loga an Administrator, AD and member of the Georgia Activity Association writes " In general, HIPAA is nothing to be afraid of for any Activity Director. The regulation was enacted to prevent privacy issues for residents of Nursing and Skilled care. If your activity department uses common sense to prevent improper disclosures you should be fine."

 

In conclusion, its always best to lead with your heart, your compasion and refer to your common sense for answers to the tough questions..

 

later Pennie

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