Survey

[kristas_mom3 0]

Surveyors are in our facility now. They came in at 3:30pm on a Sunday and Actys was a SKELETON CREW!

During survey they seemed to really focus on RESTRAINTS during programs. We have a few residents with lap belts but if we weren't using them it's possible these particular residents would lean forward in a split second and fall right out of their chairs or slide down. My assistants KNOW to take the belts off during 1:1's but I worry about groups!!? What do you all think? When you have 1 girl doing a large group, wouldn't you rather have a lap belt on and avoid a FALL?

 

Also, let me throw this out there....we have a resident who is mostly bed-bound. She is very active though. She is alert, friendly, dresses beautifully daily and wears makeup, goes to the salon weekly to get her hair done and receives 1:1's to get nails done, we have a library program that is the bookmobile who bring books specifically to her weekly as well as other residents, she attends mass and takes her lunch meal in the dining room with peers. She receives visits from other residents and has a friend visit her every Sunday. HE brings a movie and the two of them share popcorn and a movie and also socialize with her roommate. Tell me this, surveyors questioned why there wasn't a careplan in place for her. She doesn't trigger and there are approaches on her careplans from Actys. But surveyors spoke with one of my assistants, and, according to her, they told her that we should have a careplan for Actys for her specifically because she's in her room and mostly bedbound?

when I first started I wanted to put an activity careplan in place for every resident to cover Actys...my consultant said that's ridiculous and a waste of your time...and advised us to just add approaches.....

 

What should I do/have done?

 

Thanks!

[Crysty 0]

Last year our facility got hit hard on restraints, we ended up with fines. Since then we have started restraint free activities, the nursing staff will let me know who they have for rest. free meals and I will do the same residents in act. We track them fro a couple weeks and if they did great we reduce their restraint. However, my experience with this is that you have to have more than 1 person watching these people. I would not want to take full responsibility on their safety with out two people. Also, the state said they would like to see us 100% restraint free, though we have reduced them dramatically, I never see us being 100% rest. free only because like you said some people need them to keep them safe. As far as your other question, I am still wondering about care planning each resident, from the up dated guidelines on this site it looks as if we should have everyone care planned, even if they don't trigger, which is the COMPLETE opposite of what I have always been taught. We have a consulting co. here now doing a mock survey and I have asked them a similar question. i want to know what i am expected to do, if I find out anything I will let you know. I hope that i have helped with this, and good luck!!!

[kristas_mom3 0]

Thanks Crysty!

 

I agree...so many areas are "grey"....there's only SO many Activity staff...we're spread so thin....and my girls would be devastated if something happened to a resident because they couldn't get to them fast enough. How can you do an exercise program when you're constantly running over to assist a sliding or falling resident?!?!

 

As far as the calendars...if ANYONE knows....I mean, we do have "representation" on all careplans and Social Service adds us as an approach as well.

 

HELP :-o

[Pennie 26]

Hi,

This resident should and I'm sure she does have a CP for restraints. Which I'm sure you are listed on in the approaches.

The resident may be bedbound but sounds as if she is active with in room activites. Even though she didn't trigger as having a problem in activites. I have a general rule that I write a CP up on anyone who is bedbound, gets one on one's, in-room activities, or self-isolated.

These residents are put on the 1;1 or in-room calendars, this is stated on the CP approaches. I do this because state looks so closely at these type of residents.

However if you have documentated it well in your notes on the chart that res. does not have a problem with being bedbound and that she is very involved, state should not be able to write you up on this resident. Did you get a deficency on this? If so you should get with your consultant and the 2 of you should write your plan of correction as a rebutal.

They may have been looking at res. restraint issue and didn't full understand that your staff does it in 1:1's but not in group act. if only 1 person is present. If this is the case then you should clearly make note of this in you progress notes and I would be sure to write a CP up to this effect or be sure that it was covered in the approaches (under restarint) for activites.

We don't have the time to write a CP on every res. First off a CP is only written if it is a problem for the res, not staff and second if we write one for every res. this is a sure fire way of hanging ourselves. Just be sure in your progress notes to cover yourself and your staff.

I know this is a catch 22 when dealing with state and paperwork. Damed if you do damed if you don't :-?

[RachelJ 0]

In the facility I work at, we have an activity careplan on all residents regardless of their involvement in activity groups or if they trigger or not. This seems to cover us in case of any questions the state may have when they come to survey. Having a care plan on each resident doesn't seem to a waste of time to write and seems to help everyone be on the same page with each resident. The care plan is, of course, reviewed quarterly. Might want to check into doing this just to CYA...

[Guest lawrence]

I make sure each resident has a CP in place for Activities....Not everyone is marked as a problem, I make sure to put in strengths as well(i.e. states interest in playing piano...goal: will play piano 2x/month during activity social programs to encourage social interaction....)