Blog - Senior Care Solutions

Staff-2022

10/Oct/2022

There are no requirements in facilities for coffee temperature. The preferred temperature for brewing is 195 degrees or greater -— but it only takes 1 second for a serious burn to occur from liquids starting at 155 degrees.

The issue with turning the temperature down is that the coffee doesn’t brew as well and people complain about the
flavor -— we can’t turn the coffee machines down low enough to be safe without sacrificing quality. So, the answer is to eliminate the risk of burns by taking preventative steps: locking machines, moving the machines, making public coffee only available in air pots, using travel mugs with spill-resistant lids, etc.

If burns are happening from coffee pots -— leave pots open in the kitchen after filling, before covering and putting in resident reach or add ice cubes to the pot to achieve a safer, yet still palatable temperature.

Time and Temperature for Water to Cause a Serious Burn in a Healthy Adult
155ºF 68ºC 1 second
140ºF 60ºC 5 seconds
127ºF 52ºC 1 minute
120ºF 48ºC 5 minutes
100ºF 38ºC safe bathing temp

For more information on health and safety practices visit our website at srcaresolutions.net.

Staff-2022

30/Aug/2022

From the desk of Julie —

It’s hard to believe a year has passed since the Minnesota Department of Health (MDH) introduced new assisted living regulations. To date, there have been 346 survey results posted by MDH. The average number of deficiencies per survey is approximately 14. The top five most common survey deficiencies cited following a state survey were:

1. Tag 0810: 144G.45 Subd. 2 (b)-(f) Fire protection and physical environment – Fire Safety and Evacuation Plans, Training, and Drills (79% of surveys)
Common problems identified:

No evidence employees were trained on fire safety and evacuation plans upon hire and twice per year
No evidence of a plan or policy/procedure to make available annual fire safety and evacuation training for residents able to assist in their own evacuation
Fire/evacuation drills were not planned or documented
Failure to ensure fire safety and evacuation plans were readily available to residents, staff, and visitors
Failure to identify residents who may need additional assistance for evacuations

2. Tag 0480: 144G.41 Subdivision 1. (13) (i) (B) facility is not following the Minnesota Food Code, Ch. 4626; Completed by EH – (75% of surveys)
Common problems identified:

Inaccurate refrigerator temperature or no thermometer to check the temperature
TCS food not date-labeled or stored past date
No method to verify sanitizing solution (test strips) or no solution available
No certified food protection manager is employed or being shared across multiple communities
No proof staff had been trained in vomit or fecal matter cleanup procedures, and no PPE or cleanup kit made readily available
Improper food storage – dry goods on the floor, food stored on the floor of the walk-in cooler, raw foods not on the lowest level of the refrigerator
Unkempt kitchen area – rusty shelves, soiled mugs, slime on ice machine, light bulbs burned out, grease on the floor, floor drain missing a cover

3. Tag 0680: 144G.42 Subd. 10 – Disaster planning and emergency preparedness plan – (60% of surveys)
Common problems identified:

No prominent signage or postings regarding the facility’s emergency plan at the facility entrance, in the hallways, in the dining area, or the living areas
Emergency exit diagrams were not posted on each floor
Emergency preparedness staff training (on hire and twice annually) was not planned or documented
Emergency drills were not planned or documented
Hazard Vulnerability Analysis lacking analysis of potential vulnerabilities
Emergency Preparedness Plan failed to describe the population served by the facility, the process for cooperation with state and local officials, and policies and procedures for sheltering in place

4. Tag 0800: 144G.45 Subd. 2 (a) Physical environment – Good Repair and Condition – (48% of surveys)
Common problems identified:

Emergency lights or regular lights that do not work
Doors held open by wedges or that do not latch properly
Exit doors blocked
Inadequate unobstructed space below sprinkler heads
Loose or missing handrails
Flooring – cracked or missing tiles, worn or torn carpeting
Windows in secured unit missing stoppers to restrict resident elopement
Windows in sleeping rooms that are too small.

5. Tag 0780: 144G.45 Subd. 2. (a) (1) Fire protection and physical environment – Smoke Alarms – (42% of surveys)
Common problems identified:

Unplugged smoke alarms
Smoke alarms not installed where required
Disconnected or disabled smoke alarms
Smoke alarms with dead batteries or expired (more than10 years old)
Smoke alarms that were not interconnected within a unit
Obstructed sprinkler heads or covered in lint
Use of unfused and unapproved power strips and multiplug adapters

* Data obtained from Care Providers of Minnesota

What this means for you:
Be prepared for when the state arrives at your facility. As you can see, most of the top deficiencies are areas new to the assisted living license – food code and environmental. Make sure your maintenance and kitchen staff understand the new regulations. Have your maintenance team conduct environmental inspections to ensure that your facility is in good condition and that the emergency plan is up to code. Make sure to have a Certified Food Protection Manager and that there is always a person in charge. Managers should conduct routine audits of kitchens and staff to ensure proper food safety.

For assistance with updating your documents please visit our website at srcaresolutions.net.

Julie Dietz, RN, PHN
Senior Assisted Living Consultant
julie.dietz@srcaresolutions.net

Senior Care Solutions

21/Jul/2022

From the desk of Julie —

Are you complying with recently passed changes to Minnesota’s long-term care consultation services statute?Many of the provisions affecting assisted living licensees, become effective August 1, 2022.

Here is a summary of the key changes —

Changes to the Assisted Living Bill of Rights. Modifies the assisted living bill of rights regarding personal treatment and privacy. “Residents have the right to consideration of their privacy, individuality, and cultural identity as related to their social, religious, and psychological well-being. Staff must respect the privacy of a resident’s space by knocking on the door and seeking consent before entering, except in an emergency unless otherwise documented in the resident’s service plan.”

B. Modifies the additional language that must be provided with the assisted living bill of rights. “If you want to report suspected abuse, neglect, or financial exploitation, you may contact the Minnesota Adult Abuse Reporting Center (MAARC). If you have a complaint about the facility or person providing your services, you may contact the Office of Health Facility Complaints, Minnesota Department of Health. If you would like to request advocacy services, you may contact the Office of Ombudsman for Long-Term Care or the Office of Ombudsman for Mental Health and Developmental Disabilities.”

Changes to the grievance policy. Removes the requirement in the posted grievance policy to post the contact information for regional ombudsman.

B. Adds a requirement in the posted grievance policy to state that if an individual has a complaint about the facility or person providing services, the individual may contact the Office of Health Facility Complaints at the Minnesota Department of Health.

Changes to the assisted living contract. Modifies information that must be included in an assisted living contract, to require “a delineation of the grounds under which residents may have housing terminated or be subject to emergency relocation.”

B. Also requires the facility’s health facility identification number, rather than license number, to be included on the contract in a conspicuous place and manner.

Most areas of 144G that currently reference the Office of Ombudsman for Long-Term Care will now also be required to reference the Office of Ombudsman for Mental Health & Developmental Disabilities. Documents needs to include the following language:“You may contact the Ombudsman for Long-Term Care for questions about your rights as an assisted living facility resident and to request advocacy services. As an assisted living facility resident, you may contact the Ombudsman for Mental Health and Developmental Disabilities to request advocacy regarding your rights, concerns, or questions on issues relating to services for mental health, developmental disabilities, or chemical dependency.”

Documents impacted by the new language:• Notice to residents (144G.20 Subd.12)• Resident transfer plans regarding final revocation, refusal to renew, or suspension of license (144G.20 Subd. 15)• Notice regarding a meeting to discuss a resident’s termination (144G.52 Subd.2)• Included as part of the content of notice of termination (144G.52 Subd.8)• Included as part of the content of emergency relocation (144G.52 Subd.9)• Included as part of the content of nonrenewal of housing (144G.53(b))• Included as part of the content of a coordinate move (144G.55 Subd.1)• Included as part of the content of a transfer within the facility (144G.56 Subd.3)• Included as part of the content of a closure plan (144G.57 Subd.3)• Included as part of the resident notice regarding an approved closure plan (144G.57 subd.5)• Included as a required element of the service plan (144G.70 Subd.4)• Included in the updated assisted living bill of rights (144G.91 Subd.21)• Included as a reason to prohibit retaliation (contact with) regarding complaints (144G.92 Subd.1)• Included as information to be included with every assisted living contract (144g.93)

What this means for you:The new law will require administrators and nursing staff to once again update their notices, postings, and policies. Contracts and service plans will need to be modified, and a new bill of rights will need to be provided. For a full review of all the changes, see the attached link to the Minnesota Department of Health 06/16/2022 bulletin. HTTPS://content.govdelivery.com/accounts/MNMDH/bulletins/31c5092

For assistance with updating your documents please visit our website at srcaresolutions.net.

Julie Dietz, RN, PHNSenior Assisted Living ConsultantSenior Care Solutionsjulie.dietz@srcaresolutions.net

Staff-2022

21/Jun/2022

From the desk of Andrea —

The current staffing turnover and retention rates in skilled nursing homes and assisted living facilities, as well as the previous focus on infection control surveys has contributed to regulatory oversight during the COVID-19 pandemic. Immediate Jeopardy tags are on the rise, with an increasing number related to inappropriate use of slings. Factors to consider include appropriate sling size, documentation of sling size on the service/care plan and specific instruction easily available to ULP and CNAs. Additional consideration should consist of adequate supply and how the condition of a sling is determined for replacement.

Manufacturers have instruction and sizing charts available. It is recommended to keep these laminated and attached to the lift for easy reference and to verify appropriate sling size is in use. Routine audits should be conducted to ensure appropriate size selection and to ensure care/service plan matches the currently used sling. As a reminder, ensure equipment is cleaned thoroughly between resident rooms. While infection control remains a focal point in healthcare surveys, this is a reminder to shift the focus towards resident safety, which encompasses both clinical operation and infection prevention.

Andrea Raeker
Director of Administration
Senior Care Solutions

Senior Care Solutions

14/Jan/2022

From the desk of Naomi…

We are still seeing a lot of the usual corrections orders such as TB, orientation, training, service plan, documentation. But here are some of the newer trends we are seeing with the new regulations.

144G.40 Subd. 2 Uniform checklist disclosure of services

Not providing a UDALSA- Make sure you are providing your residents a copy of the UDALSA and keeping receipt of doing so. Also, ensure you have a policy related to obtaining written acknowledgement of the UDALSA from all residents prior to the execution of the assisted living contract.

144G.41 Subdivision 1 Minimum requirements

Lack of posting a daily staffing schedule- Ensure your schedule is posted daily and that there is a policy reflecting this process.

144G.45 Subd. 2 (a) (1) Fire protection and physical environment

Make sure you are reading the regulations based on your facility. We are seeing many smoke alarms not working when tested. Batteries chirping. And smoke alarms not being interconnected where they should be.

Fire extinguishers mounted in the correct areas.

Ensure you have evacuation maps posted.

And ensure all employees receive training on the fire safety and evacuation plans upon hiring and at least twice per year thereafter.

Keep up the great work out there everyone!

Naomi Evans, VP of Clinical Services

Senior Care Solutions

15/Jul/2021

From the desk of Naomi…

One thing I have learned over the years is that to be a successful leader, you must lead by example. What are some of the qualities that you appreciate in a leader that you have admired and respected? One thing that stands out to me from one of my previous supervisors came during the dreaded annual survey. Every facility I had worked at previously followed the same protocol. Survey enters, everyone freaks out, word spreads like wildfire, everyone starts checking residents, removes equipment from hallways, leaders start making rounds and answering call lights. But in this case, something different occurred. The Director of Nursing was notified, she calmly replied, “Ok, thanks!”. She did not panic, she did not freak out, she did not oddly go out and make rounds that she never normally does, and she did not start barking orders at everyone. She told everyone to do what they always do…the right thing for our residents. She had faith that she had taught and led the team to do the right thing EVERY day, not just in front of a surveyor’s eyes. The part that stands out to me is that even thought my heart was racing, seeing her calm demeanor helped ME to remain calm. I knew I had done what I needed to do, and I was confident when answering questions and providing documents requested. I learned a lot from the surveyor, instead of fearing them. We had a perfect survey that year.

Over my leadership career I have often had co-workers and other leaders tell me how much they appreciate my calm demeanor and my level-head. Although I do not always actually feel that way, I have learned how important it is to lead by example. I do not want MY team to freak out and be afraid. Therefore, I must remain calm and steady. Even when I am panicked inside, I know that projecting that energy onto my team will not help anyone. Watch what happens when you can remain confident and strong in front of your team. They see you. They watch you. You are their example. Speak greatness into them, and they will do a great job for you in their role.

For your Consulting, Training and Supplemental Staffing needs, visit our website at srcaresolutions.net

Naomi Fluck, RN

Vice President of Clinical Services

Senior Care Solutions, Inc.

Cell: 651-271-9938

naomi.fluck@srcaresolutions.net

Senior Care Solutions

27/Jun/2021

From the desk of Naomi…

Staffing Tidbits for the new AL Regulations

All assisted living facilities must have a clinical nurse supervisor who is a registered nurse licensed in Minnesota. The positions of both the assisted living director and the clinical nurse supervisor may be held by the same individual if the individual holds both licenses.

The staffing plan must be evaluated at least twice per year and include sufficient staffing at all times to meet the scheduled and reasonably foreseeable needs of each resident

A facility may not accept a person as a resident unless the facility has staff, sufficient in qualifications, competency, and numbers, to adequately provide the services agreed to in the assisted living contract.

Under the statute it does NOT give staff ratios that the facility must follow. They must be able to satisfy the requirement to meet the scheduled and reasonably foreseeable needs of each resident.

The statute dictates certain duties that must be completed by the RN:

Resident assessments
Delegation of nursing tasks
Training and competency testing of unlicensed personnel
Be available for consultation to staff performing delegated nursing tasks (either in person, by telephone, or by other means)
Supervision of staff based on statute requirements in 144G.62 Subd. 4
Certain policy development

For your Consulting, Training and Supplemental Staffing needs, visit our website at srcaresolutions.net

Naomi Fluck, RN

Vice President of Clinical Services

Senior Care Solutions, Inc.

Cell: 651-271-9938

naomi.fluck@srcaresolutions.net

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Cool, calm and collected. Who, me?

Staffing Tidbits for the new AL Regulations

Staffing Tidbits for the new AL Regulations

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