Senior Care Solutions 

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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.


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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

 


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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 —

  1. 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.”

 

  1. 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.

 

  1. 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.

 

  1. 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

 


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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


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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


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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

 

 


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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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