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The Dietary Manager (DM) must be................... If the DM is not a registered dietician, must have consultation with a registered dietician ------------------- ANS-Full time, regular, monthly The dietician must be registered with the - ANS-American Dietetic Association. Poultry must be cooked to: - ANS-165⁰ F Meats must be cooked to: - ANS-145⁰ F Hamburger and hot dogs must be cooked to: - ANS-155⁰ F Reheated food must be heated to: - ANS-165⁰ F Menus must be kept for: - ANS- 1 month (4 weeks) Menus must be prepared: - ANS-one month (4 weeks) in advance Types of therapeutic diets: - ANS-Low fat Low salt Mechanical soft or puree Low card
Thickeners: - ANS-Pudding Honey nectar A comprehensive assessment must be completed within of admission and then every or upon a ___________________ n the resident's physical or mental condition - ANS- 14 days, 12 months, significant change The comprehensive assessment is the same as the: - ANS-MDS A involves a new MDS or comprehensive review so it must be done within ------------------------------ ANS-significant change, 14 days Each resident must be examined or have a physical exam no less than every and their comprehensive assessment must be revised to ensure the continuing accuracy of the comprehensive assessment. - ANS-3 months An must sign tor certify the accuracy of the comprehensive assessment - ANS-RN The initial comprehensive assessment must be transmitted to the state within of completion of the assessment. After that, all MDS information must be transmitted to the state every
. - ANS- 7 days, 30 days The comprehensive care plan must be prepared within of completion of the comprehensive assessment. But Not later than from date of admission. - ANS- 7 days, 21 days Care Plan is prepared with the participation of the: - ANS-resident, family or legal representative, and the resident's attending physician and an RN responsible for the resident A care plan conference must be held - ANS-quarterly
Global rating is: - ANS-adding up all of the points in the rating scale Common rating errors: - ANS--Error of Central Tendency rating everyone as average or in the center
- Halo Effect - judging someone on just one trait, Always late or never smiles without regard to actual performance
- Leniency Error - rating someone whose performance is substandard as acceptable to avoid confrontation
Types of raises: - ANS--MERIT INCREASE is based on performance
- COLA is a COST OF LIVING increase based on inflation
- CPI or Consumer Price Index measures inflation
- EQUITY INCREASE is necessary to ensure longer serving workers are paid at current markets rates so newly hired workers are not paid substantially more than current workers or they will leave. Must do a salary survey every couple of years
- Benchmarking is comparing salaries paid to employees based on one wage group - i.e. nursing salaries An employee who is not given orientation is: - ANS-a liability because emergency and fire procedures are the most critical in-services OBRA 1987/Medicare mandates: - ANS-most training. The same person who does orientation should do the check list of attendees. Employee training is called In-services Line Authority - ANS-Solid line = Line authority Dotted line = Staff or advisory Management Levels: - ANS-Upper: GB, NHA, Med Director Middle: DON, Dept. Managers, Consult. Pharm. Lower: Charge Nurse Management styles: - ANS--Autocratic (dictatorial) - micromanaging and controlling everything
- Paternal is being supportive or having a fatherly or motherly attitude towards employee and wanting them to succeed. Best style.
- Laizze Faire means delegating responsibility to staff and only being involved when something goes wrong
Agenda carrying - ANS-Employees skew information based on personal needs Filter Effect - ANS-Tells manager only what they think the manager wants to hear Subgroup Allegiance - ANS-A subgroup demands allegiance from its members (nurses, kitchen staff) Status difference - ANS-Staff hesitant to approach a member of a higher status - nurse aide to doctor Hiring Statistics - ANS--Must retain employment applications for 6 months per EEOA
- Must keep statistics of number of applicants hired and interviewed and the race of applicants and who was hired Adverse Impact - ANS-Hiring rate of minorities must be at least 80% of the majority. If you hire 10 whites then you must hire 8 minorities Job Description - ANS-specifies job title, experience and education requirements, salary, benefits, who you report to and the tasks of the job. (Similar to a job ad) Job Analysis is the - ANS-mental process of collecting information about the duties, responsibilities, necessary skills, outcomes, and work environment of a particular job. Job Specification - ANS-describes or is a written description of the knowledge, skills, education, experience, and abilities you believe are essential to performing a particular job. Intangibility - ANS-Unlike a Hilton customers cannot know what it like to be in your facility without having actually been there. We need to convince them that we will take care of them
Inseparability - ANS-customers perceive a single instance of bad service by one employee as bas service provided by the entire company. One bad employee can destroy your business. Progressive Discipline - ANS-- A verbal warning
- 3 write ups
- termination Values and norms relate to - ANS-employee behavior and how we shape that behavior for our needs A value is - ANS-like a policy - it is vague (we respect resident rights) A Norm is - ANS-specific like a procedure (it implements the value - we address all residents in a calm voice by their last name - expected behavior) Operant Conditioning - ANS-is shaping behavior - come late and we write you up 3 times and then terminate you. Fire wire - ANS-High speed cable that physically connects equipment and transfers data between them at high speeds that the wire or cable glows from the fire and heat Bluetooth - ANS-Hands free and Wireless (wiFi) communication Statement of resident funds or an ACCOUNTING OF FUNDS must be provided - ANS-quarterly or every 3 months Must refund any monies held by the facility of a deceased or discharged resident within - ANS- 30 days
Expenses Income Profit Loss Net Profit Chart of Accounts - ANS-A listing of all the revenue and expense codes so you can code your invoices and find the information on the General Ledger and P&L Accounting Process: - ANS-Reporting financial results. Must produce the Profit and Loss statement and balance sheet to investors. Accounting Process includes: - ANS-1. Profit and Loss Statement (Income statement)
- Operating Revenues
- Ancillary Revenues
- Operating Expenses
- Profit
- Loss
- Shows whether your revenues covered your expenses
- P&L is produced each month. Must match revenues and expenses for that month
- Balance Sheet
- Assets = Liabilities + Capital
- Net Worth
- Assets
- Liabilities
- Capital
- Shows financial condition
- Shows net worth
- Shows solvency
- Balance Sheet is produced every 3 Months There is no cross over (hint) - ANS-P&L: How much you made (Revenues, expenses, income, profit, loss) Balance Sheet: What you are worth (assets, liability, capital, equity) *You will never find revenues and expenses on the balance sheet and will never find revenues and expenses on the Balance Sheet Accounting equation - ANS-Assets = liabilities + Capital Working Capital - ANS-Current assets - Current Liabilities = working capital *Purpose - To show how much you have available to buy equipment or invest in business. Current Ratio Equation - ANS-Current assets /Current Liabilities *Purpose- Show whether you are solvent and can pay your bills. A ratio of 1.0 to 1.0 means break even. A ratio of 2.o to 1.0 means you have 2 dollars for every dollar of debt. Quick Ratio or Acid Test Ratio - ANS-Cash + Accts Receivables + Money Market Funds / current liabilities
Golden Rules - ANS--Increase Cash:To collect cash quickly, collect your accounts receivables or AR. All you have to do is pick up and the phone ask them to pay you money they all ready owe you. If you decrease your accounts payables, you are paying off debts and decrease cash.
- EXTRA CASH ON HAND If you have extra cash on hand put it in a money market account. GAAP - ANS-Generally Accepted Accounting Principles Entity Principle - ANS-The owner is separate from the company and must disclose all transactions Conservatism Principle - ANS-must value your assets at the lowest valuation possible Time Period Principle - ANS-Must use the same calendar or fiscal year from one year to the next. Consistency Period - ANS-Must use the same accounting system from one year to the next Objective Evidence Principle - ANS-must use the most objective evidence of your income and expenses Source Documents - ANS-original documents such as cancelled checks, invoices, billing statements, etc. Materiality Principle - ANS-Must record all transactions that are material to the company's financial condition. Full Disclosure Principle - ANS-must fully record and disclose all financial transactions. Medicare - ANS-Inpatient care in a nursing home or hospital - ONLY PAYS FOR SKILLED CARE, does not pay for custodial care.
- 3 day stay (do not count day of discharge)
- 100 covered days
- First 20 are co-pay free)
- Days 21 - 100 have a 20% co-pay
- 30 days to return to facility
- 60 days to regenerate another 100 days Medicare Part A Title 18 - ANS-HHC 80% Medicare Part B - ANS-HHC 100% Medicare Part D - ANS-Prescription drugs Medicaid Title 19 - ANS-Income limit $ Asset limit $ 5 year look back period Bed Certification - ANS-Beds are either Medicaid or Medicare certified or dually certified for either Medicaid or Medicare. You can change your bed certifications 2 times a year. Cost Reports - ANS-Cost reports are due to Medicaid within 90 days of the end of the facility fiscal or calendar year - used to determine your Medicaid rate Decubitus Sores - ANS-A decubitus (De-cue-be-tus) sore is an opening in the upper and deeper layer of the skin caused by lack of oxygen to skin tissue cells or friction or sheering by bones rubbing against the skin.
- Knee space is 19 inches
- Toes are 9 inches
- High forward reach from a wheelchair is 48 inches
- The high Side reach from a wheelchair is 54" and the lowest reach is 9 inches (9-54)
- A clear access route is 36 inches wide
- cannot take more than 5 lbs of pressure to open a door or a faucet
- A railing must bear the weight of 250 lbs.
- Must have grab bars in the shower and bath
- A telephone cord is min. of 29 inches long
- Audible control on public telephone for hearing impaired is 12 - 18 decibels CIVIL RIGHTS ACT 1964: - ANS-Civil Rights Act protects 5 classes of individuals: RRGCN = Race, religion. Color, Gender and National Origin
- The CRA is enforced by the EEOC *AGE AND SEX IS NOT A PROTECTED CLASS The Tower Amendment: - ANS-Title 7 of the Civil Rights Act (CRA) allows ability testing for job applicants SAFE MEDICAL DEVICES ACT (SMDA): - ANS-Must report an injury due to medical device within 10 days to the Manufacturer and the FDA Equal Pay Act - ANS-requires that male and female workers must be paid at the same rate if doing the same work *Enforced by the EEOC Equal Employment Opportunity Act (EEOA) 1972: - ANS--amended the Civil Rights Act to define discrimination in employment as Adverse Impact.
- Adverse impact means you must hire minorities at a rate that is 80% of the hiring rate of the majority. If you fire 10 white people then you have to hire 8 minorities. *enforced by the EEOC Equal Employment Opportunity Act - ANS--Has exclusive jurisdiction over all discrimination cases
- The EEOC provides employers Uniform Guidelines on Selection of new employees per EEOA FEDERAL INSURANCE CONTRIBUTIONS ACT (FICA) - ANS-funds social security through a payroll tax.. The employer pays 50% of the FICA tax. Fair Labor Standards Act - ANS-sets the federal minimum wage, overtime, underage workers must secure a permit from the Dept of Labor. Maximum 240 hours of compensatory time per year *Enforced by the DEPARTMENT OF LABOR FAMILY MEDICAL LEAVE ACT - ANS-provides up to 12 weeks of UNPAID leave for a worker to care for themselves, a child or spouse or they parents or an adoption. Must work 12 months OR 1250 hours to take leave. Cannot take leave for sick brother or sister or divorce AGE IN DISCRIMINATION ACT - ANS-protects workers 40 and older against discrimination. Need 20 employees to be subject to this law. Cannot force an employee to retire *Enforced by the EEOC HIPAA - ANS-Health Insurance Portability and Accountability Act: The law protects workers who change jobs by requiring their new employer's insurance company to cover pre-existing conditions.
- The new employer's insurance company can only limit coverage for pre-existing medical conditions for 12 months, after which they must fully cover them.
- The worker can be covered from the first day their new insurance becomes effective if they have a certificate of Coverage under COBRA
Designation of a health care surrogate - ANS-An advanced directive that appoints an individual to act for the principal if they are incapacitated End stage disease - ANS-There is no treatment and the individual will die Terminal condition - ANS-if not treated, the individual will die but they can be cured. Vegetative state - ANS-the person is in a coma and unable to communicate with their environment Respite care - ANS-providing a care taker a holiday by placing the person who needs care in a nursing for a week or two Palliative care - ANS-providing care to relieve pain OSHA general duty clause - ANS-provide safe workplace Hazard Communication standard - ANS-inform employees of chemical dangers in the workplace through the MSDS
- Worker's right to know is the MSDS Need to be subject to OSHA laws? - ANS- 11 employees Nonfatal injuries - record in within. - ANS-300, log, 7 days Must report fatal injuries and hospitalizations of or more employees within by phone to OSHA - ANS-3, 8 hours
Year end report is the - ANS-Form 300A (a=abbreviated) between Feb 1 and April 30. Supplemental report is the form _______ which is full investigation report - ANS- 301 OSHA medical records kept during employment plus - ANS- 30 years OSHA is an agency under the - ANS-U.S. Department of Labor Must post OSHA violation at the front door for --------------------- ANS- 3 days NIOSH stands for - ANS-for National Institute of Occupational Safety and Health
- NIOSH provides research to OSHA Ergonomic - ANS-means the work place is set up to minimize stress on workers and reduce injuries from repetitive tasks Employees must have a physical exam - ANS-upon hire and then annually (TB test) OSHA Compliance Categories - ANS-1. Imminent danger (can close facility)
- Serious (A major fine)
- Non-serious violation (no harm, fine)
- Deminimis violation (no harm, no fine)
- Most often cited deficiency - failure to post MSDS National Labor Relations Board - ANS-has sole jurisdiction over all labor matters - Must supervise and approve union
