13.A.
Quality
of Care
Each resident must receive, and the facility must provide,
the necessary care and services to attain or maintain the highest practicable
physical, mental, and psychosocial well-being, in accordance with the
comprehensive assessment and plan of care for each resident that includes
measurable objectives and timetables to meet a resident's medical, nursing and
psychosocial needs that are identified in the comprehensive assessment that is
in conformance with the current standards of the Gerontological Nursing
Practice of the American Nurses Association.
13.A.1.
Activities of Daily Living
(ADL)
Based on the comprehensive assessment of a resident, the
facility must ensure that:
a. A
resident's abilities in Activities of Daily Living do not diminish unless
circumstances of the resident's clinical condition demonstrate the diminution
was unavoidable. This includes the resident's ability to:
1. bathe, dress, and groom;
2. transfer and ambulate;
3. toilet;
4. eat;
5. use speech, language or other functional
communication systems; and
6. bed
mobility.
b. A resident
is given the appropriate treatment and services to maintain or improve his or
her abilities to carry out his/her activities of Daily Living.
c. A resident who is unable to carry out
Activities of Daily Living receives the necessary services and assistance to
meet his/her needs.
d. A resident
is given encouragement and assistance to be up and dressed in his/her own
personal clothing which is appropriate to the time of day and season, clean,
attractive, and in good repair.
13.A.2.
Personal Care
Each resident shall receive proper nursing care, as defined
by the Standards of Care established by the American Nurses association. These
services include, but are not limited to:
a. Good personal hygiene, such as clean,
well-groomed hair, cleaned, trimmed fingernails, clean skin, and freedom from
offensive odors, clean mouth and teeth, and absence of dry cracked
lips;
b. Appropriate nursing
measures including encouraging and assisting resident to change position at
least every two (2) hours to stimulate circulation and prevent pressure sores,
contractures and deformities.
c.
Ensuring clean resident rooms, beds, bed linen and clothing.
d. Ensuring that resident care equipment is
in sufficient supply, in good condition, properly cleaned and cared for, well
organized and readily available.
13.A.3.
Mental and Psychosocial
Functioning
Based on the comprehensive assessment of a resident, the
facility must ensure that:
a. A
resident who displays mental or psychosocial adjustment difficulty receives
appropriate treatment and services to correct the assessed problem;
and
b. A resident whose assessment
did not reveal a mental or psychosocial adjustment difficulty does not display
a pattern of decreased social interaction and/or increased withdrawn, angry, or
depressive behaviors, unless the resident's clinical condition demonstrates
that such a pattern is unavoidable.
13.A.4.
Hydration and Nutrition
The facility must provide each resident with sufficient fluid
and nourishment to maintain proper hydration and health.
a. Based on a resident's comprehensive
assessment, the facility must ensure that a resident:
1. Maintains acceptable parameters of
nutritional status unless the resident's clinical condition demonstrates that
this is not possible; and
2.
Receives a therapeutic diet when there is a nutritional problem.
b. The facility assures that good
dietary practices are maintained through the use of self-feeding devices,
attention to individual food preferences and knowledge of food intake of
individual residents. Residents should be offered the opportunity to choose
mealtime companions and these groups should be served their meals
simultaneously.
c. As appropriate,
water and other fluids shall be provided and accessible to the
resident.
d. Special eating
equipment and utensils must be provided for residents who need them. Syringe
feeding may only be done after evaluation by an appropriate professional and
according to the plan of care developed by the multidisciplinary
team.
13.A.5.
Nasogastric and Gastrostomy Tubes
Based on the comprehensive assessment of a resident, the
facility must ensure that:
a.
Nasogastric and gastrostomy tubes are not used, unless the resident's clinical
condition demonstrates that use of a nasogastric or gastrostomy tube was
unavoidable and that the need for continued use is monitored and justified;
and
b. A resident who is fed by a
nasogastric or gastrostomy tube receives the appropriate treatment and services
according to accepted standards of nursing practice.
13.A.6.
Vision and Hearing
The facility must ensure that residents receive proper
treatment and assistive devices to maintain vision and hearing abilities. The
facility must, if necessary, assist the resident:
a. In making appointments; and
b. In arranging for transportation.
13.A.7.
Incontinence
Based on the resident's comprehensive assessment, the
facility must ensure that:
a. A
resident who is incontinent of bladder receives appropriate treatment and
services to prevent urinary tract infections and to restore as much normal
bladder function as possible.
b. A
resident who enters the facility without an indwelling catheter is not
catheterized unless the resident's clinical condition demonstrates that
catheterization was necessary.
c.
Any resident with incontinence must be assessed for causal factors for decline,
potential for decline or lack of improvement.
13.A.8.
Pressure Sores
Based on the comprehensive assessment of a resident, the
facility must ensure that:
a. A
resident who enters the facility without pressure sores does not develop
pressure sores, unless the resident's clinical condition demonstrates that the
pressure sores were unavoidable; and
b. A resident with pressure sores receives
necessary treatment and services to promote healing, prevent infection and
prevent new sores from developing.
13.A.9.
Restorative Nursing
Based on the comprehensive assessment of a resident, the
facility must ensure that:
a. A
resident who enters the facility does not experience reduction in range of
motion, unless the resident's clinical condition demonstrates that a reduction
in range of motion is unavoidable; and
b. A resident with a limited range of motion
receives appropriate treatment and services to maintain or increase range of
motion.
c. The facility shall have
an active program of rehabilitation directed towards assisting each resident to
achieve or maintain an optimum level of self-care and independence.
d. The following minimum restorative nursing
interventions shall be included in the comprehensive care plans as needed:
1. Assistance in maintaining current level of
function and adjustment to disabilities;
2. Assistance in carrying out prescribed
exercises;
3. Provision of
out-of-bed activities as tolerated;
4. Education and encouragement in achieving
independence in Activities of Daily Living.
13.A.10.
Accidents
The facility must ensure that:
a. The resident environment remains as free
of accident hazards as is possible; and
b. Each resident receives adequate
supervision and assistance devices to prevent accidents.
13.A.11.
Special Services
The facility must ensure that residents receive proper
treatment and care for the following special services:
a. Injections;
b. Parenteral and enteral fluids;
c. Colostomy, ureterostomy or ileostomy
care;
d. Tracheostomy
care;
e. Tracheal
suctioning;
f. Respiratory
care;
g. Foot care; and
h. Prostheses
13.A.12.
Laboratory Services
The facility shall have policies and procedures
which:
a. List the laboratory services
being performed within the facility;
b. Ensure that the necessary certification is
received under the Clinical Laboratory Improvement Amendments of 1988;
and
c. Outline procedures for
obtaining tests from outside laboratories.
