Long-Term Care Survey Alert

Teach staff to identify problems in real time.

Achieving a clean survey requires a daily team effort where staff keep a surveyor's eye out for common deficiencies with a goal of eliminating them quickly.

Attorney Joseph Bianculli suggests paying special attention to these survey violations from real cases:

1. Broken beds
2. Siderails that don't fit physician orders
3. Slippery inflatable mattresses
4. Cleaning equipment unsecured in the room
5. Broken wheelchairs
6. Broken floor tiles
7. Blocked doorways
8. Dirty over-bed tables
9. Curtains hanging near heaters
10.  Staff not wearing gloves
12. Latex gloves in the room of a resident with a Latex allergy
13. A call bell out of reach
14. Poor lighting
15. No privacy curtain

Also teach staff to look for these potential problems, suggests Reta Underwood, a survey management consultant in Buckner, KY.

16. Bars of soap in the bathroom. "You can never rinse a bar of soap clean," says survey consultant Reta Underwood in Buckner, KY.
17. A used brief in the trash can. "That's not only an infection control issue but also poses a dignity theme," says Underwood.
18. Dust on ceiling fans or lights bulbs, mold in the bathroom and/or water stains on ceiling tiles.
19. Clothing and shoes with the resident's name on the outside. That's another dignity issue. "The person's name should go on the inside of the clothing so you have to look for it," advises Underwood.
20. Hazards hidden in the resident's drawers. Under- wood is aware of one caregiver who sliced her hand on a resident's shaving razor as she reached into the resident's drawer for clothing items.

Other things to look for include the following, according to Bonnie Lou-Binnig, director of corporate compliance and quality improvement for Vanguard Healthcare Services, a nursing home chain based in Brentwood, TN.

21. Urinary drainage bags without dignity covers.
22. Personal items in the bathroom that are not tagged with residents' names.
23. Overloaded electrical outlets.

Tip: At one Vanguard nursing home, each department head uses an audit sheet to assess the resident's environment, unit work spaces, hallways, linen carts, medication carts, the dining room, etc., says Binnig.

If you identify it, fix it: Identifying problems or concerns is one thing, says Binnig. But more importantly, you need to effectively resolve the problems in order to maintain a high quality of care for residents, she says. "Identify the nature of the problem and develop an action plan to correct it," she advises. "Then continually monitor to make sure it doesn't recur," she adds.