Quality of Care

General Policy Statement

It is the policy of [PROVIDER] that each resident receive the necessary care to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the resident’s comprehensive assessment and plan of care.

Suggested Elements

To achieve the goal of providing quality of care, providers may wish to include the following elements as part of their corporate compliance policies:

• The facility must conduct initially and periodically a comprehensive, accurate, standardized, reproducible assessment of each resident’s functional capacity. The assessment must be based on a uniform data set specified by the state and approved by HHS;
• The facility must develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident’s medical, nursing, mental, and psychosocial needs that are identified in the comprehensive assessment;
• Each resident must receive and the facility must provide the necessary care and services to attain and maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care;
• A resident must be given the appropriate treatment and services to maintain or improve his or her ability to bathe, dress, groom, transfer, ambulate;
• The facility must ensure that a resident who enters the facility without pressure sores does not develop them unless the resident’s clinical condition demonstrates that they were unavoidable;
• A resident with pressure sores must receive necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing;
• A resident who enters the facility without an indwelling catheter may not be catheterized unless the resident’s clinical condition demonstrates that catheterization is necessary;
• A resident who is incontinent of bladder must receive appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible;
• A resident who displays mental or psychosocial adjustment difficulty must receive a psychological evaluation with appropriate treatment and services to correct the assessed problem;
• The facility must ensure that a resident whose assessment did not reveal a mental or psychosocial adjustment difficulty does not display a pattern or decreased social interaction and/or increased withdrawn, angry, or depressive behaviors, unless the resident’s clinical condition demonstrates that such a pattern was unavoidable;
• The facility must ensure that the resident’s environment remains as free of accident hazards as possible and must provide adequate supervision and assistive devices to prevent accidents;
• The facility must ensure that a resident maintains acceptable parameters of nutritional status, such as body weight and protein levels, unless the resident’s clinical condition demonstrates that this is not possible;
• Each resident’s drug regimen must be free from unnecessary drugs;
• Resident’s must be free of significant medication errors;
• The facility must have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and plans of care;
• The facility must use the services of a registered nurse (RN) for at least eight consecutive hours a day, sevens days a week;
• The facility must employ a qualified dietitian fulltime, part-time, or on a consulting basis;
• Menus must meet the nutritional needs of residents in accordance with the recommended dietary allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences;
• Each resident must receive and the facility must provide at least three meals daily, at regular times comparable to normal mealtimes in the community;
• The medical care of each resident must be supervised by a physician;
• The resident must be seen by a physician at least once every 30 days for the first 90 days after admission and at least once every 60 days thereafter;
• The facility must provide or arrange for the provision of physician services 24 hours a day, in case of an emergency;
• If required by the written order of a physician, the facility must provide or obtain specialized rehabilitative services, including, but not limited to, physical therapy, speech-language pathology; occupational therapy, and mental rehabilitative services;
• The facility must assist residents in obtaining routine and 24-hour emergency dental care, including assistance in making appointments and arranging for transportation;
• The facility must provide pharmaceutical services, and have in place procedures that assure accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals, to meet the needs of each resident;
• The drug regimen of each resident must be reviewed at least once a month by a licensed pharmacist; and
• The facility must establish an infection control program under which it investigates, controls, and prevents the spread of infections in the facility.

Note: Providers may wish to reference specific portions of state licensure statutes and/or regulations here, particularly those the provider identifies as problem areas or receiving special regulatory attention in a given state.