Letter from the President
To our membership,
We are fast approaching the 2019 NCALA Fall Conference & Trade Show, and it is shaping up to be an event packed full of information and training that will be valuable for attendees. We are also excited to announce that we have been NAB/NCERS-approved for 12 continuing education credits to accommodate administrators who hold certifications in other states and/or Nursing Home Administrators. Additionally, we were approved by NCNA for 12 contact hours for Nurses and are offering 15.50 CEUs for assisted living administrators.
This is also NCALA’s 25th anniversary! I am truly blessed to be a part of NCALA’s rich legacy of assisting our membership in regulatory, legislative, and other technical concerns. We would love to hear from you regarding suggestions about how to better support YOU! Please do not hesitate to send us feedback.
I want to take this opportunity to provide a brief regulatory update. The first six months of 2019 have been very busy on the regulatory front. NCALA has begun quarterly meetings with Megan Lamphere, Chief, Adult Care Licensure Section. We have had two very successful and informative meetings and look forward to the future with a renewed spirit of transparency and collaboration.
The following is a quick analysis of citations and violations most recently cited by ACLS:
1. 10A NCAC 13F .0605 STAFFING OF PERSONAL CARE AIDE SUPERVISORS
2. 10A NCAC 13F .0606 STAFFING CHART
Adhere to staffing rules. Citations and violations are being cited when resident care issues are identified and the community is not meeting minimum staffing requirements. This is most often cited in memory care units. Please remember, the community must have sufficient staff to meet the needs of the residents. Be aware of scheduling lunch breaks. In order for the individual staff member to be counted in the minimum daily or shift requirements, they must remain in the building and be available to work if needed. Example: Employee taking a two-hour nap in their car cannot be counted as meeting the minimum staffing requirements.
3. 10A NCAC 13F .0904 NUTRITION AND FOOD SERVICE (CONTAMINATED ICE MACHINE)
(a) Food Procurement and Safety in Adult Care Homes:
(1) The kitchen, dining, and food storage areas shall be clean, orderly and protected from contamination.
Please review community policy, which should include the ice machine manufacturer’s recommendations for cleaning. Make a checklist for the cleaning schedule and note who is to complete the cleaning task, how often the machine is to be cleaned, and who is responsible for monitoring the cleanliness of the ice machine. The community will receive a citation if the ice machine is not clean; however, if all of these pieces are in place, they might avoid a B violation. These cleaning schedules should be kept with the same diligence as the water temperature logs.
Also, review community policy regarding the follow-up of sanitation citations. Any citation given by the local sanitarian should be corrected immediately, using the standard Plan of Correction (POC) format that licensure requires. The POC must include monitoring of the sanitation citation to maintain compliance. Include the sanitation corrective action monitoring forms/logs/invoices in the community Quality Assurance/Quality Improvement program.
4. 10A NCAC 13F .1004 MEDICATION ADMINISTRATION (INACCURATE MARs RELATED TO ELECTRONIC MARs)
(j) The resident's medication administration record (MAR) shall be accurate and include the following:
(1) Resident's name;
(2) Name of the medication or treatment order;
(3) Strength and dosage or quantity of medication administered;
(4) Instructions for administering the medication or treatment;
(5) Reason or justification for the administration of medications or treatments as needed (prn) and documenting the resulting effect on the resident;
(6) Date and time of administration;
(7) Documentation of any omission of medications or treatments and the reason for the omission, including refusals; and,
(8) Name or initials of the person administering the medication or treatment. If initials are used, a signature equivalent to those initials is to be documented and maintained with the medication administration record (MAR).
Last year, the citation for inaccurate MARs was added to the top-ten lists of the most frequently cited deficiencies. The Adult Care Licensure Section has identified problems with the electronic MAR that have contributed to the increase in inaccurate MAR citations. If you are experiencing medication errors as a result of inaccurate MARs, please contact the providing pharmacy immediately and resolve the issue. Review your medication policies to ensure someone in the community has direct responsibility for checking the accuracy of the MARs at every level of data entry.
As always, NCALA recommends you refute citations and violations that you feel are not based on non-compliance to rule or general statute. Please take the opportunity to ask for an Informal Dispute Resolution meeting if you do not agree with the findings of the survey team. Also, the community can ask for the section chief to review the IDR findings if you do not agree with the IDR panel results. You can refresh your understanding of the IDR process here: https://info.ncdhhs.gov/dhsr/acls/idr.html
Please let us know if you have any questions regarding any regulatory process.
NCALA President & CEO