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“WHEN should I call Connie?”

                  If you have a REGULATORY question,

                                   If you have a SURVEY question,

                                                    If you have a POC questions, or

                                                                      If you have a QAPI question!


Reach out to our Clinical & Compliance Specialist, Connie Cheren, RN, MSW on her cell phone (678) 778-0561 or email her

Connie is available to our members as a value-added service, paid for by LeadingAge Florida, to help answer questions before, during and after surveys OR anytime throughout the year! She can help nursing home and assisted living members improve regulatory compliance and clinical outcomes and to offer suggestions about survey results and corrective plans of action.

July 8, 2017


Change is the word that best describes long term care right now, and some of these changes are significant.

All of the LeaadingAge staff, both LeadingAge Florida and national, are learning as much as we can about how to successfully implement these changes so we can keep you, our members, informed and prepared to implement the changes on time. This is certainly one of the benefits of being a member of LeadingAge Florida.

April 7, 2016 

Nursing Home Survey Trends Workshop - On April 7, 2016, at Mayflower Retirement Center in Maitland, Florida, Connie co-presented with AHCA’s Kim Smoak, Chief of Field Operations and Mary Maloney, Government Analyst II. Throughout the day providers asked regulatory questions about things they heard were supposed to do for regulatory compliance. Time and again Kim reminded the attendees to “go to the regulations."

This is a good reminder for all of us. We can easily become convinced something is in the regulation when it isn’t and at times policies are written based on our belief about what the regulations say. And, as Kim acknowledged, sometimes surveyors can even misinterpret the regulations. Kim encouraged attendees and providers to contact their Area Supervisor or her office for clarification if they believe a surveyor is misinterpreting the regulations.

All staff should have easy access to the Long-Term Care Survey regulations, either in hard copy or electronically (Because the link to the Federal Regulations on the AHCA website is not the easiest to follow Connie has included the link to the regulations and guidance to surveyors found on the CMS website). The regulations detail the minimum requirements to be met for continued participation in the Medicare and Medicaid programs. To ensure all 167 regulations found in the survey book are met, it is a good idea to delegate the sections of regulation to the department ultimately responsible for compliance with the regulation.

A good exercise for nursing homes to do is to ask how you know you are in compliance with a regulation. It should be easy to see compliance in the records, in observations of care and by interviews.

Compliance is a year round, on-going effort. When staff know the regulations and have systems in place to ensure compliance the annual AHCA survey is less stressful.

Below are articles/videos provided by Connie.


April 29, 2016

What Do I Need To Know About Staffing?
How a nursing home is staffed makes all the difference in patient care. Many facilities are considered "task oriented" long-term care facilities, focused on the many tasks needing to be done - the task of giving medication, feeding, bathing, and making sure physician orders are carried out, amongst others.

If you break down all of these tasks, many nursing homes are just most concerned about getting this task completed. So, in a 24 hour period, they complete the task but at the end of the day the resident has gotten lost in the process. Click here for more information.



April 14, 2016

Quality Assurance
What exactly does Quality Assurance mean? At the end of the day Quality Assurance is the act of ensuring the product we produce in the long-term care industry is good patient care and good resident care. Quality Assurance is really a combination of auditing, tracking, rounding, and measuring your outcomes. Click here to view Connie's video on this topic.


April 1, 2016

Enhanced Dining V. Traditional Dining

Dining can be what separates a good nursing facility from an excellent facility when people focus on the dining experience—traditional dining vs. enhanced dining. When you take a tour you can tell if it is traditional or not by seeing the availability of traditional dining chairs. The second thing you notice is when residents arrive for meals. Traditional dining is the act of getting people fed.

Enhanced dining is one of the more exciting things in long-term care because it's really where a facility can excel and be innovative. In enhanced dining, people have to walk to the dining room chair, use a napkin (instead of a clothing protector), and as soon as they sit down they're giving something to eat and drink— either a breadbasket on the table or crackers and their server offers them a beverage.


 March 25, 2016


Meaningful Engagement 


Meaningfully engaged is really the absence of boredom and boredom is something that we all fight against. In a long-term care facility you don't want the residents to be bored. Many times we think of activities as an activity calendar- so the Activity Director works very hard to put together a calendar to have really good group activities for residents. Many times we think that just being engaged belongs to the director of activities, when in all actuality being engaged is for everybody to be involved in the facility. If you want to know whether or not you residents are engaged take a notepad with a line drawn the middle, and walk around the facility. On one side put residents that are meaningfully engaged and on the other a list of residents who aren’t meaningfully engaged.


March 17, 2016

How To Be The Best Of The Best: Care Plans

For surveyors it's all about the care plan. If you ever have a lawsuit it's all about the care plan. We have to ensure the care plan is the document it was intended to be and is used by everybody. Care plans have become very complicated over the years and people have so many opinions.


March 10, 2016

Quality Measures and The Five-Star Quality Rating System

Quality measures have been a part of CMS Nursing Home Compare Five-Star Quality Rating System since 2008. The goal of the rating system is to help consumers make meaningful distinctions among high and low performing nursing homes. The two other components which make up the quality rating system are results based on outcomes from state health inspections as well as staffing levels found in nursing homes in the two-week period prior to the state survey.

In April 2016, CMS will begin posting data for six new quality measures on Nursing Home Compare, and will begin using five of the six measures in the calculation of Five-Star Quality Rating QM ratings beginning July 2016. The data for these new measures will be gathered from Medicare Fee-For-Service claims and MDS data. Click here for an overview of the CMS powerpoint improvements to the Nursing Home Compare Five-Star Quality Rating System.

In this writer's opinion the Five-Star Quality Rating doesn't always distinguish the best nursing homes from poor performing facilities but it is a measure many consumers use to determine placement for a family member. It is important for a facility to ensure they have a five star rating.

A facility should understand how stars are determined and what they can do to positively affect the measures. For example, one of the new measures is the percentage of residents in the nursing home greater than 100 days who decline in mobility. A restorative program for mobility can help ensure this measure positively impacts a facility's star rating.

It will also be important to accurately assess the physical functioning of residents on admission and at discharge in transfer, locomotion on unit and walk in corridor. Combining a strong restorative program with rehab services can help residents make greater improvements in these ADL measures and improve a facility's star rating


February 12, 2016

Zika Virus Alert

Governor Scott has declared a health emergency related to the Zika virus. The emergency actions include mandatory reporting of any confirmed cases of Zika virus. As of Monday, February 8, 2016, there have been 16 people in Florida identified with the Zika virus— cases of the mosquito-borne illness have been found in Broward, Hillsborough, Lee, Miami-Dade Santa Rosa, and St. Johns counties. All 16 were infected while traveling outside the United States. There have been no locally-acquired cases of Zika virus in Florida.

Long-term care communities can help with the efforts to prevent the spread of the Zika virus in Florida. Recommendations include:
1. Know the facts: CDC and Florida health officials are good resources for updated information. Appoint someone in your community to be the point of contact for following updates about Florida's response to the Zika virus. Establish a working committee to address the community response and protocol to the Zika virus.
2. Be available to assist staff on how to find updates and reliable information regarding the Zika virus. Staff may have family members living in the affected areas. Staff will need to be able to access current and reliable information about the spread of the Zika virus.
3. Educate your staff about the Zika virus including the signs and symptoms and the current travel warnings for pregnant staff. The community should develop a plan on how to address staff returning to work after traveling to one of the affected countries.
According to the Centers for Disease Control and Prevention, the Zika virus typically causes a
mild rash, fever and joint pain. Only one in five people infected with the virus are symptomatic.

4. Encourage your staff to follow the guidelines to help eliminate mosquitoes including removing all standing water from their homes. The mosquito breeds in standing water.
5. Communities should assist with efforts to eliminate the mosquito by addressing any standing water on their property. Everyday someone should walk the outside property to ensure there isn't any standing water including rainwater.

LeadingAge Florida will continue to follow updates about the Zika virus and keep our members informed of any developments. Click here to learn more about the Zika virus. If you have additional questions, please contact Connie E. Cheren.



 February 4, 2016

Is It A Restraint?

Last month we heard about discussions with AHCA that products we have not considered restraints may now be looked at as a possible restraint by the surveyors. These products include bolsters placed in beds, tab alarms, pad alarms, scoop mattresses, etc.

The decision about whether a product is a restraint should be decided by an assessment. My recommendations to members are to complete the Restraint CAA for any resident using any of the products listed above. The first question on the Restraint CAA is "Does the product meet the definition of a restraint"? Remember you can complete the Restraint CAA even if it doesn't trigger.

The definition of a restraint has not changed. A restraint in the regulations is defined as "any manual method or physical or mechanical device, material or equipment attached to or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body (e.g. leg restraints, arm restraints, hand mitts, soft ties or vest, lap cushions, and lap trays the resident cannot remove easily)”.

If you find a surveyor may cite or has cited you for F221, please let Connie know, preferably during the survey or immediately after.

As a value added service LeadingAge Florida encourages you to do this. We are tracking and trending all tags so we can keep you informed of changes you may need to know to avoid being cited. If you cannot reach Connie, contact Susan Langston, LeadingAge Florida VP of Advoacy at (850) 671-3700.



January 28, 2016

Achieving A Good Survey

Every nursing home facility wants to have a good survey because it impacts both their state and federal 5-star rating. The best survey is a survey with no deficiencies cited. To achieve this objective, facility staff need to know how a surveyor will determine if staff are meeting the regulations.

Regulations and interpretation of regulations can change through rule-making at both the state and federal level. When this happens, rule changes are published and providers are notified with an opportunity to comment. The recent changes to 59A-4 Health Facility & Agency Licensing (12/21/15) is an example of this. When there are major changes there is usually training for surveyors and providers.

Change can also happen when surveyor protocols change such as in the recent Dementia Care Survey Tools (11/27/15) issued by the Center for Clinical Standards and Quality/Survey and Certification Group.

A third way compliance with a regulation can change, is when surveyors “interpret” compliance in a new way. This occurred years ago when surveyors began to cite facilities for restraint use. Regulations didn’t change but how surveyors “interpreted” proper restraint use changed.

LeadingAge Florida is committed to helping their members have good surveys. Surveys are being reviewed for information and trends that we will share with members on how they can ensure compliance.

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