ACC Quality Assurance & Improvement 2 — Questions and Answers
Question 1: Which federal regulation establishes quality-of-life requirements for activity programs in skilled nursing facilities?
- OBRA 1987 (F679/F680) (Correct answer)
- ADA Title III
- HIPAA Privacy Rule
- CMS Conditions of Participation §482
Correct answer: OBRA 1987 (F679/F680)
OBRA 1987, implemented through F-tags F679 and F680, mandates that SNFs provide an ongoing activities program to meet residents' interests and physical, mental, and psychosocial well-being.
Question 2: During a QAPI root cause analysis meeting, the team discovers activity participation rates dropped 18% over three months. What is the BEST next step?
- Immediately change the activity calendar to more popular programs
- Identify and analyze contributing factors before implementing changes (Correct answer)
- Retrain all activity staff on engagement techniques
- Report the finding to the state survey agency
Correct answer: Identify and analyze contributing factors before implementing changes
Root cause analysis requires identifying contributing factors first so that interventions address the actual cause rather than symptoms.
Question 3: An activity consultant uses the '5 Whys' technique during a performance improvement project. This tool is best categorized as a:
- Data collection instrument
- Root cause analysis method (Correct answer)
- Benchmarking strategy
- Outcome measurement scale
Correct answer: Root cause analysis method
The '5 Whys' is a root cause analysis technique that repeatedly asks 'why' to drill down from a problem's symptom to its underlying cause.
Question 4: A facility's QAPI committee wants to measure activity program effectiveness. Which metric BEST reflects meaningful resident engagement?
- Number of activities offered per week
- Percentage of residents attending at least one activity daily (Correct answer)
- Total supply budget spent on programming
- Number of new activity ideas submitted by staff
Correct answer: Percentage of residents attending at least one activity daily
Daily attendance percentage directly measures whether residents are engaging meaningfully with programming rather than just measuring program quantity.
Question 5: When writing a Plan of Correction (POC) for an activity-related deficiency, which element is REQUIRED?
- A list of all activities offered in the past year
- Specific corrective actions, responsible parties, and completion dates (Correct answer)
- Signatures from all residents who were affected
- Approval from the state ombudsman
Correct answer: Specific corrective actions, responsible parties, and completion dates
A valid POC must include specific corrective actions, who is responsible for each action, and target completion dates to demonstrate accountability.
Question 6: The Plan-Do-Study-Act (PDSA) cycle is used in activity departments primarily to:
- Document resident care plans
- Test and refine small-scale quality improvements before full implementation (Correct answer)
- Schedule monthly activity calendars
- Train new activity aides on documentation
Correct answer: Test and refine small-scale quality improvements before full implementation
PDSA cycles allow teams to pilot changes on a small scale, measure results, and adjust before committing to facility-wide implementation.
Question 7: A resident consistently refuses group activities but her care plan does not reflect an individualized alternative. This represents a deficiency in which area?
- Infection control documentation
- Individualized activity programming and care planning (Correct answer)
- Staffing ratios per shift
- Grievance procedure compliance
Correct answer: Individualized activity programming and care planning
CMS requires that activity programs be individualized; when a resident refuses groups, the care plan must document alternative one-to-one or bedside programming.
ACC Quality Assurance & Improvement 2
Which federal regulation establishes quality-of-life requirements for activity programs in skilled nursing facilities?