SMQT Comprehensive Care Plan Process 4 — Questions and Answers
Question 1: During a survey, you observe that care plan conferences are held but family members consistently report not being invited. The most likely citation would be:
- F-tag 550 (Resident Rights – Dignity)
- F-tag 656 (Comprehensive Care Plan) for failure to ensure participation (Correct answer)
- F-tag 726 (Nurse Aide Competency)
- F-tag 812 (Food Safety)
Correct answer: F-tag 656 (Comprehensive Care Plan) for failure to ensure participation
Failing to provide residents and representatives an opportunity to participate in care planning is a direct deficiency under F-tag 656.
Question 2: A care plan correctly identifies a pressure injury but the interventions listed have not been updated despite documented wound progression. A surveyor would cite this as:
- Acceptable because the problem was identified
- A deficiency because the care plan must be revised when conditions change (Correct answer)
- Acceptable if the physician has not ordered new treatment
- Not a deficiency unless the wound reaches Stage 3
Correct answer: A deficiency because the care plan must be revised when conditions change
Care plans must be updated to reflect current status; failing to revise interventions when a wound progresses constitutes a care planning deficiency.
Question 3: Which of the following best represents a person-centered care plan approach as emphasized in current CMS regulations?
- Goals written exclusively by clinical staff using standardized templates
- Goals reflecting the resident's own preferences, strengths, and life history (Correct answer)
- Goals focused solely on reducing clinical risk regardless of resident preference
- Goals approved only after family consent overrides resident choice
Correct answer: Goals reflecting the resident's own preferences, strengths, and life history
CMS Phase 2 and 3 rules emphasize individualized, person-centered care plans that incorporate resident preferences, values, and goals.
Question 4: A facility uses a computerized care plan system that auto-populates generic interventions from the MDS. A surveyor's concern with this practice would be:
- Electronic care plans are not accepted by CMS
- Auto-populated plans may not be individualized to the specific resident (Correct answer)
- Generic interventions are acceptable as long as they are reviewed annually
- Only paper care plans are legally enforceable
Correct answer: Auto-populated plans may not be individualized to the specific resident
Even when using electronic systems, care plans must be individualized; generic auto-populated content that is not customized constitutes a deficiency.
Question 5: If a surveyor finds that care plan goals are not being met and interventions are not being followed by staff, the root cause investigation should first examine:
- Whether the care plan was laminated properly
- Whether staff were educated on the care plan and whether the plan is accessible at point of care (Correct answer)
- Whether the administrator signed off on the care plan
- Whether the resident agreed with the goals in writing
Correct answer: Whether staff were educated on the care plan and whether the plan is accessible at point of care
Implementation failures often stem from staff not knowing about or having access to the care plan, making education and accessibility the first root cause to examine.
Question 6: A resident requests that their care plan goal be changed from 'ambulate 50 feet daily' to 'remain in bed during evening hours.' The facility should:
- Refuse, because the existing goal is clinically superior
- Update the care plan to reflect the resident's preference and document any risks discussed (Correct answer)
- Require physician approval before making any goal changes
- Defer the change until the next quarterly review
Correct answer: Update the care plan to reflect the resident's preference and document any risks discussed
Residents have the right to participate in and direct their care; the facility must honor the preference and document informed decision-making.
Question 7: Which statement about care plan signatures is most accurate under federal nursing facility regulations?
- All interdisciplinary team members must sign the care plan for it to be valid
- Regulations specify who must sign but do not require signatures from every discipline (Correct answer)
- Only the Director of Nursing and physician signatures are required
- Care plans require no signatures as long as they are dated
Correct answer: Regulations specify who must sign but do not require signatures from every discipline
CMS regulations require the care plan to be developed by the interdisciplinary team but do not mandate a specific signature block from every discipline.
SMQT Comprehensive Care Plan Process 4
During a survey, you observe that care plan conferences are held but family members consistently report not being invited.
The most likely citation would be: