SMQT Comprehensive Care Plan Process 5 — Questions and Answers
Question 1: A facility's policy states care plans are updated 'as needed.' A surveyor would find this policy deficient primarily because:
- Policies must state specific staff responsible for updates
- Regulations mandate minimum review frequencies that cannot be replaced by discretionary language (Correct answer)
- Policies are irrelevant if the care plans themselves are current
- The phrase 'as needed' is not an approved CMS term
Correct answer: Regulations mandate minimum review frequencies that cannot be replaced by discretionary language
Federal rules require quarterly review at minimum; a policy permitting updates only 'as needed' creates a gap where mandatory reviews could be skipped.
Question 2: A resident with dementia is assessed as having high fall risk but refuses to use a bed alarm or call light. The care plan should:
- Document refusal and exclude fall interventions since the resident refused
- Document refusal, offer alternatives, and include all feasible interventions the resident will accept (Correct answer)
- Override the refusal because the resident lacks decision-making capacity
- Contact state authorities before proceeding
Correct answer: Document refusal, offer alternatives, and include all feasible interventions the resident will accept
Even when a resident refuses specific interventions, the facility must document the refusal, provide education, and implement all other feasible safety measures.
Question 3: Which scenario best demonstrates a systemic care planning deficiency versus an isolated individual deficiency?
- One resident's care plan is missing a dietary goal
- Multiple residents' care plans lack psychosocial goals despite documented depression diagnoses (Correct answer)
- A single care plan conference was held without the social worker present
- One care plan goal was not updated after a minor medication change
Correct answer: Multiple residents' care plans lack psychosocial goals despite documented depression diagnoses
A pattern of missing psychosocial goals across multiple residents with identified depression indicates a systemic failure rather than an isolated error.
Question 4: Under the OBRA framework, which document provides the foundation for identifying care planning 'triggers' that require further assessment?
- The facility's quality improvement committee minutes
- The Care Area Assessment (CAA) process initiated by MDS triggers (Correct answer)
- The resident's insurance pre-authorization form
- The state inspection report from the prior survey
Correct answer: The Care Area Assessment (CAA) process initiated by MDS triggers
The CAA process, triggered by specific MDS items, guides the interdisciplinary team in deciding which areas to address in the care plan.
Question 5: A resident's care plan goal reads: 'Resident will express satisfaction with meal choices by next review.' This goal is problematic because:
- Meal satisfaction is not a valid care plan topic
- It lacks a measurable baseline or criterion for success (Correct answer)
- Dietary goals require a registered dietitian co-signature
- Satisfaction goals must be written in the resident's own words
Correct answer: It lacks a measurable baseline or criterion for success
Without a measurable criterion (e.g., 'rates meals ≥7/10 on satisfaction scale'), progress toward this goal cannot be objectively evaluated.
Question 6: A surveyor observes that the care plan room is locked and staff must request access from the charge nurse to review care plans. The concern with this practice is:
- Care plans must be stored in the resident's room by regulation
- Restricted access may prevent timely implementation of care plan interventions by all staff (Correct answer)
- Only the Director of Nursing is permitted to access care plan files
- Care plans should be available on the internet for family access
Correct answer: Restricted access may prevent timely implementation of care plan interventions by all staff
If care plans are not readily accessible to all direct care staff, timely and consistent implementation of interventions is compromised.
Question 7: A resident's care plan was developed and signed 90 days ago but has not been reviewed since. The resident recently developed a urinary tract infection that resolved two weeks ago. Is a care plan revision required?
- No, because the infection resolved and no ongoing problem exists
- Yes, because any new clinical event requires a care plan update regardless of resolution
- Yes if the infection caused a significant change; otherwise the quarterly review is sufficient (Correct answer)
- No, because quarterly reviews are optional for short-term clinical events
Correct answer: Yes if the infection caused a significant change; otherwise the quarterly review is sufficient
A resolved, uncomplicated UTI is unlikely to constitute a significant change requiring an unscheduled revision, but it should be addressed at the next quarterly review.
SMQT Comprehensive Care Plan Process 5
A facility's policy states care plans are updated 'as needed.' A surveyor would find this policy deficient primarily because: