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Provider Feedback Needed!
Hand in Hand
 A Training Series for Nursing Homes Toolkit 
CMS created the Hand in Hand training series of six one-hour video-based modules for nursing homes to ensure that nurse aides and other staff receive regular training that emphasizes person-centered care for persons with dementia and the prevention of abuse. 


The Office of Inspector General, Division of Health Care, has prepared a short survey to evaluate the utilization and effectiveness of the Hand in Hand toolkit. Please take a few minutes to complete this survey. Your responses will remain confidential. The survey is now available and will be open until COB, Friday, August 2, 2013. 


Click Here to take the short survey.


Thank you for your participation in the survey. Your feedback is important to us.

Want to Know Kentucky's Top 10 Citations for Nursing Homes?

Basic Chart

Health Care


Life Safety Code



CMS 5-STAR Results



July Results


Year 3 Report

To learn more about the 5-STAR program click the link below 

Overview of CMS 5-STAR System  


CMS Announces Updated, Enhanced Tools for Patients to Compare Nursing Homes.  click link below for details

 Nursing Home Compare Updates  

Life Safety Code

Life Safety Code

CMS Medicare News 

Recent Survey and Certification Letters


Below you'll find links to survey and certification letters issued by the Centers for Medicare and Medicaid Services (CMS) pertaining to Long Term Care facilities.  Please take a look and determine how these may impact your facility.
Below are the S&C memos for this month 
  • S&C 13-42-NH- Reminder:  Access and Visitation Rights in LTC Facilities
  • S&C 13-43-NH- Changes to the NH Compare Website Data that is Available for Download on the Website 
  • S&C 13-44-NH- Five-Star Quality Rating System Three-Year Report 

Previous Survey & Certification Memos

CMS Survey and Certification Group

Announcing the CMS, Center for Clinical Standards and Quality, Survey and Certification Group training site. The CMS training website allows providers to take courses that surveyors take. 
@ttention Providers!
E-mailE-mail Addresses Needed

So that we may deliver the best customer service, please ensure that the Division of Health Care has up to date contact information for your facility, including e-mail addresses.  Please contact 502-564-7963 to provide this important information!



The Kentucky Department for Public Health would like to establish an email notification distribution group for Infection Preventionist (the person who is the leader for the Infection Control efforts at each facility) practicing in long-term care.  This email group would receive notifications concerning outbreaks, educational opportunities and pertinent State communications regarding infection prevention and control in the long-term care setting.  Names and e-mail addresses need to be sent to in Public Health.  Thank you.


MDS/RAI Updates

CMSNet Juniper Client Mandatory Upgrade


A mandatory upgrade to the CMSNet Juniper Client will occur for eastern states on August 17, 2013 and for western states on August 31, 2013. QIES users who connect to CMS Systems using CMSNet must follow the instructions in this document.


CMSNet Juniper Client Upgrade


MDS 3.0 Manual Record Correction Requests 


A few types of errors in a record in the QIES ASAP system cannot be corrected with an automated Modification or Inactivation request. These errors are:


1. The record is a test record inadvertently submitted as production.

2. The record has the wrong submission requirement in item A0410.

3. The record has the wrong facility ID in the control item FAC_ID.


In all of these cases, the facility must contact the State Agency to have the problems fixed. The State Agency will send the facility the MDS 3.0 Manual Assessment Correction/Deletion

Request form. The facility is responsible for completing the form. The facility must submit the completed form to the State Agency via certified mail through the United States Postal Service (USPS). The State Agency must approve the provider's request and submit a signed form to the QIES Help Desk via certified mail through the USPS.


Please use  this form to complete these requests and mail to the address below.  It is preferred that the request form be placed in double envelopes to ensure privacy.


Cabinet for Health and Family Services

Office of Inspector General

Attn:  Rhonda Littleton-Roe

275 E. Main St., 5 E-A

Frankfort, KY  40621


MDS/RAI Coordinator Changes

For MDS assessment or coding issues, please contact Michelle Mitchell at 502-564-7963, x3304 or via  e-mailMichelle is graciously filling in until we refill this position of State MDS/RAI Coordinator. You can continue to contact Rhonda Littleton-Roe at 502-564-7963, x3300 or via  email for any transmission or technical issues. 





 Quick Links

Office of Inspector General Website

Survey & Certification Letters


Long Term Care Inspection Findings


Long Term Care Newsletter Archives  


CMS Appendix Q - Guidelines for Determining Immediate Jeopardy


 CMS Appendix P - Survey Protocol for Long Term Care Facilities  


CMS Interpretive Guidelines for Nursing Homes

Kentucky Board of Licensure for Nursing Home Administrators


Long Term Care Regulations and Statutes


OIG Life Safety Code Portal 


CMS Surveyor/Provider Training 

Issue: #07-2013  

                    July 2013

Welcome to the Office of Inspector General, Division of Health Care's July 2013 edition of the Long Term Care Provider Newsletter.  This newsletter is a valuable vehicle to update you on current events affecting Long Term Care.  
Please feel free to share this newsletter with anyone you think would benefit.  To continue receiving this newsletter, be sure to join our mailing list by clicking the link at the bottom.  We look forward to serving you through this communication vehicle.
Decipher the Code
Understanding Code Status


Do Not Resuscitate (DNR) designates that in the event of a cardiopulmonary arrest (the heart is no longer pumping blood throughout the body) there will be no cardiopulmonary resuscitation.  At times the designation of DNR is often  thought of as a plan to provide less aggressive care for the resident.  However, the degree of treatment desired by the resident should not be inferred from the DNR designation.  A DNR order "does not indicate that the resident is declining appropriate treatment and services.  It only indicates that the resident should not be resuscitated if respirations and/or cardiac functions cease." (Centers for Medicare and Medicaid {CMS} State Operational Manual {SOM} 483.25 Quality of Care F309).  A discussion with the resident and/or legal representative is needed to come to an understanding of the expectations for end-of-life medical care.


A "Full Code" designates that the resident wants all medical measures taken including cardiopulmonary resuscitation.   Limited Code Status indicates which lifesaving measures the resident has chosen to be taken.   


It is important for the facility to have an effective system to identify and honor a resident's code status choice, whether it is a "full code" or "DNR".   The facility needs to ensure someone offers and explains to the resident and/or legal representative their right to choose their code status.  This information should be documented in the resident's clinical record.  The facility needs to ensure they have an effective system to identify the resident's code status.  Often, in the time of an emergency, staff is unaware of the resident's code status and valuable time is lost trying to locate the resident's chart to obtain this information.  The facility needs to ensure the system they are using is easily accessible and allows staff to quickly obtain the resident's code status.


Remember to offer your residents the opportunity to choose their code status (SOM Interpretive guidelines Resident Rights 483.10 (b)(8) F156).  Document this information in the clinical record (SOM 483.75(1) Clinical Records F514).  Additionally, the facility needs to have an effective system to ensure this information is readily accessible to staff, especially in an emergency situation. 

Medtronic SynchroMed Implantable Infusion System Devices:

Class 1 Recalls - Feed Through Failure, Failure of Priming Bolus, and Catheter Occlusion


In June 2013, Medtronic, Inc. initiated four medical device notifications to customers worldwide about the SynchroMed Implantable Infusion System. The Food and Drug Administration (FDA) has classified three of these notifications as Class I recalls. The fourth notification is an update to a 2011 action related to pump refill which was previously classified by the FDA as a Class I recall.   
  • Medtronic SynchroMed II and SynchroMed EL Implantable Drug Infusion Pumps - Failure of Priming Bolus
  • Medtronic SynchroMed II and SynchroMed EL Implantable Drug Infusion Pumps - Feed Through Failure
  • Medtronic Sutureless Connector Intrathecal Catheter Products - Catheter Occlusion
  • SynchroMed Implantable Infusion Pump Refill Procedure Safety  Update



Complete MedWatch Safety Alert with Links to Recall Notices

Minimum Data Set (MDS) 3.0 Training
Two-day Training Scheduled for 
August 8 & 9, 2013


The training will be held on August 8 & 9, 2013 at the

Ramada Plaza hotel located at 9700 Bluegrass Parkway, Louisville, KY 40299.


For reservations for overnight accommodations contact the Ramada Plaza @ 502-491-4830.

In order to get our discounted room rate you will need to inform them that you are with the "Office of Inspector General" Room Block. They have been kind enough to offer room rates of $80 plus tax (Occupancy & State Sales Tax- 15.01%). The cut-off date to get the discounted room rate is before 3:00pm on 7/31/13. If you have any hotel specific questions please call 502-491-4830.     

How to Register: 

  • Go to TRAIN
  • Search for  Course ID: 1045187
  • Online Registration is Open & Limited.
  • Registration Deadline is 
    Tuesday, August 6th.

More information to follow on the Division of Health Care web page.


If you have any questions about the training you may contact Jessica Lowe at 502-564-7963 at extension 3310 or via email.

Free LTC Provider Training 

Tentatively Scheduled for August


 Dementia Beyond Drugs:

Changing the Culture of Care

Presenter: G. Allen Power, M.D.

Award-Winning Author, Board Certified Geriatrician, and Expert Resource in Person-Directed Dementia Care


Based on Dr. Power's award-winning book, this 2-day learning experience uses the framework of culture change to create a new approach to caring for people who live with dementia.


Learn why the current paradigm for dementia care can never produce satisfactory results and explore an experiential model that facilitates growth, meaningful engagement, and improved well-being via the application of person-directed care.


Participants will learn how to:

  • Identify the limitations of our current approach to care for those living with dementia;
  • Envision an "Experiential Model" for viewing dementia and recognizing the importance of enhancing well-being for all; and
  • Apply the model to everyday situations and challenging behaviors, by using creative solutions to empower individuals to live full and positive lives. 
  • Decrease reliance on psychotropic medications, while complying with F-tags F329 and F428.
Here are comments from recent training participants:

"This was one of the best seminars I have attended. Dr. Power made changing things so easy and simple."

"Dementia Beyond Drugs training was a fantastic learning experience! You will experience a true paradigm shift in the way you think about and provide care for your elders facing the daily challenges of living with dementia."

The Office of Inspector General, Division of Health Care, Training Branch will offer a free educational opportunity for Long Term Care Providers to attend the "Dementia Beyond Drugs: Changing the Culture of Care" two-day training scheduled for late August 2013.  This program will take place in Louisville, Kentucky.


Target Audience: Two individuals per facility

- one person must be a member of the direct care staff (must be a SRNA/CNA/RN/LPN/etc) and one person from management. 


More details with specific dates, training location, and registration information to follow in a Special Edition Newsletter.  

Voluntary Termination

of the Medicare Provider Agreement


Dear Nursing Home Administrator,


Provisions specified in Section 6113 of the "Patient Protection and Affordable Care Act" (the Affordable Care Act) (Pub. L. 111-148) and amended sections 1128I and 1819 (h) of the Social Security Act require the nursing home administrator to notify the Secretary (CMS), the State Survey Agency (SSA), the State Medicaid Agency and the State Long Term Care (LTC) Ombudsman of the impending closure of a nursing home. The administrator is to provide notice a minimum of 60 days in advance of closure of the Skilled Nursing Facility (SNF) or Nursing Facility (NF). Advanced notification assures residents' living in our nation's nursing homes an opportunity to network with other prospective providers to locate quality health care services in a certified facility. Along with notice of closure, provide to CMS, the State and the LTC Ombudsman your facility's closure plan which provides for the orderly relocation of residents. The plan must be approved by the State Agency before closure of the nursing home. The intent of this document is to provide some of the minimum requirements that should be addressed in your relocation plan. Submit the closure plan and all related documents to the State Survey Agency. Your earnest cooperation in sharing information with the State Agency during the voluntary closure is appreciated.




Sandra M. Pace, ARA

Associate Regional Administrator

Division of Survey & Certification


Click here for the Full Disclosure Packet

 Cabinet for Health and Family Services

Office of Inspector General

Division of Health Care


Leadership Team 

 Mary Reinle Begley, Inspector General

Unbridled Spirit  

The Office of Inspector General is Kentucky's regulatory agency for licensing all health care, day care, long-term care, and child adoption/placing facilities and agencies in the Commonwealth. 

If you would like more information, please visit our website
If you have an idea for a future article, please contact Christina Libby.