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Environment Survey Preparedness Laura Remus, REHS, Environmental Health and Safety Section, BCHS
Robert Posthumus, Facilities Director, Pilgrim Manor
Objectives
Review of Physical Environment F-tags for Long Term Care
Overview of examples and helpful tips for a successful survey
Examples of common citations and potential solutions
What is the Environment?
Areas of the physical environment that are used by residents or areas that affect residents. Resident rooms
Common areas such as dining rooms, activity and therapy room, bathing rooms, outdoor areas (smoking, gardening, etc.)
Areas that affect the residents, such as storage and utility rooms
Building systems – heating and cooling systems, mechanical ventilation, water supply and wastewater, emergency generators
Physical Environment F Tags
F-455 – Emergency Power
F-456 – Patient Care Equipment
F-457 – Bedroom Accommodations
F-458 – Room square footage
F-459 – Direct access to exit
F-460 – Full Visual Privacy
F-461 – Room with a window
F-462 – Toilet Facilities
F-463 – Resident call system
F-464 – Dining and Resident activities
F-465 – Other Environmental Conditions
F-466 – Available water supply
F-467 – Outside Ventilation
F-468 – Handrails
F-469 – Pest Control Program
Other applicable F Tags
F-323 – Accidents
F-441 – Infection Control
F-445 – Linen
F-517 and F-518 – Disaster and Emergency Preparedness
Changes with new CMS Regulations
Facility wide assessment (2019) Determine resources necessary to care for residents during day-to-day
operations and emergencies
New Construction (2016) No more than 2 residents per room
Each resident room must have it’s own toilet room
State Licensure requirements
Sanitarians will also be ensuring physical environment requirements of state licensing rules are met. Licensed bed count based on “room sheets” or “bed sheets”
Verify correct number of beds - *Helpful tip: have information ready for the surveyor including a floor plan with designated beds/room shown.
20 sq-ft (pre 1969)or 30 sq-ft (post 1969) per bed of designated dining activity space. Example: 100 bed facility must provide 2000 sq-ft if built before 1969 or 3000 sq-ft if built
after 1969
A provider’s perspective
The survey team walks into your facility… what do you do?
A provider’s perspective
Routine Maintenance Many citations result from lack of investment
into the building infrastructure Examples: Heating and cooling systems, boilers,
roof, building finishes, etc.
Planning ahead – money spent now vs. emergencies later
A provider’s perspective…
Documentation – what to have and how to organize it Service contracts (examples: HVAC, pest control, generator testing)
Monitoring Water temperatures
Resident room inspections
General maintenance issues – ceiling tiles, handrails, exhaust grilles, etc.
A provider’s perspective…
The survey is over, now what? Begin to prepare for your POC
Improved monitoring of maintenance
How can you prepare for the next survey?
Facility Assessment
This includes hazards specific to your area, and unique to your facility.
Questions to ask:
What natural disasters are we prone to?
Is there a nearby industry that could pose a potential hazard?
How can we protect our residents?
Legionella
ASHRAE Standard 188: https://www.ashrae.org/resources--publications/bookstore/ansi-ashrae-standard-188-2015-legionellosis-risk-management-for-building-water-systems
CDC Toolkit Developing a Water Management
Program to Reduce Legionella Growth and Spread in Buildings
www.cdc.gov/legionella
What are some common issues seen during surveys?
General cleaning/maintenance
Pest control
Plumbing
HVAC (Heating, Ventilation, Air Conditioning)
Call light systems
Plumbing
Surveyors will be looking for a functioning system, and also looking for cross-connections.
Cross connections are any instance that crosses the potable water supply with potential contamination.
Plumbing and maintenance
Facility MaintenanceDamaged ceiling tiles indicators of leaking roofs or condensation accumulation in above ceiling spaces.
Surface and water temperatures
Too hot? Surface temperatures
Pest Control
Evidence of pests Facility Program Contracts with pest control companies
Current invoices
Monitoring
Reporting mechanisms from staff and residents
Pest Control
MDHHS Emerging Diseases http://www.michigan.gov/emergingdiseases
HVAC
Filters Are they dirty? Is there a schedule for
changing?
Maintenance? In-house or contract?
Questions?
Laura Remus, REHS
Environmental Health and Safety Section
517-388-6233
Bob Posthumus
Pilgrim Manor, Facilities Director