question

1) Policy:

answer

Must have a policy. May state that the facility will not handle monies in excess of $5,000.00. The facility may charge a reasonable fee not to exceed the ACTUAL COST of providing service.

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2) Required Printed Information:

answer

This must be given resident upon admission. A statement that the facility will handle personnal funds if no other person is available. Periodic statement of accounts (Minimum: Quarterly)

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3) Procedure: American Institute of CPA

answer

Quarterly statements including all activity, (A-H) in easily readable form. Written account of all personal funds held in trust must be sent to the executor, administrator, rep payee or next of kin within 10 DAYS OF THE DEATH OF A PATIENT. Account must be closed and balance sent to resident within 3 DAYS OF DISCHARGE.

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4) Financial records:

answer

not less than two (2) hours during normal business hours.

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5) Petty Cash:

answer

during all normal business hours.

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6) Funds:

answer

Cannot be CO-MINGLED with any other facility funds (Can with Residents')

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7) Interest Bearing Accounts:

answer

May keep up to $200.00 in a non-interest bearing account of petty cash fund. Money in excess of $200.00 shall be deposited in an interest bearing account within 15 days of the date the $200.00 minimum is exceeded.

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8) Designation For Patient Unable To Handle Own Funds:

answer

Facility notifies the Family Independence Agency, Adult Protective Services in writing when a mentally incompetent patient has no one to act on his behalf.

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9) Sale Or Transfer of Ownership

answer

Written receipt from new owner acknowledge receipt of the funds for safeguarding.

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10) Surety Bond:

answer

Not LESS than $2,000.00 or 125% of the previous year's patient trust funds average balance held, whichever is greater.

question

11) Department of Community Health (MDCH or DCH)

answer

DCH is responsible for the Medicaid Program under contract to the federal agency named Centers for Medicare and Medicaid Services (CMS). MDCH also contracts with other departments and agencies to provide specific services.

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12) Medical Services Administration (MSA)

answer

This agency, under authority of MDCH writes policy, acts as fiscal intermediary, designs categorical reimbursement programs, audits and authorizes facility-specific reimbursement rates.

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13) Bureau of Health Systems: DCH

answer

has this bureau under its department for oversight of the quality of care within nursing homes through the certification process. The actual certifying agency is CMS. This is accomplished through the surveys and inspections.

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14) Department of Community Health, Bureau of Construction Codes, Office of Fire Safety.

answer

DCH contracts with Office of Fire Safety to conduct the Life Safety Code portion of the survey.

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15) Michigan Department of Human Services (DHS):

answer

DCH contacts with DHS who determine an individuals Medicaid eligibility and "co-payment" responsibility. DHS utilized the local offices for direct contract with applicants.

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16) Bureau of Health Professions: DCH

answer

Has this bureau under its department for oversight and licensing of Nursing Home Administrator (NHA)

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17) Michigan Department Community Health

answer

This Department contracts directly with the federal agency CMS and as such is designated responsibility for Title XIX of the Social Security Act. Currently this program is 56% federally funded and 44% state funded.

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18) Medical Service Administration (MSA)

answer

itself handles two primary aspects of the program POLICY AND REIMBURSEMENT.

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19) Providers must adhere to

answer

ALL POLICIES TO PARTICIPATE

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20) Facility must be licensed

answer

MANDATORY

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21) Certification of Facility

answer

VOLUNTARY

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22) MDCH uses the

answer

Bureau of Health Systems to perform surveys for this certification.

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23) Delivery of Services (Fairness/Non-Discrimination Doctrine)

answer

Services Reimbursed by MSA are listed in the Medicaid manual. Facilities MUST render covered services to ALL ELIGIBLE recipients in the same scope, quality, and manner as provided to the general public.

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24) Compliance:

answer

Facility must render services in accordance with all federal and state statutory and regulatory requirements.

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25) Medicaid is Payor of :

answer

LAST RESORT

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26) Medicaid Payment is:

answer

PAYMENT IN FULL (critical issue) For covered services the facility must except the Medicaide reimbursement rate as payment in full for each and every Medicaid recipient. The facility may not seek additional payment from residents or families for covered services.

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27) For NON-COVERED SERVICES

answer

The facility may seek payment from the recipient IF the resident chooses the service AND is informed of the charge PRIOR to receiving the service.

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28) Retention:

answer

Facility services - 6 years Orders of Contracted Services (Not records) - 6 years

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29) Attending Physicians' responsibility

answer

Federal and State regulations require the attending physician (MD or DO licensed in Michigan) to provide specific services to recipients.

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30) Physician Compliance

answer

It is the facilities responsibility

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31) Physician Visits

answer

Every 30 days for first 90 days, then every 60 days thereafter (more frequently if medically necessary)

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32) Physicians' must have

answer

Written Plan of Care, signed

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33) Under State Plan, DCH utilizes its

answer

Bureau of Health Services to complete this during the annual survey. Process assures that residents are receiving the appropriate care at the APPROPRIATE level of care.

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34) Facility actions that:

answer

Threaten the health, safety, or welfare of Medicaid recipients (determined through the survey process)

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35) Facility actions that:

answer

Threaten the fiscal integrity of the Medicaid program. Abuse of Resident Trust Fund

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36) Enforcement actions:

answer

Failure to meet the federal conditions of enrollment or participation Failure to meet the Certification Standards Termination or suspension of Medicare automatically does the same to Medicaid

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37) Patient Pay Amount

answer

recipient must pay to the nursing home each month the amount of income determined to be in excess. Facility is responsible for collecting May NOT bill Medicaid for uncollected portion.

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38) Co-insurance:

answer

Must be applied to the FIRST DAYS OF STAY. Remember facility MAY NEVER CHARGE A MEDICAID RECIPIENT MORE than the MEDICAID RATE.

question

39) Medicaid resident is discharged on the 11th of the month. How much do you charge whom if: Private Pay Rate: $100.00 per day Medicaide Rate: $80.00 per day Patient Payed: $1000.00 per day

answer

Amount due = Medicaid Rate X Days of Stay (80.00 X 10 = 800.) Facility may charge for day of Admission, but not day of Discharge. So stay = 10 days. You must notify the local DSS office of all discharges. Amount due from (to) resident = Amount Due - Patient Pay Amount for month (800 - 1000 = -200) You owe resident $200.00 Bill Medicaid 0.00

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39). Under NO circumstances may a facility change the payment status of the resident to private pay and charge the full $100.00.

answer

The DHS determines whether or not the recipient is Medicaid eligible. If the resident had stayed more days, you would have billed Medicaid.

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40) Prior authorization for Services is Mandatory for

answer

all recipients BEFORE receiving care.

question

41) Prior authorization for Routine Services is accomplished

answer

Through the PreAdmissions Screening of PASAAR. Conducted by MDCH by contract to local Community Mental Health (CMH). Pre-payment review for nursing need.

question

42) Prior Authorization for Ancillary Services

answer

is Mandatory for all ancillary services (Therapies and Durable medical equipment).

question

43) Invoice (DSS-1073) is submitted to DCH AFTER

answer

SERVICES RENDERED. You may bill both ROUTINE and ANCILLARY services on the same bill.

question

44) Therapeutic Leave Days:

answer

Each recipient is entitled to 10 hospital leave days providing: Hospitalization is unexpected Return Anticipated within 10 days Resident returns before day 10

question

45) DCH

answer

is the fiscal intermediary for Medicaid program.

question

46) Reimbursement Structure:

answer

limits are established by legislature.

question

47) Cost Reporting:

answer

to determine the facility-specific rates, DCH utilizes the MICHIGAN STATISTICAL and OPERATING COST REORT which must be filed within 90 days of the facility's fiscal year end.

question

48) Many recipients are eligible for both types of benefits.

answer

If so, then facility MUST first bill Medicare, receive initial payment and then bill Medicaid

question

49) Medicare Part A:

answer

Routine Services plus Ancillaries Medicare pays in full for days 1 - 20 On Day 21, you begin to bill co-insurance (Medicaid) for day 21 - 100.

question

50) A recipient must enroll in Medicare Part A to be eligible for Medicaid.

answer

If a recipient refuses to enroll, he is automatically denied Medicaid.

question

51) Medicare Part B:

answer

Ancillary Services provided Outpatient or Medical Services Therapies (Non Medicare A) Billable Medical Supplies D.M.E. Diagnostic Services Payment: Bill deductible to Medicaid

question

52) Purpose:

answer

Alternative to employer "tort" liability in the legal system.

question

53) Sole:

answer

Workers Compensation is the sole remedy for workers injured or disabled in the corse of employment.

question

54) Employees accepting workers compensation

answer

cannot sue the employer

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55) Workers Compensation Benefits

answer

are statutory

question

56) Workers Compensation Rates

answer

are set by rating agency on behalf of insurers

question

57) Workers Compensation Claims

answer

appeals process is handled by state bureau

question

58) "Rate Making"

answer

Process used in determining rates to be charged by insurance companies. Rates are set by the bureau

question

59) "Loss Experience"

answer

Actual Payments and reserves for anticipated payments added together.

question

60) "Manual (or Book) Rate"

answer

Assume parity with the averages within a given employer group, such as clerical, nursing, maintenance.

question

61) "Reserves"

answer

Estimates of medical cost and lost time payment (including fringe benefits) that are set aside by the carrier for each anticipated injury AT THE TIME THE CLAIM IS FILED.

question

62) Michigan is a Total Disability State:

answer

any injury is considered total disability. Either you can work or you can not.

question

63) Compensable injuries:

answer

any injury arising out of and in the course of employment. death due to or rising out of the course of employment any injury received going to or from the workplace on the premises where work is to be performed and within a reasonable time before and after working hours.

question

64) Employers Mandatory Participation:

answer

Every private employer who employs one or more employees 35 hours per week or more for 13 weeks or longer.

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65) Compensation Payments:

answer

No loss time compensation shall be paid unless the employee is incapacitated from earning wages for more than one week.

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66) Benefits Level:

answer

Maximum weekly benefit is 90% of State average weekly wages as set by the Department of Consumer and Industry Services

question

67) Statue of Limitations:

answer

Two years from date of injury, or two years from the time that employee knows that injury is work related.

question

68) Form 100

answer

"Employers' Basic Report of Injury" Filed immediately with The "Bureau of Workers' Compensation" and copies distributed to The insurance carrier The employer and The employee

question

69) Form 104

answer

"Petition for Hearing" -

question

70) Form 107

answer

"Notice of Dispute" aq

question

71) Petition NLRB (National Labor Relations Board

answer

potential union members for interest with signature cards. show interest must be equal to or greater than 30% of potential bargaining unit interested. the election (NLRB Conducts; 50% plus 1 of potential bargaining unit members voting wins)

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The Nursing Home shall provide a written copy of facility rules and regulations:

answer

to the patient or the patient's representative upon admission and when the rules and regulations are changed.

question

The Policy shall be developed by a:

answer

Patient Care Policy Committee

question

The Patient Care Policy Committee must consist of:

answer

At least 1 Physician, the Director of Nursing, and the Administrator, with such additional memebers as the committee dems appropriate.

question

Oxygen Administration:

answer

Only personnel who have been trained to administer oxygen shall do so and that Oxygen shall only be administered on the Order of a Physician or as authorized in Emergency Situations.

question

Infection Control Committee

answer

The Director of Nursing and Representative of Administration, dietary, housekeeping, and maintenace services.

question

Medical Examination of Patients

answer

1) Except in the case of a Friday Admission, in which case the patient shall be exaimed by a licensed physician within 72 hours. 2) A patient admiitted to a home shall be examained by a licensed physician within 48hours after admission

question

Medical Examination of Patient currently in the facility:

answer

Shall be seen and, to the extent appropriate, shall be examined by a licensed physician at least once every 60 days, unless justified otherwise and documented by the attending

question

Standing Orders Must be:

answer

Reproduced in the patients Clinical record and shall be signed by attending physician within 48 hours.

question

Telephone or Verbal Orders Recorded by the licensed nurse in charge

answer

Shall be countersigned by the physician withhin 48 hours.

question

The Director of Nursing

answer

Shall be a Registered with specialized training or relevant experience in the area of gerontology and shall be employed FULL TIME BY ONLY 1 NURSING HOME

question

The Charge Nure

answer

A licensed nurse shall be the charge nurse on each shift or tour of duty and shall be responsible for the immediate direction and supervision of nursing care provided to patients.

question

In Homes less than 30 beds the Director of Nursing

answer

May serve as Charge Nurse on a shift when present for full shift.

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Reporting and enforcement of nurse staff requirements:

answer

A home Shall maintain for a priod of Not Less than 2 years , employee time records, including time cards or their equivalent and payroll record

question

An Ambulatory Resident/Patient shall have a complete Tub or Shower

answer

under staff supervision at least once a week, unless the physician writes an order to the contrary.

question

A Bedfast Resident/Patient shall be assisted with bathing or bathed completelt

answer

at least twice a week and shall be partially bath daily and as required due to secretions, excretions, or odoors.

question

A patient's Clothing or Bedding shall be changed Promptly

answer

when they become wet or soiled

question

A patient shall be Weighed and have his or her vital signs tanken and recorded

answer

On Admission and at least Monthly thereaftter or more frequently if ordered by a physician.

question

Begining Patient Care Planning

answer

An assessment of a patient shall be initiated by licensed nursing personnel within 24 hours of admission and the results of the assessment shall be documented in the patients clinical record.

question

A Patient Care Confrence

answer

shall be held periodically, but not less than Once Every 90 Days to evaluate a patient's needs and evaluate care plan

question

Equipment and Supplies Bed

answer

An individual bed not less than 36 inches wide and 72 inches long, or longer when necessary, with springs in good condition, and a mattress not less than 5 inches thick in good condition, with a nonobsorbent cover.

question

The home Shall provide a written copy of facility rules and regulations

answer

To the patient or the patients representative upon admission and when the rules and regulations are changed

question

Diversional Activities

answer

A Home shall provide an on going diversional activities program that stimulates and promotes social interaction, communication, and constructuctive living.

question

Patient Counsel

answer

shal permit the formation of a patient/resident counsel by interested patients, and at time of admission to home shall inform all of the counsel and the rules if any

question

When the Dietary or Food service supervisor is other than a registered dietitian

answer

The supevisor shall receive routine consultation and tecnical assisstance from a registered dietitian (R.D) not less than 4 hours every 60 days.

question

Food and Nutritional Needs of a patient

answer

Shall be met in accordance with the physicians orders in keeping with acceptable standards of practice of most recent recommended daily dietary allowences

question

Not less than 3 meals or their equivalent

answer

shall be served daily, at regular times, with not more than a 14 - hour span between a substantial evening meal and breakfast.

question

Menus, postings, filing

answer

as actually served to patients must be kept for preceding 3 montns on file in the home

question

Food acceptance record

answer

shall be retained in the facility

question

Self Administration of Medication by a Patient

answer

shall not be permitted, except when special circumstances exist and when supported by a physician's written order and justification

question

Diagnostic Services

answer

An arrangement shall be made by the administrator for obtaining promptly and conveniently a clinical laboratoy, x-ray, or other diagnostic services ordered by the physician

question

A written report of each diagnostic test and service

answer

shall be included in the patients clinical record within 1 week

question

Clinical Records of DISCHARGED patients

answer

shall be completed within 30 days following discharge. Clinical records shall be under the supervision of a full time employee of the home

question

Clinical Records are Retained for a Minimum of

answer

6 years from date of discharge or, in the case of a minor, 3 years after the individual comes of age under state law, which ever is longer.

question

Accident Records and Incident Reports

answer

shall be prepared for each accident or incident involving a patient, personnel, or visitor and shall include all of the following information.

question

Employee Records and work Schedules

answer

a daily work schedule shall be prepared in writting and be maintaned to show the number and type of personnel on duty in the home for the previous 3 months

question

A Time Record for each employee

answer

shall be maintained for not less than 2 years

question

"Medical Audit"

answer

means the retrospective examination, review, and evaluation of the clinical application of medical knowledge utilized in the diagnosis and treatment of poatients as revealed n the patient's clinical record and carried out for purpose of education, accountability, and quality control.

question

"Quality Control"

answer

means the planned and systematic medical management actions which assures the consistent acceptabe quality of health care and services rendered to patients including the use of variousmonitoring techniques.

question

"Utilization Review"

answer

means retrospective, concurrent, and prospective review of the provision and utilzation of health care services by providers and recipients in terms of cost, effectiveness, efficiiency, and quality

question

Home Entrance for Physically Hanicapped

answer

IN A NEW CONSTRUCTION, addition, major change, or conversion after AUGUST 22, 1969, at least 1 entrance Shall provide easy access for the Physically handicapped

question

A minimum od 20 square feet of floor space per patient bed

answer

Shall be provided for dayroom, dining room, recreation, and activity purposes.

question

A new contruction after August 22, 1969 Shall provide

answer

A sleep, day, dining room, recreation, or activity room with a minimum ceiling height of 8 feet

question

20 feet of unobstructed vision space outside of any

answer

window in a room requiring windows. One additional foot shall be added to the minimum distance of 20 feet for each 2 foot rise above the first story up to a max of 40 feet of required unobstructed space

question

A multi bed patient room (not more than 4 beds)

answer

shall have a 3 foot clearance btw beds and not less than 70 square feet of usable floor space per bed

question

The temerature of HOT WATER at plumbing fixtures used by patients

answer

shall be regulated to provided tempered water NOT LESS than 120 degrees fahrenheit.

question

A room used for patients shall maintain a regular daytime temperature

answer

of NOT LESS than 72 dehrees fahrenheit

question

Kitchen and Dietary A Reliable Thermometer

answer

shall be provided for each refrigerator and freezer

question

In new construction (August 22, 199) general storage space of

answer

10 square feet shall be provided in the home

question

In a 100 bed Nursing Home Day Staff

answer

8:1 ration RN?LPN/ CNA

question

In a 100 bed Nursing Home Evening Staff

answer

12:1 ratio RN/LPN/CNA

question

In a 100 bed Nursing Home Night Saff

answer

15:1 ration RN/LPN/CNA

question

Class Outlines and Lesson Plans

answer

shall be retained in the facility for not less than 2 years

question

MIOSHA General recording criteria

answer

You must consider an injury or illness to meet the criteria, if it results in a) DEATH b) Days away from work c) Restricted work or transfer to another job d) Medical treatment beyond first aid e) LOSS of consciousness

question

MIOSHA Retention and Updating

answer

Must save MIOSHA 300 Log during the 5 year storage period

question

MIOSHA Hospitilization

answer

Within 8 hours after death of any employee from a work-related incident or the inpatient hospitialization of 3 ormore employees as a result of a work-related incident

question

MIOSHA incident reporting

answer

You must orally report the fatality/multiple hospitilization by telephone or in person to the Michigan Department of Consumer and Industrial Services, Bureau of Safety and Regulation, State Secondary complex

question

MIOSHA If the Building Office is Closed, May I report the incident by leaving a message on MIOSHA's answering machine, faxing the bureau office, or sending an e-mail?

answer

NO! If you can't talk to a person at the bureau office you must report the fatality or multiple hospitilization incident using the 800 number 800-858-0397

question

"Licensed bed capacity"

answer

means the autorized and licensed bed complement of a nursing home

question

Rule #107 Type Documentation

answer

When the statue or these rules required a document or parts of a document to be printed in 12 point type the distance btw the top

question

Rule # 111 Governing Body

answer

The governing body of the nursing home shall assume full responsibility for the overall conduct and operation of the home

question

The Governing Body Shall Appoint a

answer

Licensed Nursing Home Administrator and shall deligate to the administrator the responsibility of operating the facility according to the policy and perceedures they established

question

Rule #112 Posting Resident Rights

answer

Shall develop, adopt, post in a public place, distribute, and implement a Policy on the rights and responsibilities of patients in accordance with the requirements

question

All patient complaints shall be investigated with in

answer

15 days of the complaint and home within 30 days following the complaint the home shall provide complintee a written status report or results of investigation

question

Patient Trust

answer

Policy that home will not handle funds freater than $5,000.00

question

Patient has the right to have a representative from_____________ to handle his/her funds

answer

Social Security Administration

question

Disaster Plan

answer

Shall have a written Plan or procedure to be followed in case of fire, explosion, or other emergency

question

A regular Simulated Drill

answer

shall be held for each shift NOT LESS than 3 times per year

question

Building Construction

answer

If the building has a common wall with a nonconforming building, the common wall is a fire barrier having at least two hour fire resistance rating

question

Interior Walls and Partitions in building of Type I or Type II

answer

construction shall be noncombustible or limited-combustible material.

question

Interior Walls and Partitions in building of Type I or Type II

answer

shall be noncombustible or limited-combustible materials

question

Interior Finish 2000 EXISTING

answer

Interior finish for corridors and exitways, includeing exposed interior surface of building has flame spread rating of Class A or Class B

question

Interior Finish 2000 NEW

answer

Must have Flame Spread Rating of Class A or Class B. LOWER PORTION OF CORRIDOR WALLS CAN BE CLASS C

question

Corridor Walls and Doors 2000 EXISTING

answer

are separated from use areas by walls constructed with at least 1/2 hour fire resistance rating.

question

Corridor Walls 2000 NEW

answer

NO fire resistance rating is required for corridor walls.

question

Doors 2000 EXISTING

answer

doors protecting corridor opening in other than required enclosures of verticle openings, exits, or hazardous areas shall be constructed of 1 3/4 inch sold-bond wood

question

Doors in Sprinkler buildings

answer

are only required to resist smoke.

question

Exit Components 2000 Exists

answer

such as stairways are enclosed with construction having a fire resistance rating of at least one hour,

question

Smoke Barriers New 2000

answer

shall be provided to form at least two smoke compartments on every sleeping room floor for more than 30 patients

question

The smoke compartment

answer

shall not exceed 22,500 square feet and smoke barrier shall not exceed 200 feet

question

Exit and Exit Access

answer

Not less than Two exits, REMOTE from each other, are provided for each floor or fire section of the building

question

Exit and Exit access shall be arranged such that no

answer

cooridor, aisle or passageway has a pocket or dead-end exceeding 30 feet

question

Width of Aisle or Corridors 2000 EXISTING

answer

clear and unobstructed, serving as exits shall be at least 4 feet

question

Width of Aisles or Corridors 2000 NEW

answer

clear and unobstructed serving as exit access in hospitals and nursing homes shall be at least 8 feet

question

Illumination of Means and Egress including exit discharge

answer

is arranged so that failor of any single lighting fixture (bulb) will not leave the area in darkness

question

Emergency Lighting of at least

answer

1 1/2 hour duraton is provided in accordance

question

Fire Alarm System 2000 Existing

answer

There shall be ANNUNCIATION of the fire alarm system to an approved central station.

question

Fire Alarm System 2000 NEW

answer

There shall be remote annunciation of the fire alarm system to an approved central station

question

Automatic Smoke Detection 2000 New

answer

An automatic dectection system is installed in all cooridors with detector spacing not further apart than 30 ft on center, nor more than 15 ft from any wall.

question

Windor and Door 2000 Existing

answer

Every patient sleeping room shall have an outside window or outside door. The allowable height shall not exceed 36 inches (91 cm) above the floor.

question

Soiled linen or trash collection receptacles

answer

shall not exceed 3 gal (121) in capacity

question

Oxygen storage locations of greater than

answer

3,000 cu ft are enclosed by a one-hour separation.

question

Generators are inspected

answer

weekly and exercised under LOAD for 30 minutes per month and shall be in accordance

question

National Fire Protection Association

answer

Private, nonprofit organizaton - NOT A GOVERNMET AGENCY. Author of Life Safety Code Nursing Homes are required by OBRA to meet LSC

question

Proceedure in Event of Fire

answer

1) Removing all residents involved 2) Transmitting alarm 3) Isolating the fire by closing doors 4) Evacuating by plan

question

Stairs: Clearance

answer

44"; riser height - 7" max

question

Smoke Towers

answer

stair enclosure designed to limit penetration of heat and smoke. No more than 1% of the volume of air in stairwell will emanate from fire area

question

Handrails at bottom of stairs

answer

Must extend parallel to floor for 12"

question

Windows must have

answer

opening force requirement of no more 5lbs.

question

Preventive Maintenance

answer

1) Save expense of requirs 2) Save labor 3) Assure safety

question

Facility Temperature

answer

71F - 81F

question

Bed Space for each Patient

answer

80 sq ft per resident in multi-bed rooms, 100 sq ft in private room

question

Obra Requirement for Housekeeping

answer

Services necessary to maintain a sanitary, orderly, and clean interior.

State of Michigan Nursing Home Administrator Exam – Flashcards

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