Description

OVERVIEW

The Nursing Home Administrator is responsible for the overall operation of the facility. The administrator directly communicates with the staff in the facility as well as the Board of Directors and other Corporate staff. The administrator operates the facility in accordance with Federal, State and Local regulations to maintain quality resident care as well as sound fiscal management.

DAILY

Walk Through

The day begins with a morning walk-through of the facility.

During the walk-through:

*Communicate with the staff

Ex: "Good Morning" "How is it going today?"

*Illicit input on how the facility is operating.

*Listen to the staff to see if procedural changes need to be made.

*Monitor the cleanliness of the building.

*Monitor the cleanliness of the residents.

Clothes should be clean, hair combed, no food on face, dry and odor free.

*Monitor the temperature of the building.

*Address odors.

*Watch for and check to ensure compliance of company policies and State Regulations.

Walk-through should be done first thing in the morning and at other times of the day as time permits. Lunch time and shift changes are also good times for a walk-through.

Department Head Meetings

Hold Department Head meetings as early as possible so the Department Head can attend to their departments. Minutes of these meeting should be taken and copies be placed on the wings to ensure continuity of communication.

The Administrator should run the meeting:

*Address each Department Head

*Allow each to state what each department is doing for that day.

*Allow each to state what changes have occurred since the last meeting, plus any other pertinent information.

*Discuss any Policy changes.

*Inform the staff of any information that they need to know.

*Allow the Unit Managers (MDS/Care Plan Nurses) to do basic nurses report for their prospective wing so that a ‘change in resident condition’ can be addressed.

Again copies of the minutes are to be placed on wings to ensure continuity of communication.

Individual Supervisor Meetings

These are informal, brief daily discussions with each supervisor that are to take place at some point in the day.

The purpose is to discuss problems in the department such as:

*staffing issues.

*discipline.

*budgeted hours.

*problem employees.

*supplies and expenses.

*policies and regulations.

*or other needed discussions.

Corporate Liaison Meetings

On a monthly basis two members of the Board of Directors will visit each facility. They will meet with the Administrator and tour the facility. The Administrator should address all pertinent issues regarding the facility at this time

Public Relations

Daily actions of the administrator that attempt to create favorable public opinion among employees, residents, families and the general community.

The administrator should visit area hospitals, assisted living facilities, senior groups, etc. on a regular basis. The Admissions Director should accompany the administrator to touch base with discharge planners.

Some excellent public relations activities include:

*health fairs

*blood drives

*craft shows

*family nights

Marketing

The marketing committee should be made up of department heads. The committee must also illicit input from the floor staff. The committee must meet at least monthly. The committee should continuously update their marketing approach internally and in the community. Health fairs and other public events should be attended by members of the committee. Approaches to bring the community into your facility should also be discussed. The committee must take some pressure off the Admissions Director so weekly marketing calls at the hospital can be done.

WEEKLY/BIWEEKLY

Activities

The administrator must ensure that there is regular and adequate:

*daily activities.

*evening activities.

*weekend activities.

The Activities Fund must be monitored.

All receipts are to be sent over to Accounts Payable at corporate office.

Care Plan Meetings

These are held weekly. The administrator should attend as time warrants or at the request of the team. The administrator will ensure that all issues brought up in these meetings will be addressed by the appropriate staff. Each resident must have a quarterly care plan meeting to address changes in their condition and warranted changes in their care. Residents and families may attend these meetings.

Decubiti Meetings

Meetings are held weekly or bi-weekly depending upon the amount and severity of skin breakdowns. The meeting can be run by the D. O. N., Q. A. Nurse or the

Treatment Nurse. The administrators presence should be as time permits or at the request of the committee. The administrator should monitor skin grids so they can check the progress of the decubiti. The administrator must make sure that necessary steps are taken to address skin breakdowns, I. E. ointments, turn schedules, increased protein intake, waffle cushions and specialized beds.

Skin break downs which occur In-House may be a sign that proper resident care is not being maintained.

Falls Committee Meetings

This meeting should be run by the D. O. N., Q. A. Nurse or Restorative Nurse, and is to be held depending upon need, but at least weekly. The administrators presence should be as time permits or at the request of the committee. The administrator must monitor falls and sign the Accident/Incident Report Log. The administrator must make sure falls are being addressed. Falls can be addressed with walkers, geri walkers, side rails, low frame beds, gym mats, lap lock restraints, etc.

Medicare Meetings

The D. O. N. or Admission Director can run this meeting on a weekly basis. The administrator should attend this meeting if possible. Any changes in a resident’s Medicare status should be addressed in this meeting. The Admissions Director is to complete a form listing Medicare residents, skilling diagnosis, date on Medicare and days left on Medicare.

P. P. S. Stand- Up Meetings

These meetings should be held daily and the administrator should be present. The D. O. N., M. D. S. Nurses, Admissions Director, Restorative Nurses and Therapy Representatives should also be present. New admissions and re-admissions should be discussed. Assessment dates, skilling criteria and therapy needs must be addressed.NHADRES Rev. 9/2000 4

Payroll

The administrator must closely monitor the incentive bonus and make sure that it is applied fairly to all eligible staff. The administrator must also monitor department hours and overtime so that any increases can be addressed with Department Heads.

Weight Variance Meetings

These meetings are to be directed by the Dietary Supervisor and should be held bi-weekly or as needed. The administrator should attend as time permits or at the request of the committee. The administrator must monitor substantial weight losses and ensure that they are being addressed in a timely fashion.

MONTHLY

Accounts Receivable

The administrator is to review delinquent accounts with the bookkeeper as needed, but at least monthly. The administrator may need to communicate as needed with:

*Insurance Companies

*Families

*The Social Security Office

*The Welfare Office

*Corporate Accounts Receivable Personnel

The administrator will oversee eviction notices and other letters that will need to be completed and sent in some cases.

Corporate Meetings

The Administrators Meeting is held at 10:00 a.m. at the Corporate Office on the fourth Tuesday every month (except January, April, July & October). The purpose of this meeting is to communicate census information and other pertinent information.

In the months of January, April, July and October, a quarterly meeting is held on the second Tuesday of the month at 10:00 a.m. at a site to be determined.

Maintenance Walk Through

The administrator is to do a monthly maintenance walk-through with the maintenance supervisor. Together they should document any problems which need the attention of the Maintenance Supervisor.

The administrator is to verify that the following are completed and documented by the Maintenance Supervisor:

*Room Temperatures

*Water Temperatures

*Fire/Disaster Drills

*Generator Tests

*Preventive MaintenanceNHADRES Rev. 9/2000 5

Resident Council Meetings

The Activities Director, Social Services or both will run the meeting. The administrator need attend these meetings only at the request of the resident council. Minutes are to be taken and copies made and distributed to All Department Heads. The administrator is to receive a written plan of Correction for all resident complaints brought up in council. The minutes and corrections must be maintained for State Review.

Safety Council Meetings

A representative of Human Resources Department directs the meeting. The administrator must address all safety concerns at this meeting. It is the administrators responsibility to monitor the follow through and completion of necessary forms.

Salary, Wage and Expense Reports

*Monitor the salary and wage report

*Increases are to be addressed with Department Heads.

*Focus on budgeted hours plus overtime.

*Monitor the expense report

*Address increases with the necessary department heads.

*The administrator is to do comparisons of current and past year-to-date totals.

*Monthly meetings will be held at the corporate office with the corporate accountants to review expenses. If necessary, changes may need to be made after corporate advisement.

QUARTERLY

Quality Assurance Meetings

This meeting is directed quarterly by the Quality Assurance (Q.A.) Nurse and attended by:

*Medical Director

*Laboratory

*Pharmacy

*Key Facility Personnel

Faculty problems can be addressed in this meeting. Although it is not mandatory, it is a good practice to have monthly Q.A. Meetings.

The Q.A. Nurse is to supply a form listing:

*The problem

*Department

*Solution

*Action to be takenNHADRES Rev. 9/2000 6

Each department head must obtain a form and address the issues in their departments. The administrator must ensure that this is completed. All administrative issues brought up in this meeting must be addressed through the Q. A. process.

A written response is to be submitted by each department head to the administrator.

DUTIES TO BE DONE AS NEEDED

Corporate Meetings

Occasionally other meetings may be scheduled by corporate office. The administrator must be available for these meetings as well as give input in corporate matters.

Discipline

All discipline issues and employee write-ups must go through the administrator. Encourage Department Heads to document all issues pertaining to the problem employees. Investigate all discipline to make sure that it is warranted. If a write-up is warranted:

*Sign the form.

*Let the supervisor handle verbal & written warnings.

Counsel a problem employee as needed before it reaches the suspension stage. The administrator handles all suspensions and terminations.

Consult Human Resources Department in some cases when needed.

Employee Appreciation Days

Make sure that each department is recognized on their specific department day. Consult with the department head for a decision on the proper reward.

Employee Evaluations

Department Heads

Department head positions in Nursing should be evaluated by the administrator in conjunction with the D.O.N.

The administrator is also responsible for 90 day evaluations for new department heads.

Supervisors

The administrator is to complete evaluations on all supervisors.

Employees

The administrator will receive from the corporate office an evaluation list regarding floor staff. Give a copy of this list to supervisors. It is your responsibility that all evaluations are completed and sent to the corporate office in a timely manner.

Interviews

Department Head Positions

The administrator is responsible for interviewing of all Department Head positions.

Floor Staff Positions

Generally, the supervisors interview for floor positions, but the administrator should meet all perspective employees before they are hired. The administrator is to see that supervisors are checking references.

Monitor the following pre-hire policies:

*Completion and proper documentation of MANTOUX Testing

*Completion of Fingerprinting

*Completion of Physical Exams

*Completion of all required application, and state and federal employment

forms.

Orientation

Department Head Orientations should be handled through the Human Resource Department. The Human Resource Department will set up an orientation with a department head at another facility.

Floor Staff Orientations should be set up by that department’s supervisor. Two weeks is an adequate amount of time for an orientation, but every employee is different. New employees should be given their job descriptions and given a tour of the facility. New nursing assistants should work with a preceptor for their first two weeks.

Resident and Family Issues

Occasionally, the administrator will need to discuss sensitive issues with residents and families. These impromptu meetings must be handled very tactfully. Remember that the resident may be depressed and family members may feel guilty. Listen and address any issues which can be corrected.

Open Door Policy

Administrators must have an open door policy for residents, families and staff. When a staff member comes to an administrator with a problem, the administrator must reinforce the chain of command. If the staff member has used the proper channels then the issue can be addressed.

State Survey Preparation

Consult with the Corporate Quality Assurance Nurse and make sure that all problems identified by them are addressed by the appropriate department heads.

Obtain a Survey Check-off List form the Corporate Q.A. Nurse.

Maintain a File Folder with all the forms necessary for the survey. Upon request of The State upon entrance into the facility, you will have all you need in this file.

Supplies

All supplies for the facility must be ordered through TradeMasters. If TradeMasters does not carry the product, they will find a company that does. Department Heads who handle medical supplies, housekeeping supplies, maintenance supplies, office supplies and dietary supplies should fill out their order form weekly. The administrator must review and initial the order before it is faxed to TradeMasters.

Scotch Tape

Scotch tape can not be used on varnished or painted surfaces within the facility. The administrator is the only employee permitted to order scotch tape.

Contracts

All contracts must be reviewed by the administrator and then sent to the executive director for review. If the executive director and the lawyers are satisfied with the terms of the contract they will sign it and return it to the facility.

Qualifications