Minimum Daily Average Survey Tool - OHCA - Ohio Health ...



|Minimum Daily Average Survey Tool |Ohio Department of Health |

| |Division of Quality Assurance |

| |PROTOCOLS – November, 2001 |

|OBJECTIVES: |PROCEDURE: | |

| | | |

|Determine if the home has the possibility of |Open the Excel Minimum Daily Average Survey Tool by double | |

|negative outcomes or non-compliance that may be |clicking on the Staffing Survey Tool icon on your desktop. | |

|related to insufficient staffing. | | |

| |Save the document as the provider number-date. Click file,| |

|Determine if the home meets the minimum daily |save as, type the provider number-date (with no separators)| |

|average of 2.00 NA, .20 RN, and .55 additional |in the file name dialogue box. For example, if the |If either of the yellow shaded boxes under questions 1 |

|direct care hours per resident per day. |provider number is 360001 and the date is 10/02/2001. Type|and 2 is YES, go to Step 6, otherwise skip to Step 11. |

| |360001-100201. | |

|Determine if the home meets the minimum 1 to 15 NA | |Obtain staffing schedules for today and the previous 6 |

|to resident ratio. |Enter Nursing Home Name |days for all direct care staff including: DON, RN, LPN,|

| |Nursing Home Number |Nurse Aide, OT, OT Assistant, PT, PT Assistant, |

|Ensure consistent application of the nursing home |Provider Number |Dietician, Social Services Worker, and Activities Aide.|

|licensing rule and compliance determinations. |Nursing Home Capacity | |

| |Exit Date |Inquire if the home has a variance to use LPNs to meet |

| |Type of Survey |the RN .20 minimum daily requirement. Indicate Yes or |

| | |No using the pull-down menu for Question 4 |

| |Based on your observations of the home, use the pull-down | |

| |menus to answer questions 1(A-G) and 2 (A-D) for instances | |

| |of possible non-compliance and/or negative outcomes. | |

| | |

|Minimum Daily Average Survey Tool |Ohio Department of Health |

| |Division of Quality Assurance |

| |PROTOCOLS – November, 2001 |

|Indicate the present day of the week by using the |(Do not enter OT or PT aide hours in the spreadsheet. | |

|pull-down menu for Question 5. | | |

| |(Do not enter zeros in the spreadsheet. If there are no | |

|Enter the census for each day you are collecting |hours, leave the cell blank. | |

|staffing data in the boxes provided under Number 6 | | |

|on the tool. |(Round the hours to the nearest .5 hour. For example, 7 | |

| |hours and 15 minutes = 7.5 hours, 7 hours and 14 minutes = | |

|(Enter the number of hours worked on each shift for|7.0 hours |Click save under the file pull down menu. This will |

|each of the direct care staff listed in the survey | |save the most recent changes made to the document you |

|tool. | |saved in step 2 above under Procedures. |

| | | |

|(For RNs and LPNs, indicate the number of hours | |Send the completed survey tool as an e-mail attachment|

|spent each day performing nursing services and the | |to your DO. |

|number of hours spent performing nurse aide | | |

|services (NAS) | |Note: Even if Minimum Daily Average is met, determine|

| |Review the Staffing Requirement box to determine if the home|if home has sufficient additional staff to meet the |

|(For ancillary staff, only enter the number of |should be cited for failure to meet the minimum daily |needs of the residents. |

|hours spent providing direct care to residents. |average staffing requirements. | |

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Note: Do not answer statements in yellow shading – they will change automatically in response to your answers to questions 1 (a-G) and 2 (A-D).

As a general rule, only cite facilities if they fail to comply with the minimum daily average twice within one category or three times over all of the categories.

Note: Staff schedules will need to be broken down into 8 hour (3 shift) increments.

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