In order to get some sense of the basic administrative structure of a skilled nursing facility, I spoke with Clara Allen in November of 2012, then the Administrator of the San Bruno Skilled Nursing Hospital in San Bruno, California.
It needs stating right off the bat that this institution is a for-profit model, a division of Meridian Foresight. Nevertheless, the size of this organization seems very manageable and we can learn some basic proportions of staff to patients and how the various departments break out. This five star (top rating) facility houses 45 residents, has a staff of 58 (both FT and PT plus on-call staff), and eight departments: nursing (5-6 RNs, 5-6 LVNs, 25 CNAs), social services, maintenance, dietary, activities, housekeeping, staff development and business office. They are accountable to Clara and each department (which has its own budget) gives her a spend down report on their expenses twice a month.
They have an IDT – an Interdisciplinary Team – that meets to discuss things like falls, patient weight loss or gain, new admits. Everyone works together to find solutions, see how different elements are contributing to a problem.
They have three different committees that meet monthly: Customer Service (plans big events like karaoke, bingo night, dances) and one that plans bigger outing events like picnics. The Quality Assurance Committee (lab, pharmacy, others) meets quarterly to address infections, falls, budget overviews. There are also monthly General Staff Meetings to discuss issues that concern every department, like personnel policy changes, or culture change.
Culture change is an action-oriented collaboration that seeks to transform the institutionalized culture of a nursing home. The goal is to create a person-centered and resident-directed environment to help improve staff retention and resident care in nursing homes. – California Culture Change Coalition
As part of her duties, Clara is also in charge of marketing, oversees maintenance projects and does the admission paperwork with new patients and their families. She does the long and short-term planning. She is also in charge of customer care, responding to comments and complaints that are submitted on their surveys.
The big responsibility (for any SNF) is the state and federal mandated annual survey, which means a team of inspectors is in the building for 4-5 days and examines the following things:
• up to 30 patient charts are audited
• all required proper documentation is on file; compliance with forms
• activities match what the residents want
• Rx dosages are reduced as possible (not overly medicated)
• discharge planning
• kitchen; food has proper textures
• emergency responses and procedures in place
“2567” is the name of the form that is used by the state to inform each facility what deficiencies were found during their annual survey. It’s mailed approximately one week after the survey concludes. A plan of correction (POC) must be submitted, usually within 10 days of receiving the 2567. On of the advantages of being owned by a larger corporation is that Clara has the assistance of doing a “pre-survey” to prepare for the annual survey, which helps to make sure everything is in place. Last year San Bruno had no corrections and received the top possible rating of 5! As a non-profit organization, where might we find alternative systems of support that a parent corporation provides? How does this staff structure seem to you?