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NO
UR
ISH
TEA
MW
OR
KA
ND
CO
MM
UN
ICAT
ION
Cha
nge
conc
epts
iden
tifie
d:
Expe
ct a
nd s
uppo
rt e
ffect
ive
com
mun
icat
ion
with
sta
ff an
d be
twee
n st
aff.
Be c
lear
in y
our
expe
ctat
ions
—T
he a
rt o
f CO
MM
UN
ICAT
ION
incl
udes
the
art
of
LIST
ENIN
G
Why
–
Red
uce
clin
ical
err
ors
Impr
ove
resi
dent
out
com
es
Impr
ove
proc
ess
outc
omes
Impr
ove
resi
dent
sat
isfa
ctio
n
Incr
ease
fam
ily s
atis
fact
ion
Red
uce
staf
f tur
nove
r
Red
uce
resi
dent
and
fam
ily g
riev
ance
s an
d co
mpl
aint
s
The
y ar
e co
mfo
rtab
le a
skin
g fo
r he
lp, a
dmitt
ing
mis
take
s an
d lim
itatio
ns a
nd t
hey
take
ris
ks.
The
y ta
p in
to o
ne a
noth
er's
skill
s an
d ex
peri
ence
s.T
hey
avoi
d w
astin
g tim
e ta
lkin
g ab
out
the
wro
ng is
sues
and
rev
isiti
ng t
he s
ame
topi
cs o
ver
and
over
aga
in.
The
y m
ake
high
er q
ualit
y de
cisi
ons
and
acco
mpl
ish
mor
e in
less
tim
e an
d fe
wer
re
sour
ces.
The
y ca
n pu
t cr
itica
l top
ics
on t
he t
able
and
hav
e liv
ely
mee
tings
.T
hey
can
alig
n th
e te
am a
roun
d co
mm
on o
bjec
tives
and
goa
ls, a
nd t
hey
can
reta
in
star
em
ploy
ees.
Team
pla
yers
offe
r su
ppor
t an
d en
cour
agem
ent
to e
ach
othe
r.T
hey
keep
the
line
s of
com
mun
icat
ion
open
so
that
oth
ers
can
feel
free
to
shar
e id
eas.
The
yar
eco
mfo
rtab
leas
king
for
help
adm
ittin
gm
ista
kes
and
limita
tions
and
they
Char
acte
rist
icss
off H
ighh
Perf
orm
ingg
Team
s…
COO
MM
UN
ICAT
ION
ISA
FFEC
TED
BY.
..
Pers
onal
Fac
tors
M
ood
/ene
rgy
leve
l / fa
tigue
Bo
dy la
ngua
ge
Envi
ronm
ent/
nois
e /t
empe
ratu
re
Wri
tten
, spo
ken
lang
uage
Gen
erat
iona
l diff
eren
ces
Oth
er d
istr
actio
ns
Whe
ther
we
use
old
tech
nolo
gy o
r ne
w, e
ffect
ive
com
mun
icat
ion
incl
udes
act
ive
liste
ning
, cho
osin
g ou
r w
ords
ca
refu
lly a
nd m
atch
ing
them
with
our
bod
y la
ngua
ge.
LEA
RN
ING
TOC
OM
MU
NIC
ATE
We
are
NO
T b
orn
with
the
abili
ty to
com
mun
icat
e
Taug
ht b
y fa
mily
, fri
ends
, com
mun
ity th
roug
h fo
rmat
ive
year
s
Som
etim
es w
e ne
ed t
o ge
t ri
d of
old
com
mun
icat
ion
styl
es
Som
etim
es y
ou n
eed
to b
ring
mor
e sk
ills
to th
e w
orkp
lace
Act
ion
Pla
n…Im
prov
e yo
ur c
omm
unic
atio
n an
d yo
ur te
amw
ork
will
impr
ove!
EFFE
CTI
VE
CO
MM
UN
ICAT
ION
•M
eani
ng o
f any
com
mun
icat
ion
lies
only
in
wha
t the
rec
eive
rs t
akes
it t
o m
ean,
re
gard
less
of t
he s
ende
r's in
tent
ion
•It
isn’
t wha
t we
mea
n by
our
co
mm
unic
atio
n, b
ut w
hat o
ther
s th
ink
we
mea
n.
MA
RK
TWA
INS
AID
….
•“I
f we
wer
e su
ppos
ed to
talk
mor
e th
an w
e lis
ten,
we
wou
ld h
ave
two
tong
ues
and
one
ear”
•“T
he m
ost b
asic
and
pow
erfu
l way
to c
onne
ct
to a
noth
er p
erso
n is
to li
sten
. Ju
st li
sten
. Pe
rhap
s th
e m
ost i
mpo
rtan
t thi
ng w
e ev
er
give
eac
h ot
her i
s ou
r atte
ntio
n.”
Rac
hel N
aom
i Rem
en
7. O
THER
BES
TPR
AC
TIC
E
Hud
dles
-W
hat
is it
?
A b
rief
5–1
0-m
inut
e di
scus
sion
hel
d as
soo
n as
pos
sibl
e fo
llow
ing
stab
iliza
tion
of
resi
dent
aft
er a
fall.
An
oppo
rtun
ity
for
staf
f to
disc
uss
the
pote
ntia
l cau
se o
f the
fall
and
pote
ntia
l m
isse
d op
port
unit
ies
for
prev
enti
ng t
he fa
ll.
An
oppo
rtun
ity
to d
eter
min
e th
e m
easu
re t
hat
will
be
impl
emen
ted
to p
reve
nt a
re
peat
fall
and
to in
form
sta
ff of
the
res
iden
t w
ith
a hi
gh fa
ll ri
sk s
tatu
s.
If a
new
inte
rven
tion
can
be
dete
rmin
ed a
t th
at t
ime
it is
add
ed t
o th
e ca
re p
lan.
An
oppo
rtun
ity
to le
arn
toge
ther
.
TOP
PER
FOR
MER
S…
Lead
with
a s
ense
of p
urpo
se, r
ecru
it an
d re
tain
the
ri
ght
staf
f, co
nnec
t w
ith r
esid
ents
in a
cel
ebra
tion
of
life
and
nour
ish
team
wor
k an
d co
mm
unic
atio
n. T
hey
help
res
iden
ts a
nd fa
mili
es u
nder
stan
d an
d th
ey u
se
hudd
les
to a
ssis
t w
ith p
ost
asse
ssm
ents
.
OBJE
CTIV
ES
QIP
MO
Bud
get
plan
ning
-H
isto
rica
l A
naly
sis
•C
ensu
s•
Rev
enue
•E
xpen
ses
Bud
get
Dev
elop
men
t•
Rea
listi
c an
d ac
hiev
able
Bud
get
Man
agem
ent
•H
ow o
ften
to
revi
ew?
Bud
get
Impl
emen
tati
on•
Dep
artm
enta
l buy
-in
WHA
TIS
ABU
DGET
?
Sim
ply,
a b
udge
t is t
he e
stim
atio
n of
reve
nues
and
ex
pens
es w
ithin
a sp
ecifi
c tim
e fr
ame.
Th
e bu
dget
is y
our o
rgan
izat
ion’
s ann
ual f
isca
l pla
n th
at
will
incl
ude
finan
cial
goa
ls a
nd o
bjec
tives
, pla
n fo
r re
venu
es a
nd e
xpen
ses,
and
influ
ence
s the
org
aniz
atio
n on
the
best
use
of a
ll re
sour
ces.
WHA
TIS
ABU
DGET
?
Orga
niza
tions
typi
cally
use
two
type
s of b
udge
ts.
Ope
rati
ng B
udge
t: Th
e op
erat
ing
budg
et is
a c
ombi
natio
n of
kno
wn
expe
nses
, exp
ecte
d fu
ture
co
sts,
and
a fo
reca
st o
f rev
enue
s ove
r a p
erio
d of
tim
e, w
hich
is u
sual
ly o
ne
year
.
Capi
tal B
udge
t:Th
e ca
pita
l bud
get i
s a p
roje
ctio
n of
any
maj
or p
urch
ases
whi
ch m
ay in
clud
e eq
uipm
ent,
reno
vatio
ns, l
and,
and
new
cons
truc
tion.
FORE
CAST
ING
Cens
us e
stim
atio
n an
d re
venu
e pl
anni
ng is
usu
ally
the
first
step
in p
repa
ring
a b
udge
t. Ce
nsus
and
pay
er m
ix
will
det
erm
ine
the
reve
nues
(inc
ome)
for a
faci
lity
and
will
giv
e yo
u an
idea
of h
ow m
uch
mon
ey y
ou w
ill h
ave
to
oper
ate
on e
ach
mon
th.
REV
ENU
EPL
AN
NIN
G
Occ
upan
cy
•H
isto
rica
l Dat
a •
Rev
iew
pri
or 1
2-18
mon
ths
Paye
r M
ix
•M
edic
are
Man
aged
Car
e•
Med
icai
d
P
riva
te P
ay
Rat
es
•M
edic
are
Man
aged
Car
e•
Med
icai
d
P
riva
te P
ay
CONT
ROLL
ABLE
VS.
NON-
CONT
ROLL
ABLE
COST
S
Expe
nses
are
cat
egor
ized
as c
ontr
olla
ble
and
non-
cont
rolla
ble
cost
s. A
cont
rolla
ble
cost
(var
iabl
e) is
one
that
is in
fluen
ced
by a
dep
artm
ents
man
ager
. For
exa
mpl
e, la
bor c
osts
, su
pplie
s, tr
avel
, equ
ipm
ent r
enta
ls, e
tc.…
wou
ld b
e co
nsid
ered
cont
rolla
ble
cost
s.Q
IPM
O
CONT
ROLL
ABLE
VS.
NON-
CONT
ROLL
ABLE
COST
S
Expe
nses
are
cat
egor
ized
as c
ontr
olla
ble
and
non-
cont
rolla
ble
cost
s. A
non-
cont
rolla
ble
cost
(fix
ed) i
s one
that
a d
epar
tmen
t m
anag
er h
as n
o in
fluen
ce o
ver.
Rent
, mor
tgag
e, a
nd
insu
ranc
e w
ould
be
non-
cont
rolla
ble
cost
s tha
t rem
ain
the
sam
e no
mat
ter t
he ce
nsus
num
ber.
QIP
MO
CO
ST
CEN
TER
S
Nurs
ing
Mai
nten
ance
/Lau
ndry
//
Ho
usek
eepi
ng
Dini
ngg S
ervi
ces
Acti
viti
es/S
ocia
ll Se
rvic
es/O
ffic
e
Expe
nses
A Co
st C
ente
r cos
t th
at v
arie
s re
lati
ve to
Co
st C
ente
r Act
ivit
y.
Exam
ple::
Cat
hete
rss u
sedd
perr
patie
nt.. C
ostss
incr
easee
ass
patie
ntt vo
lum
ee in
crea
ses.
An o
verh
ead
expe
nse
that
var
ies b
ased
on
som
e m
easu
re o
f ac
tivity
. Ex
ampl
e: N
utri
tion
al
Serv
ices
exp
ense
s in
crea
se
rela
tive
to n
umbe
r of
pat
ient
da
ys.
A Co
st C
ente
r Co
st th
at d
oes
not v
ary
rega
rdle
ss o
f ac
tivity
. Ex
ampl
e: D
irec
tor
of
nurs
ing
cost
doe
s no
t in
crea
se r
egar
dles
s of
vo
lum
e.
An o
verh
ead
expe
nse
that
do
es n
ot v
ary
rega
rdle
ss o
f ac
tivity
. Ex
ampl
e: M
ortg
age
cost
do
not i
ncre
ase
rega
rdle
ss o
f vo
lum
e.
Dire
ctIn
dire
ct
Fixe
d
Vari
able
{
{
Actu
al G
L co
sts a
ssoc
iate
d w
ith co
st ce
nter
bas
ed o
n pa
yrol
l, ac
crua
ls an
d ex
pend
iture
s.
Allo
cate
d to
cost
cent
ers
base
d on
stan
dard
fact
or
such
as s
quar
e foo
tage
, %
of to
tal e
xpen
ses,
hist
oric
al
usag
e.
TOP
DEP
AR
TMEN
TAL
EXPE
NS
ES
Nur
sing
Labo
r
Supp
lies
Equi
p. R
enta
ls
Din
ing
Serv
ices
Raw
Foo
d
Labo
r
Supp
lies
Hou
seke
epin
g/L
aund
ry
Labo
r
Che
mic
als
Line
n
Plan
t
Util
ities
(E
lect
ric)
Labo
r
Supp
lies
DAT
AS
OU
RC
ES
•His
tori
cal D
ata
•Qua
lity
Mea
sure
s•P
BJ•Q
API
•CA
SPER
•Sur
vey
Rep
orts
•Dep
artm
ent M
anag
ers
QIP
MO
DEV
ELO
PIN
GTH
EB
UD
GET
Cen
sus
driv
es t
he b
udge
t. H
avin
g a
real
istic
pro
ject
ion
of c
ensu
s nu
mbe
rs a
nd p
ayer
mix
will
be
criti
cal
whe
n de
velo
ping
the
bud
get.
Per
Patie
nt D
ay (P
PD)
is a
ter
m u
sed
in h
ealth
care
to
dete
rmin
e th
e nu
mbe
r of
pat
ient
day
s (o
ccup
ancy
).
100
Res
iden
ts*3
0 D
ays=
3000
Pat
ient
Day
s
HPP
D is
the
det
erm
inat
ion
of s
taffi
ng n
eeds
beg
ins
by a
sses
sing
the
tota
l hou
rs o
f nur
sing
car
e (o
r ot
her
depa
rtm
ents
) bas
ed o
n ce
nsus
24
hour
per
iod
also
kno
wn
as th
e ho
urs
per
patie
nt d
ay (H
PPD
).
Tota
l Dire
ct C
are
Hou
rs/C
ensu
s=H
PPD
170/
60=2
.83
HPP
D
DEV
ELO
PIN
GTH
EB
UD
GET
•D
epar
tmen
t bu
dget
s ar
e br
oken
dow
n by
spe
cific
“cat
egor
ies”
als
o kn
own
as
budg
et li
ne it
ems.
Budg
et li
ne it
ems
may
be
reve
nues
or
expe
nses
and
can
be
very
bro
ad o
r ve
ry d
etai
led
depe
ndin
g on
the
org
aniz
atio
ns p
refe
renc
e.
CEN
SU
SD
ATA
/REV
ENU
E
•C
ensu
s D
ata
•A
vaila
ble
Bed
s
•M
edic
are
Bed
s
•O
ccup
ancy
Rat
e
•C
ensu
s D
ays
•A
vera
ge C
ensu
s
•Pa
tien
ts b
y Ty
pe
–P
riva
te
–P
riva
te R
CF
–P
riva
te S
peci
al C
are
–P
riva
te B
ehav
iora
l
–P
riva
te N
on-C
erti
fied
•Pa
tien
ts b
y Ty
pe-C
ont.
–M
edic
are
–M
edic
aid
–M
edic
aid
Spec
ial C
are
–M
edic
aid
Beh
avio
ral
–M
edic
aid
Oth
er
–M
enta
l Hea
lth
–M
enta
l Hea
lth
Cer
tifie
d
–V
A -
SNF
–V
A -
ICF
–V
A -
SNF
Cer
tifie
d
–V
A -
ICF
Cer
tifie
d
–R
espi
te C
are
–H
ospi
ce
NU
RS
ING
DEP
AR
TMEN
T
•W
ages
-D
ON
•W
ages
-A
DO
N
•W
ages
-LP
N
•W
ages
-C
NT
•W
ages
-C
MT
•W
ages
–R
N
•W
ages
-MD
S C
oord
inat
or
•W
ages
-Sta
ff D
evel
opm
ent
•Pa
id D
ays
Off
•Pa
yrol
l Tax
es
•Em
ploy
ee B
enef
its
•W
orke
rs’ C
ompe
nsat
ion
Ins
•N
ursin
g Su
pplie
s
•N
on L
egen
d D
rugs
•N
ursi
ng C
onsu
ltant
s
•M
edic
al D
irect
or
•M
edic
al C
onsu
ltant
•U
tiliz
atio
n R
evie
w
•Tr
aini
ng &
Edu
catio
n
•C
NA
Tra
inin
g Ex
pens
e
•Eq
uipm
ent R
enta
l
•Eq
uipm
ent R
epai
r
•Em
ploy
ee R
ecru
itmen
t
•C
ontr
act
LPN
•C
ontr
act
CN
A
•C
ontr
act
CM
T
•C
ontr
act
RN
•M
ed S
heet
s
DIN
ING
SER
VIC
ES
•W
ages
-D
ieta
ry•
Paid
Day
s O
ff•
Payr
oll T
axes
•Em
ploy
ee B
enef
its•
Wor
kers
’ Com
pens
atio
n In
s•
Raw
Foo
d•
Food
Sup
plem
ents
•
Supp
lies
•U
tens
ils
•C
onsu
ltant
•Eq
uipm
ent
Ren
tal
•Eq
uipm
ent
Rep
air
SP
ECIA
LS
ERV
ICES
/AN
CIL
LAR
YS
ERV
ICES
•W
ages
-A
ctiv
ities
•W
ages
-So
cial
Ser
vice
•Pa
id D
ays
Off
•Pa
yrol
l Tax
es
•Em
ploy
ee B
enef
its
•W
orke
rs’ C
ompe
nsat
ion
Ins
•A
ctiv
ities
Sup
plie
s/C
rafts
•So
cial
Ser
vice
Sup
plie
s
•M
edic
al R
ecor
ds C
onsu
ltant
•So
cial
Ser
vice
Con
sulta
nt
•Ph
arm
acy
Con
sulta
nt
•O
ther
Con
trac
t Se
rvic
es
•M
isc.
Res
iden
t Ex
pens
e
•Eq
uipm
ent
Ren
tal
•W
ages
-R
esto
rativ
e A
ide
•Ba
rber
& B
eaut
y Ex
pens
e
•Ph
ysic
ian
Fees
•Pa
id D
ays
Off
•Pa
yrol
l Tax
es
•Em
ploy
ee B
enef
its
•W
orke
rs’ C
ompe
nsat
ion
Ins
•Fl
u Sh
ots
•A
ncill
ary
Expe
nse
LAU
ND
RY/
HO
US
EKEE
PIN
G
•W
ages
-La
undr
y
•Pa
id D
ays
Off
•Pa
yrol
l Tax
es
•Em
ploy
ee B
enef
its
•W
orke
rs' C
ompe
nsat
ion
Ins
•Li
nen
& B
eddi
ng
•Su
pplie
s
•C
ontr
act S
ervi
ce
•Eq
uipm
ent R
enta
l
•Eq
uipm
ent R
epai
r
•W
ages
-H
ouse
keep
ing
•Pa
id D
ays
Off
•Pa
yrol
l Tax
es
•Em
ploy
ee B
enef
its
•W
orke
rs' C
ompe
nsat
ion
Ins
•Su
pplie
s
•C
ontr
act S
ervi
ces
•Eq
uipm
ent R
epai
r
PLA
NT
(MA
INTE
NA
NC
E)
•W
ages
-Pl
ant
•Pa
id D
ays
Off
•Pa
yrol
l Tax
es
•Em
ploy
ee B
enef
its
•W
orke
rs‘ C
ompe
nsat
ion
Ins
•Li
abili
ty In
sura
nce
•G
as/F
uel B
uild
ing
•El
ectr
icity
•C
able
Tele
visi
on
•W
ater
/Sew
er
•Sa
nita
tion/
Tras
h
•A
larm
-Sp
rink
ler
•Se
curi
ty S
ervi
ces
•M
aint
enan
ce S
uppl
ies
•R
epai
r an
d M
aint
.
•Eq
uipm
ent M
aint
enan
ce
•G
roun
ds M
aint
enan
ce
•D
epre
ciat
ion
-Veh
icle
•G
ain/
Loss
-A
sset
Dis
posi
tion
AD
MIN
ISTR
ATIO
N
•W
ages
-M
edic
al R
ecor
ds
•W
ages
-Be
autic
ian
•M
edic
al R
ecor
ds S
uppl
ies
•R
esid
ent V
ehic
le E
xpen
se
•W
ages
-Adm
inis
trat
ors
•W
ages
-Offi
ce
•Pa
id D
ays
Off
•Pa
yrol
l Tax
es
•Em
ploy
ee H
ealth
Insu
ranc
e
•W
orkm
en's
Com
pens
atio
n
•Em
ploy
ee B
enef
its
•R
ecru
itmen
t Adv
ertis
ing
•Tr
aini
ng a
nd E
duca
tion
•Tr
avel
-O
ther
Tha
n M
eals
•Tr
avel
-M
eals
Onl
y
•O
ffice
Sup
plie
s
•Pr
intin
g
•D
ues
and
Subs
crip
tions
•Po
stag
e an
d Fr
eigh
t
•Te
leph
one/
Com
mun
icat
ions
•Ye
llow
Pag
e A
dver
tisin
g
•Pr
omot
ion/
Publ
ic R
elat
ions
•Le
gal F
ees
•Li
cens
es a
nd F
ees
•Pr
ofes
sion
al F
ee's
•Eq
uipm
ent
Ren
tal
•Eq
uipm
ent
Rep
air
•Ba
d D
ebts
•Pr
ovid
er T
ax
•O
ther
Tax
REA
LIS
TIC
APP
RO
AC
H
BUD
GET
Rea
listi
c
Iden
tify Pl
an
Rec
ogni
tion
Qua
lity
Car
e
Effic
ientIden
tify
A
reas
of
Impr
ovem
ent
DEP
AR
TMEN
TAL
BU
Y-IN
•Sh
are
the
DR
AFT
budg
et w
ith y
our
team
. Inv
olvi
ng y
our
team
and
hel
ping
th
em u
nder
stan
d th
e bu
dget
ing
proc
ess
crea
tes
a se
nse
of s
hare
d ow
ners
hip
and
enco
urag
es y
our
empl
oyee
s to
find
cre
ativ
e w
ays
to m
anag
e ex
pens
es.
INPU
TA
ND
FEED
BA
CK
•In
put
–A
sk fo
r de
part
men
t lea
ders
inpu
t whe
n pl
anni
ng a
nd p
repa
ring
the
budg
et.
–A
sk t
hem
if t
hey
have
a “
wis
h lis
t”.
–D
o th
ey n
eed
incr
ease
in s
taffi
ng h
ours
or
wag
es, s
uppl
ies,
or o
ther
bud
get
line
item
?
•Fe
edba
ck–
Let t
hem
rev
iew
the
bud
get
if po
ssib
le.
–A
sk t
hem
if it
is a
ttai
nabl
e/re
alis
tic.
BU
DG
ETIM
PLEM
ENTA
TIO
N
•O
nce
the
budg
et is
fina
lized
and
has
bee
n re
view
ed, i
t m
ust
be im
plem
ente
d.
–R
evie
w t
he fi
nal b
udge
t with
dep
artm
ent m
anag
ers
–Pr
ovid
e de
part
men
t man
ager
s w
ith th
eir
resp
ectiv
e de
part
men
ts P
PD’s
–C
lear
ly c
omm
unic
ate
expe
ctat
ions
and
ram
ifica
tions
in r
egar
ds t
o va
rian
ces “
Thi
s is
wha
t ha
ppen
s if…
”
MA
NA
GIN
GTH
EB
UD
GET
•H
ow o
ften
to r
evie
w–
Staf
fing
shou
ld b
e re
view
ed d
aily
to
effe
ctiv
ely
man
age
a st
affin
g H
PPD
.
–R
evie
w p
ayro
ll re
gula
rly-
Keep
an
eye
on o
vert
ime!
–W
eekl
y de
part
men
tal c
heck
book
s ak
a sp
endd
own
shee
t.
–R
evie
w e
xpen
ses
mid
-mon
th to
ens
ure
atta
inm
ent o
f tar
gete
d go
als.
–R
evie
w fi
nanc
ial s
tate
men
ts a
s so
on a
s po
ssib
le t
o en
sure
acc
urac
y an
d to
look
for
targ
et
area
s.
MA
NA
GIN
GTH
EB
UD
GET
Act
ual v
s. Bu
dget
Rev
iew
with
D
epar
tmen
t M
anag
ers
Vari
ance
Rep
orts
. W
hy t
he
diffe
renc
e?
Act
ion
Plan
s
H
ow c
an y
ou
redu
ce c
ost?
Don
’t sw
eat
the
smal
l stu
ff. D
o be
tter
nex
t m
onth
!
REV
IEW
POLI
CIE
S
•Fi
scal
pol
icie
s an
d pr
oced
ures
–Is
cen
sus
data
cor
rect
?
–W
hat
is t
he p
olic
y fo
r ac
coun
ts r
ecei
vabl
e?
•Is
bill
ing
bein
g do
ne t
imel
y?
•Is
bill
ing
accu
rate
?
•Is
rev
enue
col
lect
ed t
imel
y?
•M
edic
aid/
Med
icar
e bi
lling
com
plet
e an
d ac
cura
te?
–W
hat
is t
he p
olic
y fo
r ac
coun
ts p
ayab
le?
•W
ho a
ppro
ves
expe
nditu
res?
•W
ho c
odes
invo
ices
?
•Fi
nanc
ial R
epor
ts–
Dep
artm
enta
l Che
ck R
egis
ters
–M
anag
emen
t Rep
ort/
Stat
emen
t of
Ope
ratio
ns
–Ba
lanc
e Sh
eet
–In
teri
m A
ged
Ana
lysi
s (A
/R A
ging
Rep
ort)
DIR
ECTO
RO
FN
UR
SIN
G1Q
IPM
O
Any
reg
iste
red
nurs
e w
ho is
wor
king
as
the
Dire
ctor
of N
ursi
ng o
f a S
kille
d N
ursi
ng F
acili
ty (S
NF)
lice
nsed
by
the
stat
e an
d/or
cer
tifie
d to
be
a M
edic
are/
Med
icai
d pr
ovid
er s
houl
d ha
ve t
he fo
llow
ing
job
skill
s an
d pe
rfor
m th
e fo
llow
ing
func
tions
. The
iden
tific
atio
n of
the
se jo
b fu
nctio
ns/s
kills
is b
ased
on
the
assu
mpt
ions
that
:•
the
patie
nt/r
esid
ent p
opul
atio
n is
frai
l, co
mpl
ex in
nat
ure
and
expe
rien
ces
man
y ill
ness
es a
nd d
ysfu
nctio
ns;
•it
is im
pera
tive
to id
entif
y th
e es
sent
ial m
ix o
f nur
sing
clin
ical
ski
lls;
man
agem
ent a
nd le
ader
ship
ski
lls; a
nd k
now
ledg
e of
fisc
al m
anag
emen
t, et
hica
l pri
ncip
les,
stat
e an
d fe
dera
l reg
ulat
ory
requ
irem
ents
and
st
anda
rds
of p
rofe
ssio
nal n
ursi
ng p
ract
ice
that
the
Dire
ctor
of N
ursi
ng
mus
t pos
sess
in o
rder
to
deve
lop
and
impl
emen
t a s
yste
m o
f nur
sing
ca
re t
hat m
eets
the
nee
ds o
f the
faci
lity’s
pat
ient
/res
iden
t pop
ulat
ion.
MED
ICA
LD
IREC
TOR
•T
he M
edic
al D
irect
or is
res
pons
ible
to
the
owne
r/go
vern
ing
body
/lice
nsed
ad
min
istr
ator
•T
he M
edic
al D
irect
or d
efin
es t
he
scop
e of
med
ical
ser
vice
s•
The
Med
ical
Dire
ctor
ens
ures
ph
ysic
ian
acco
unta
bilit
y. T
he M
edic
al
Dire
ctor
impl
emen
ts a
nd e
nfor
ces
polic
ies
and
proc
edur
es t
hat
cove
r es
sent
ial p
hysi
cian
res
pons
ibili
ties
to
the
patie
nts/
resi
dent
s an
d th
e fa
cilit
y, in
clud
ing:
•T
he M
edic
al D
irect
or p
artic
ipat
es a
ctiv
ely
in t
he fa
cilit
y’s q
ualit
y im
prov
emen
t pr
oces
s. •
The
Med
ical
Dire
ctor
hel
ps e
stab
lish
and
mai
ntai
n su
rvei
llanc
e of
the
hea
lth s
tatu
s of
em
ploy
ees
•T
he M
edic
al D
irect
or p
erfo
rms
othe
r es
sent
ial d
utie
s re
late
d to
clin
ical
car
e an
d ph
ysic
ian
prac
tices
and
the
pro
visi
on a
nd
qual
ity o
f car
e.•
The
Med
ical
Dire
ctor
pro
vide
s Pr
actit
ione
r ov
ersi
ght
FOO
DA
ND
DIN
ING
SER
VIC
ESM
AN
AG
ER
1QIP
MO
Hav
e th
e kn
owle
dge,
ski
lls a
nd a
bilit
y to
:•
Ass
essi
ng th
e nu
triti
onal
nee
ds o
f res
iden
ts;
•D
evel
opin
g an
d ev
alua
ting
regu
lar
and
ther
apeu
tic d
iets
, inc
ludi
ng t
extu
re o
f fo
ods
and
liqui
ds, t
o m
eet
the
spec
ializ
ed n
eeds
of r
esid
ents
;•
Dev
elop
ing
and
impl
emen
ting
pers
on c
ente
red
educ
atio
n pr
ogra
ms
invo
lvin
g fo
od a
nd n
utri
tion
serv
ices
for
all f
acili
ty s
taff;
•O
vers
eein
g th
e bu
dget
and
pur
chas
ing
of fo
od a
nd s
uppl
ies,
and
food
pr
epar
atio
n, s
ervi
ce a
nd s
tora
ge; a
nd,
•R
esou
rces
:•
Cer
tifyi
ng B
oard
for
Die
tary
Man
ager
s h
ttps
://w
ww
.cbd
mon
line.
org/
•M
isso
uri F
ood
Cod
e ht
tps:
//hea
lth.m
o.go
v/sa
fety
/food
safe
ty/p
df/m
isso
urifo
odco
de.p
df
DIE
TIC
IAN
•A
sses
s nu
triti
onal
nee
ds, d
iet
rest
rict
ions
and
cur
rent
hea
lth p
lans
to
deve
lop
and
impl
emen
t di
etar
y-ca
re p
lans
and
pro
vide
nut
ritio
nal c
ouns
elin
g.•
App
rove
pat
ient
men
us a
nd n
utri
tiona
l sup
plem
ents
.•
Adv
ise
patie
nts
and
thei
r fa
mili
es o
n nu
triti
onal
pri
ncip
les,
diet
ary
plan
s, di
et m
odifi
catio
ns a
nd fo
od
sele
ctio
n an
d pr
epar
atio
n.•
Prov
ide
nutr
ition
al a
sses
smen
ts p
er fa
cilit
y po
licy
and
regu
latio
n.•
Rev
iew
and
app
rove
men
us d
evel
oped
by
the
faci
lity.
•C
ouns
el in
divi
dual
s an
d gr
oups
on
basi
c ru
les
of g
ood
nutr
ition
, hea
lthy
eatin
g ha
bits
and
nut
ritio
n m
onito
ring
to
impr
ove
thei
r qu
ality
of l
ife.
•C
onsu
lt w
ith p
hysi
cian
s an
d he
alth
car
e pe
rson
nel t
o de
term
ine
nutr
ition
al n
eeds
and
die
t re
stri
ctio
ns o
f pat
ient
.•
Mon
itor
food
ser
vice
ope
ratio
ns t
o en
sure
com
plia
nce
to n
utri
tiona
l, sa
fety
, san
itatio
n an
d qu
ality
st
anda
rds
as p
er t
he c
ount
y, st
ate
and
fede
ral g
uide
lines
.