Requirements of Participation Toolkits

Phase 1   |   Phase 2   |   Phase 3

Phase 1

Freedom from Abuse, Neglect, and Exploitation
Abuse Policy 
Abuse RoP Checklist
Abuse Training Plan
Abuse, Neglect, and Exploitation Binder
Answer Key – Quiz for Abuse
Freedom from Abuse Education for Direct Caregiver (PowerPoint)

Pharmacy Services (§483.45)
Drug Regimen Review (§483.45(c)

Drug Regimen Review Policy
Drug Regimen Review RoP Checklist
Drug Regimen Training Plan for Licensed Clinical Staff
Drug Regimen Review Audit
Drug Regimen Review Presentation 
Post Test – Drug Regimen Review
Post Test Answer Key – Drug Regimen Review

Quality of Care and Quality of Life (§483.25)
Bed Rail Use and Bed Inspection

Bed Inspection Policy 
Bed Rail Use Policy 
Bed Rail Assessment
Bed Rail Data Collection
Training Plan – Bed Rail and Bed Inspection
Quiz – Bed Rail and Bed Inspection
Answer Key – Quiz for Bed Rail and Bed Inspection
Bed Inspection and Rail RoP Checklist
Bed Rail Use and Bed Inspection Training

Resident Rights (§483.10)
Grievance (§483.10(j)

Grievance Policy
Grievance Policy and Procedure Checklist 
Grievance Complaint Log
Training Plan – Grievance Policy and Procedure – All Staff 
Post Test – Grievance Policy and Procedure 
Post Test Answer Key – Grievance Policy and Procedure
Grievance Policy and Procedure Training for All Staff

Visitation Rights (§483.10(f)(4)
Visitation Right Policy 
Visitation Rights RoP Checklist 
Training Plan – Resident Visitation Rights
Post Test – Resident Visitation Rights 
Post Test Answer Key – Resident Visitation Rights 
Visitation Rights Presentation

Administration (§483.70)
Developing Your Facility Assessment: Essential Components 
RoP – Administration Checklist 

Advanced Directives (§483.10(g)(12)
Tool-Advance Directive Policy and Procedure Checklist
Advance Directives Policy and Procedure
Audit for Advance Directives
Advance Directives P&P Training Plan
Post Test- Advance Directives
Post Test- Answer Key Advance Directives
Advanced Directives Presentation

Behavioral Health (§483.40)
Mood and Behavior
Mood and Behavior Policy and Procedure Checklist
Resident Mood and Behavior Policy and Procedure
Mood and Behavior Assessment Log
Audit Form – Mood and Behavior Program Tracking
Audit Form – Behavior Assessment Tool for IDT Data Collection
Social Services Initial Assessment
Mood and Behavior P&P Training Plan
Post Test- Resident Mood and Behavior
Post Test Answer Key- Resident Mood and Behavior
Mood and Behavior Presentation – Training

Food and Nutrition (§483.60(i)(3)
Food Safety
Food Safety Requirements Policy and Procedure
Checklist Tool – Food Safety Requirement
Audit Form – Food Items Brought Into Facility
Food Safety Presentation Training Plan
Food Safety Requirements Presentation Training for All Staff
Post Test – Food Safety
Post Test Answer Key- Food Safety

Resident Assessment (§483.20)
 IL PASARR Policy and Procedure
PASARR RoP Checklist
PASARR Tracking Log
PASARR P&P Training Plan
Post Test – PASARR
Post Test Answer Key – PASARR
PASARR Training Presentation

Training Requirements (§483.95)
Requirements of Participation -Training Requirements Checklist

Admissions, Transfers, and Discharge Rights (§483.15)

Bedhold and Return
Bed Hold and Return to Facility RoP checklist
Bed Hold and Return to the Facility P&P
Audit Form – Bed Hold and Return to Facility Notice Tracking
Bed Hold PP Training Plan
Post Test- Bed Hold and Return P&P
Answer Key Post Test- Bed Hold and Return
Bed Hold P&P Training Presentation

Discharge Summary
Tool-Discharge Summary Policy and Procedure Checklist 
Discharge Summary Policy and Procedure
Audit Form for Discharge Summary
Discharge Summary P&P Training Plan
Post Test- Discharge Summary
Answer Key Post Test- Discharge Summary
Discharge Summary Presentation

Room Change Policy
Room Change P&P Checklist 
Room Change P&P
Room Change PP Training Plan
Pre and Post Test- Room Change
Answer Key Post Test- Room Change
Audit Form – Room Change Log
Room Change P&P Training

Transfer Discharge Process
Transfer Discharge P&P Checklist 
IL Transfer Discharge Policy and Procedure
Transfer Discharge P&P Training Plan
Transfer Discharge Sample Notices
Post Test- Transfer Discharge Process
Post Test Answer Key- Transfer Discharge Process
Transfer Discharge Policy and Procedure Training

Comprehensive Resident Centered Care Plans (§483.21)
Discharge Care Plan
Tool-Discharge Care Plan Policy and Procedure Checklist
Discharge Care Plan Policy and Procedure
Medication Discharge Education Tool
Post Discharge Follow Up Log
Discharge Planning and Referral Form
Discharge Care Plan PP Training Plan
Post Test- Discharge Care Plan
Post Test Answer Key Discharge Care Plan
Discharge Care Plan Presentation Training

Dental Services (§483.55(a)
Tool-Dentures Policy and Procedure Checklist
Dentures Policy and Procedure
Missing or Broken Dentures QAPI Action Plan
Dentures P&P Training Plan
Post Test- Dentures
Post Test Answer Key- Dentures
Dentures Presentation

Nursing Services (§483.35)
Building Nurse Competency
Tool-Nursing Services Building Competency Evaluations Policy and Procedure Checklist
Nursing Services Competency Evaluations Policy and Procedure
Tracking Log for CNA Education and Evaluation Competency
Licensed Nurse Competency Checklist
Nurse Aide Skills Observation
Nursing Services Competency P&P Training Plan
Post Test- Nursing Services Competency Evaluations
Post Test Answer Key – Nursing Services Competency Evaluations
Nursing Services Competency Evaluations Presentation

Phase 2

Facility Wide Risk Assessment
CMS Facility Assessment Tool
SAMPLE Facility Wide Resource Assessment Implementation

Full Toolkit

1 – Overview
2 – Tool-Facility Assessment Checklist
3 – Data – Importance as it relates to Facility Assessment
4 – Facility Assessment Policy and Procedure
5.1 – Tool-Facility Assessment Checklist 
5.2 – Tools Included in the Template Section
5.3 – Facility Assessment Template with Instructions
5.4a – Facility Assessment Template SAMPLE
5.4b – Facility Assessment Template WORKING VERSION
5.5 – QIO Facility_Assessment_2017_08_18_Final
6 – Toolkit Instructions How to Use the Toolkit 
7 – Toolkit Section Insight and Overview
8.1a – Facility Resident Population Probing Questions Template
8.1b – Facility Resident Population Intent Description and Guide
8.2 – Tools Included in the Facility Resident Population Section
8.3 – INTERACT Nursing_Home_Capabilities_List SAMPLE
8.4 – CMS 672 05 2012 form and directions
8.5 – CMS CASPER Reporting MDS Provider User’s Guide-Section 1
8.6 – CMS Matrix with Instructions
8.7 – SWOT Template Summary
8.8 – Facility Assessement Summary Worksheet – Resident Community Population
9.1 – Personnel Resources Intent Information and Guide
9.1a – Tools Included in the Personnel Resources Section
9.2 – Comprehensive Facility Personnel Resources Workbook
9.3 – Facility Personnel Non Detailed (excel)
9.4 – EXAMPLE Staffing Analysis blank
9.5 – Nutrition Services Personnel Workbook – DRAFT TEMPLATE
9.6 – Facility Assessment Staffing Tool to Meet Resident Needs Sample
9.7 – LN Competency Assessment Tool Sample
9.8 – CMS 671 form and directions
9.9 – CMS-20062 Sufficient and Competent Staff
9.10 – Peri Care Return Demonstration Tool EXAMPLE
9.11 – Facility Assessment Summary Worksheet – Facility Personnel
9.12 – Facility Assessment Summary Worksheet – Nutrition Services
9.13 – Facility Assessment Summary Worksheet – Nursing Services
10.1 – Training Program Evaluation Intent and Overview
10.2 – Facility Assessment Summary Worksheet – Training Program Evaluation
11.1 – Infection Control Intent and Guidance
11.2 – Tools Included in the Infection Control Section
11.3 – Monthly Infection Control Log
11.4 – Employee Infection Line List
11.5 – Facility Assessment Summary Worksheet – Infection Control
12.1 – Policy and Procedure Revision Intent and Guidance
12.2 – Tools Included in the Policy and Procedure Revision Section
12.3 – Policy and Procedure Review Checklist (excel file)
12.4 – Policies and Procedures Required in RoP
12.5 – Facility Assessment Summary Worksheet Policy and Procedure
13.1 – Facility and Community Risk Assessment Intent and Overview
13.2 – Tools Included in the Facility Community Risk Section
13.3 – HVA Template and Resources
13.4 – Survey-and-Cert-Letter-17-29
13.5 – Emergency Preparedness Checklist
13.6 – CMS General-Resources-for-Emergency-Preparedness
13.6d – Facility-Transfer-Agreement-Example
13.7  – Surveyor-Tool-EP-Tags for Post Acute Care (excel file)
13.8 – By-Name-by-State-Healthcare-Coalitions for E Prep
13.9 – Facility Assessment Summary Worksheet Facility and Community Risk
14.1 – Resources – Physical Plant and Equipment Intent and Overview
14.2 – Tools Included in the Physical Plant Equipment and Other Services Section
14.3 – Physical Plant Equipment Supplies and Services Worksheet (excel file)
14.4 – Facility Assessment Summary Worksheet Physical Plant
14.5 – Facility Assessment Summary Worksheet Equipment Summary 
14.6 – Facility Assessment Summary Worksheet Other Services 
15.1 – Resource – Health Information Technology Intent and Overview
15.2 – HIT Tools Included in the Section
15.3 – HIT Evaluation Worksheet (excel file)
15.4 – Facility Assessment Summary Worksheet HIT 
16.1 – Resource – Third Party Agreements Intent and Overview
16.2 – Tools Included in the Third Party Agreement Section
16.3 – Third Party Agreements (excel file)
16.4 – Facility Assessment Summary Worksheet Third Party Agreements 
17.1 – Intent and Overview QAPI
17.2 – QAPI Tools Included in the Section
17.3 – Sample QAPI Plan
17.4 – QAPI Five Elements
17.5 – QAPI Plan Guide
17.6 – Process Tool Framework
17.7 – Root Cause Analysis Worksheet (excel file)
17.8 – QAPI At a Glance
17.9 Facility Assessment Summary Worksheet – QAPI
18.1 Training Plan Facility Assessment Overview
18.2 Tools Included in the Training Plan Presentation Post Test Section
18.3 – FWRA Presentation (PowerPoint)
18.4 – Post Test
18.5 Post Test Answer Key 
19.1-Tool-Antibiotic Stewardship RoP Checklist
19.1c – Acronyms
19.2a – Survey and Cert Memo Appendix
19.2b – Survey and Cert Memo Appendix Phase-2
19.3a – List of Revised FTags
19.4a – F-Tag-Crosswalk (excel file)
19.5 – Additional Resource Links
19.6 – Facility Assessment F838 Crosswalk

Antibiotic Stewardship
Antibiotic Stewardship RoP Checklist
Antibiotic Stewardship Policy and Procedure
AHRQ Tools for Nurses to Evaluate and Communicate Infection Criteria
Criteria for Infection Report Form Gastrointestinal (GI) Tract Infections. 2017
Criteria for Infection Report Form Respiratory Tract Infections 2017
Criteria for Infection Report Form Skin, Soft Tissue, and Mucosal Infections 2017
Criteria for Infection Report Form Urinary Tract Infections (UTIs)
Monthly Infection Control Log
Individual Antibiotic Use Tool
Antibiotic Stewardship PP Training Plan
Post Test- Antibiotic Stewardship
Post Test Answer Key- Antibiotic Stewardship
Practitioner Education Sheet
Antibiotic Use Audit Tool
Antibiotic Stewardship (PowerPoint)

Baseline Care Plans
Baseline Care Plan RoP Checklist
Baseline Care Plan Policy and Procedure
Baseline Care Plan
Baseline Care Plan P and P Training Plan
Post Test- Baseline Care Plan 
Post Test Answer Key- Baseline Care Plan
Baseline Care Plan Audit Tool
Baseline Care Plan (PowerPoint) 

Emergency Preparedness
Emergency Preparedness Binder
CMS Emergency Preparedness Rule for Toolkit (PowerPoint)
Surveyor-Tool-EP-Tags for Post Acute Care (Excel File)
Implementation Guide For Emergency Preparedness
Emergency Prepardeness Toolkit – Overview Risk Assessment and Planning
Emergency Prepardeness Toolkit – Risk Assessment and Planning 
Emergency Prepardeness Toolkit – Sample Emergency Plan 
Emergency Prepardeness Toolkit – Policies and Procedures
Emergency Prepardeness Toolkit – Incident Command System Healthcare
Emergency Prepardeness Toolkit – Communication 
Emergency Prepardeness Toolkit – Training and Testing
Training Plan for Emergency Prepardeness
CMS Emergency Prepardeness Rule for Toolkit
Emergency Prepardeness – CMS NFPA Crosswalk
Emergency Prepardeness Toolkit Resources
Surveyor Tool -EP-Tags for Post Acute Care
By Name – By State Healthcare Coalitions

Infection Prevention

Infection Control RoP Checklist
Infection Control Policy and Procedure
Hand Hygiene Procedure
Influenza Vaccine Policy and Procedure
Post Test- Infection Control
Post Test Answer Key- Infection Control
Infection Control (PowerPoint)
Infection Control Program Audit
Monthly Infection Control Log
Employee Infection Line List

Medication Management
Tool-Medication Management RoP Checklist
Medication Administration QuickPath
Medication Management Policy and Procedure 
Checklist for Medication Management and Policies
Medication Management PandP Training Plan 
Post Test- Medication Management 
Post Test Answer Key- Medication Management
Medication Administration Audit
Medication Management (PowerPoint)

Psychotropic Medication
Tool-Psychotropic Drug Use RoP Checklist
Psychoactive Medication Informed Consent Form 5.2013
Psychotropic Drugs Policy and Procedure
Psychotropic Drug Assessment 8.2017
Sleep Assessment 8.2017 
Sleep Study 
PHS Behavior and Mood Assessment Log
Psychotropic drug use care plan
Psychotropic Drugs P and P Training Plan 
Post Test- Psychotropic Drugs 
Post Test- Psychotropic Drugs 
Psychotropic Drugs (PowerPoint)

QAPI Binder
Post Test with answers – QAPI
QAPI Training with Speakers Notes (PowerPoint)
Root Cause Analysis Worksheet (Excel file)

Resident Rights
Resident Rights Binder
Post Test-Answer Key Resident Rights Accommodation of Needs. Homelike Environment. Resident and Family Groups
Resident Rights. Accommodation Needs. Homelike Environment. Resident Family Groups (PowerPoint)

Self-Administration of Medicines
Tool-Self Administration of Medications RoP Checklist 
Self Administration of Medications Policy and Procedure 
Self admin assessment tool
Self admin resp tx- nebs 
Self Administration of Medication Audit Tool 
Self Administratin of Medication Policy signature page 
Self Administration of Medications PandP Training Plan 
Post Test- Self Administration of Medications 
Post Test Answer Key- Self Administration of Medications 
Self Administration of Medication (PowerPoint)

Smoking Policy
Tool-Smoking RoP Checklist 
Smoking Policy and Procedure 
Smoking Evaluation Tool 
Smoking PP Training Plan 
Post Test- Smoking 
Post Test Answer Key- Smoking 
Smoking (PowerPoint)
Staff Competency
Staff Competency Binder
Post Test Answer Key – Nursing Services Competency Evaluations
Nursing Services and Interdisciplinary Team Competency Evaluations (PowerPoint)

Transfer, Notice and Discharge
Transfer, Notice and Discharge Binder
Post Test Answer Key- Transfer Discharge Process
Transfer Discharge PP Training (PowerPoint)

HHA CoP Regulatory Checklist
Emergency Preparedness Policy and Procedure Checklist
Governance-Administration Policy and Procedure Checklist
HCBS Summary of Major Regulatory, Quality and Payment Initiatives 
Patient Record Policy and Procedure and Checklist
Patient’s Rights Checklist
Personnel Requirements Checklist

Phase 3

Foundations of Trauma – Informed Care; Training for Senior Staff and Board Leaders (Resilience for All Ages)
Foundations of Trauma – Informed Care; Training for All Staff (Resilience for All Ages)
What is Trauma Informed Care? (Resilience for All Ages)
An Introductory Primer (Resilience for All Ages)
User Guide (Resilience for All Ages)