National Exam Quick Review Sheet - Answers

NURSING HOME ADMINISTRATOR LICENSURE EXAM REVIEW COURSE

National Exam ◘ MODULE 8

referencsection Final Comprehensive Test

Examination  Answer key Answer Sheet

Stan Mucinic, LNHA

LEGAL NOTICES

Final Exam Answer Key Copyright © 2005-2011 by Stan Mucinic. All rights reserved. 1 of 38 Students enrolled in the “National Nursing Home Administrator Licensing Course” are purchasing the professional knowledge of the instructor to assist the student to prepare for the national licensure exam administered by the National Association of Boards of Examiners (NAB). This is a 5-week intensive independent study program designed to provide students a unique personalized and structured learning environment where progress is monitored by the instructor through email to help students maintain focus and complete scheduled assignments timely. THE INSTRUCTOR MAKES NO EXPRESS OR IMPLIED WARRANTY OR REPRESENTATION OF ANY KIND THAT COMPLETION OF THIS OR ANY LICENSURE PREPARATION COURSE OFFERED BY INSTRUCTOR WILL GUARANTEE A PASSING SCORE ON ANY LICENSING EXAM. An individual’s ultimate success in passing the licensure exam is dependent on an individual’s professional experience, academic preparation, and the time and energy the individual can commit to exam study and preparation. A student’s work schedule or other commitments may require more time to prepare for an exam than allotted. The student is solely responsible for licensing exam registration/testing and retesting fees.

Contact Information You may contact Stan Mucinic by email at [email protected] with any questions.

1 Per the ADA the range for a hearing compatible phone is 12 – 18 decibels

2 Lip Smacking and uncontrolled facial gestures

3 Chronic Obstructive Pulmonary Disease

4 Congestive Heart Failure

5 A blockage of the arteries is arteriosclerosis

6 Hardening of the artery walls is called atherosclerosis

7 Trans Ischemic Attack

8 A TIA is a stroke)

9 Electro Kardio (cardio) Gram (measures heart activity)

10 Cerebral Vascular Accident

11 A CVA is a stroke

12 A physiatrist is a physician who works with the musculoskeletal system and works closely with the physical therapists

13 OBRA 1987 does not specify any requirement that a resident must have a bath

14 OBRA 1987 does not specify any requirement that a resident must have a shower – it is assumed that you will keep the resident clean

15 Gerontology is the study of the aging process

16 A gerontologist is a person who studies the aging process

17 The 4 stages of a decubitis sore: 1. redness/warm to touch 2. a blister that opens with possible pus 3. Tissue loss of the upper and lower layers of the epidermis 4. tissue loss down to the bone

18 Class 1 deficiency – no harm, no potential for harm, Class 2 deficiency – no harm but potential for harm (they could not identify any residents actually harmed), Class 3 deficiency – Harm but not immediate jeopardy and Class 4 deficiency is Harm and immediate jeopardy

Class 1 – A – isolated B- patterned C – Widespread Class 2 - D – isolated E- pattered F- Widespread Class 3 - G – isolated H – patterned I- widespread Class 4 - J - isolated K – Pattered L – Widespread

20 A myocardial infarct is a heart attack

21 The first stage of the annual survey is OFFSITE PREPARATION where the surveyors review the facility’s prior surveys, incident reports, ombudsman reports, quality indicators and other information from OSCAR

22 In the EXIT CONFERENCE the survey team sits down with staff and discloses the results of the annual survey

23 In the ENTRANCE CONFERENCE the team leader sits down with the facility staff and discusses the survey about to take place and what records they will need to see

24 The FACILITY TOUR involves the survey team walking around the facility and identifying the layout of the facility

25 SAMPLE SELECTION involves the survey team identifying which people they want to talk to and records they want to review

26 INFORMATION ANALYSIS involves identifying which deficiencies, if any, the facility will cited for

27 INFORMATION GATHERING involves the survey team observing residents and staff, taking notes, interviewing the resident council and other residents

28 What is the correct order of the steps of an annual survey

1. offsite preparation 2. entrance conference 3. sample selection 4. information gathering 5. information analysis 6. exit interview

29 The facility must receive a report of the results of a compliance survey within 10 days of the exit interview

30 A facility must submit a plan of correction for any alleged deficiencies within 10 days from receipt of the report of deficiencies

31 Your date certain for re-survey ( the earliest the survey team can return to verify the facility corrected all cited deficiencies) is 30 days from the date the survey team exited the facility

32 You will receive a form 2567 that will detail any deficiencies found during an annual or complaint survey

Final Exam Answer Key Copyright © 2005-2011 by Stan Mucinic. All rights reserved. 4 of 38 33 You have 20 days from the date you receive the 2567 to file a request for administrative hearing to dispute a citation

34 An IDR is an informal dispute resolution (i.e. sending a letter to the survey team leader or requesting a face to face meeting with the local licensing office to dispute a citation)

35 An FDR is a formal dispute resolution which involves requesting a hearing before an administrative law judge within 20 days of receipt of the 2567

36 OSCAR stands for Online Survey and Certification Reporting

37 The CMS created OSCAR and it is a national base that collects all of the information collected from the MDS data entered into the system from each of the 17,000 nursing homes in the nation

38 The survey team will print off:

1) the facility profile report 2) the facility characteristics report 3) resident level summary

from OSCAR before they enter your facility

39 A standard survey is an annual survey

40 An abbreviated standard survey is a complaint survey

41 A extended survey would be imposed if the surveyors found substandard care during an annual survey

42 A partial extended survey would be imposed if the surveyors find substandard care during a complaint survey

43 A re-survey is done to verify a facility corrected any cited deficiencies where the facility was cited for no more than a level F citation

44 A psychiatrist is a physician who specializes in mental disorders

45 An MDS is a minimum data set

46 The MDS is required to maintain a continuing evaluation of each residents physical, mental and psychosocial well-being throughout the year

47 A facility must maintain each resident’s highest practical physical, mental and psychosocial well being and minimize decline per OBRA 1987

Final Exam Answer Key Copyright © 2005-2011 by Stan Mucinic. All rights reserved. 5 of 38 48 You must provide residents an environment that is homelike and de-emphasizes the institutional look of most nursing homes

49 Type 1 Diabetes is insulin dependent diabetes and is treated with regular insulin injections

50 Type 2 diabetes is adult onset and is treated with diet, exercises and pills

51 CMS stands for the Centers for Medicare and Medicaid Services

52 A facility must be surveyed at every 15 months

53 A class 1 deficiency is no harm and no potential for harm

54 What is a class 2 deficiency is no harm but potential for harm

55 What is a class 3 deficiency is Harm but not immediate jeopardy

56 What is a class 4 deficiency is harm and immediate jeopardy

57 A class A fire extinguisher would be used to put out a PAPER OR WOOD fire

58 A class B fire extinguisher would be used to put out a FLAMMABLE LIQUID FIRE like kerosene

59 A class C fire extinguisher would be used to put out an ELECTRICAL fire

60 A class D fire extinguisher would be used to put out a flammable METALS fire like magnesium

61 An MDS must be signed by a registered nurse

62 A care plan must be signed by a registered nurse

63 A comprehensive assessment must be completed within 14 days of admission to a facility

64 A care plan must be completed within 7 days of the completion of the MDS

65 A significant change must be processed within 14 days (the comprehensive assessment is the MDS and a significant change means doing a completely new MDS)

66 A comprehensive assessment must be reviewed every 3 months (quarterly) and completely updated annually or since last significant change.

67 A care plan must be reviewed every 3 months (quarterly) and completely updated annually. (The care plan must be updated every time the MDS is revised)

68 HCFA stands for the Health Care Financing Administration

69 HCFA is the sister organization to the CMS. HCFA sets the rates for Medicare and establishes the RUG rates that SNF’s are paid

Final Exam Answer Key Copyright © 2005-2011 by Stan Mucinic. All rights reserved. 6 of 38 70 OIG is the office of the Inspector General. This is the inspector general for the Department of Health and Human Services which oversees the CMS and HCFA

71 The OIG investigates Medicare and Medicaid Fraud

72 The American College of Health Care Administrators represents health care administrators

73 The AHCA represents for profit nursing homes

74 The AAHSA represents non-profit long term care facilities

75 DHHS stands for the Department of Health and Human Services and it administers the Social Security Administration, CMS, HCFA, and the FD

76 NIOSH provides research to OSHA

77 OSHA stands for Occupational Safety and Health Act or the Occupational Safety and Health Administration which enforces the Act

78 OSHA protects American workers by ensuring a safe workplace

79 The Occupational Safety and Health Administration enforces OSHA

80 ANSI or the American National Standards Institute sets the standards for the for the American with Disabilities Act?

81 NFPA develops and publishes the life safety code

82 WE follow the life safety code of 2000

83 The life safety code is designed to prevent deaths due to structural fires

84 The Civil Rights Act of 1964 prohibits discrimination on the basis of (RRGCRN) _Race, religion, gender, color and national origin.

85 The EEOC enforces the Civil Rights Act

86 The EEOC enforces the provisions of the Americans with Disabilities Act with respect to discrimination in employment based on physical disabilities?

87 The Age in Discrimination Act prohibits discrimination against workers 40 years and older

88 Need 20 employees to be subject to the Age in Discrimination Law

89 The EEOC enforces the Equal Employment Opportunity Act

90 ADVERSE IMPACT is the standard we use today to determine if discrimination in hiring employees has occurred per the EEOA

91 If I hire 10 white people (the majority group), then I need to hire 80% of the majority or 80% x 10 = 8 minorities.

93 NFPA stands for National Fire Protection Association

94 NFPA researches and publishes the life safety code. It does not enforce the code.

95 ANSI means the American National Standards Institute

96 ANSI develops and publishes the Americans with Disabilities Act. It does not enforce the Act?

97 NFPA enforces the Life Safety Code

98 The Architectural Barriers Compliance Board enforces the ADA with respect to access to public buildings by the handicapped

99 The EEOC enforces the Discrimination in Pregnancy Act

100 The main objective of the Equal Pay Act is to ensure that females are paid the same wages as males for the same work

101 Plegia means paralysis

102 Paraplegia is paralyzed from the waist down

103 Quadriplegia means paralyzed from the neck down

104 Hemiplegia means paralyzed on one side of the body

105 FMLA stands for family medical leave act

106 Must work 12 months or 1250 hours to be eligible for FMLA

107 Cannot accrue more than 240 compensatory hours each year (this is time off to compensate overtime exempt employees for hours they work and are not paid time and a half)

108 False the employer is not required to provide paid leave while on FMLA. You can be required to use up any vacation and sick leave before you go to unpaid status

109 False – the employer is required to pay for health insurance premiums while an employee is on FMLA. You must pay it back if you do not return to work

110 False – they worked more than 1250 hours and that qualifies them for FMLA

111 The administrator of a facility is considered overtime exempt or salaried. Salaried employees do not punch a clock

112 An exempt employee is not entitled to over time pay

113 An employee who punches in on a time clock is considered hourly or non-exempt

115 An hourly employee is not an overtime exempt employee. They must be paid overtime

116 MUST KNOW THIS - Respondent Superior means the superior must respond for the inferior or servant. The employer must pay for injury or damage to third persons caused by employees

117 the federal employer liability Act says the employer must pay for the medical bills and lost time for a worker injured on the job

118 The state licenses each nursing home

119 The CMS certifies nursing homes to be a provider for Medicaid and Medicare

120 A facility subject to a federal survey would receive an F tag or Federal Tag

121 A facility subject only to a state survey would receive an N tag or Non-Federal tag)

122 A facility with life safety violations would receive a K tag

123 The CMS administers Medicare and Medicaid contracts

124 Substandard care means a resident was harmed and is a class 3 or 4 violation

125 Businesses file business taxes quarterly while individuals file annually

126 Businesses use form 941 file FICA and workers compensation taxes

127 Employees are provided a W-2 that is a statement of their wages and taxes paid

128 Each employee fills out a Form W-4 to declare number of exemptions

129 The Immigration law requires workers to complete an I-9

130 Must complete the I-9 within 3 days of hire

131 The Fair Labor Standards Act requires employers to pay their employees a minimum federal wage

132 SMDA means Safe Medical Devices Act

133 You have 10 days to report any injuries from a medical device

134 Must report injuries from medical devices to the manufacturer and the FDA

135 A power of attorney is for financial matters only and a durable power of attorney can be for both financial and health care decisions as well

136 A guardian would make decisions for a person declared not competent by a court

Final Exam Answer Key Copyright © 2005-2011 by Stan Mucinic. All rights reserved. 9 of 38 137 A living will specifies whether an individuals wants artificial life prolonging measures if they cannot sustain bodily functions on their own

138 PSDA stands for the Patient Self Determination Act

139 The PSDA requires a facility to inform a resident they have the right to make an advanced directive but cannot require them to do so

140 Must keep OSHA medical records for the course of employment plus 30 years

141 Must enter all injuries into the OSHA summary log of occupational injuries and illnesses within 7 days

142 Must report any injuries that require medical attention or lost time

143 You enter most injuries into the summary log and supplemental log of injuries and illnesses within 7 days. If several workers are hospitalized or killed then you must call within 8 hours

144 Need 11 employees to be subject to the OSHA injury reporting requirement

145 OSHA requires the safety committee

146 The safety committee must meet monthly

147 The quality assurance committee must meet quarterly

148 OSHA requires nursing home staff to use universal precautions

149 Universal precautions are gloves and a gown and handwashing and standard precautions means total body protection and involves a gown, face mask, gloves and head covering

150 OSHA Blood-borne Pathogen Program requires a written plan in case of exposure

151 The Hazard communication standard focuses on the MSDS

152 An “employee’s right to know” means the MSDS

153 OSHA does requires employees to have a physical exam

154 OSHA requires a TB test and vaccination against Hepatitis B

155 Workers need annual TB test and offer Hepatitis B exam

156 OSHA general duty clause requires employers to provide workers a safe workplace

157 If 3 or more workers are hospitalized or killed, how must you notify OSHA and within 8 hours by telephone

158 HIPAA stands Health Insurance Portability and Accountability Act

Final Exam Answer Key Copyright © 2005-2011 by Stan Mucinic. All rights reserved. 10 of 38 159 HIPAA makes a workers insurance portable by limiting the period of time a workers new insurance company can refuse to cover pre-existing conditions to 12 months

160 The Wagner Act requires employers to bargain collectively with unions

161 The Norris LaGuardia Act prohibits federal courts from issuing an order preventing unions from striking

162 The Taft Hartley Act created the National Labor Relations Board?

163 A union must give employers 10 days notice before they can strike

164 Must provide 90 days notice of an intent to change an existing union contract.

165 Employers must provide employees training in any changes in OSHA laws within 90 days

166 A nursing home may have 2_ bargaining units.

167 The National Labor Relations Board must approve any bargaining unit

168 Can only have 2 bargaining units – professional and non professional

169 The president may halt a union strike for 80 days

170 A manager tell workers how they feel about a union but they cannot ay anything else or ask any questions about union participation of meetings or donate monehy ot a union

171 A mission statement is simply the purpose of a corporation

172 The by-laws are the governance of a corporation – by these laws we govern

173 The certificate of incorporation is filed with the state to form a corporation

174 The by-laws details the name of a corporation, the officers and directors, the number and amount of stock to be issued, and how the corporation will be run?

175 The governing body has ultimate legal responsibility for the operation of a nursing home?

176 The administrator has responsibility for the day-to-day operation of a nursing home

177 The National Labor Relations Board must supervise union elections

178 The governing body must make the critical decisions for a nursing home

179 The governing body must approve the budget for a nursing home

180 The governing body must implement facility policies in a nursing home

181 The governing body must develop the mission statement for a nursing home

182 Have you ever been convicted – cannot ask you have ever been arrested

184 A physician must determine if a job applicant requires special accommodation under the ADA

185 Use the following scenario to answer questions 186 -

John Smith was newly hired by ABC nursing home today. John came from another nursing home where he participated in the company’s major medical plan. John’s new health insurance plan with his new employer will become effective in 90 days. John has a serious heart condition and is worried about having continuous coverage to pay for his expensive monthly health bills

186 The new insurance company can preclude coverage for pre-existing conditions for up to 12 months

187 John can elect to continue coverage under COBRA under his previous employers health plan for up to 12 months provided he pays the full cost of the insurance. John will most likely continue coverage for the 90 day probation period until new insurance become effective.

188 If John produced a certificate of coverage under COBRA then the new insurance plan has to cover John in full the day his coverage becomes effective

189 John can continue COBRA coverage for 18 months

190 COBRA was designed to allow workers with pre-existing conditions to move from one employer to another without losing insurance coverage for pre-existing conditions. With the certificate of coverage John is covered in full by his new employer

191 A facility policy is a broad statement of a goal

192 The purpose for policies and procedures to provide guidance to staff to allow the facility to run 24 hours a day even when managers are not physically present in the building

193 A procedure is a step by step description on how to implement a policy

194 Professional Liability insurance will cover you if a resident was harmed because a nurse gave a resident the wrong medication

195 Auto insurance will cover the facility if an employee damages the facility van

196 General liability insurance will cover the facility ff a nursing aide punches a visiting family member, causing serious injury

197 Property insurance with cover a facility if a wind storm blows the roof off the facility

198 Business interruption insurance will cover a facility if an electric power transformer blows up down the block, and your facility loses power for a week and you lose $100,000 in income

199 Burglary insurance will cover a facility if someone breaks into the facility safe and steals $1000

Final Exam Answer Key Copyright © 2005-2011 by Stan Mucinic. All rights reserved. 12 of 38 200 Officers and Directors insurance will cover a facility if the CEO is sued by shareholders for mismanaging the company and losing money

201 Must have 12 drills per year, all three shifts per quarter

202 The emergency generator must switch on within 10 seconds if there is a loss of power

203 It cannot take more than 5 lbs of pressure to operate a faucet

204 It cannot take more than 5 lbs of pressure to operate a water fountain

205 It cannot take more than 5 lbs of pressure to flush a toilet

206 A railing or grab bar must support a minimum of 250 ibs

207 A telephone cord must be minimum of 29 inches long

208 You must have 7 days of emergency food

209 Must prepare the menu 30 days in advance

210 Must keep the menu 30 days

211 Must record the date of an injury, employee name, and type of injury (i.e back sprain) this is only a summary.

212 The Supplemental Log is your accident investigation form and contains all of the detailed information about the incident

213 The year end report is essentially the summary log that is posted between February 1 and April 31 by the employee clock

214 The year end summary is essentially the summary log but you may need to redact employees names with confidential medical conditions (i.e exposure to HIV/AIDS)

215 The MSDS stands for Materials safety data sheets

216 Hepatitis is an inflammation of the liver

217 Arthritis is inflammation of the joints

218 Nephritis is inflammation of the kidneys

219 The medical director must approve resident care policies

220 All facility policies be reviewed annually

221 The don, a physician and three staff members must attend the quality assurance committee meeting. The NHA does not need to attend.

Final Exam Answer Key Copyright © 2005-2011 by Stan Mucinic. All rights reserved. 13 of 38 222 Respondent superior requires to employer to answer to third parties injured or damaged by an employees actions

223 A window sill cannot be higher than 36 inches

224 The livable space in a resident room would not include the bathroom, closet, vestibule or hallway

225 A semi private room must have a minimum of 80 square feet of living space per person

226 A private room must have a minimum of 100 square feet

227 High forward reach from a wheel chair is 48 inches

228 Side reach from a wheel chair is 9 – 54 inches

229 Toe clearance is 9 inches

230 Knee clearance is 19 inches

231 The closet must have 30 x 48 inch clear floor space, a clothes rack and a shelf no higher than 54 inches high (high side reach)

232 Must provide residents a bed, mattress, side table, dresser with drawers, chair, bed pan and window or door with a window to the outside,

233 The final rinse cycle of a hot water dishwasher 180 degrees

234 A 3 compartment sink: compartment 1 – warm sudsy water, compartment 2 – clear water to rinse and the compartment 3 – sanitizing solution (wash – rinse- sanitize)

235 Must have a wheelchair passing lane every 200 feet

236 Two wheelchairs require 60 inches to pass

237 A wheelchair is 30 inches wide

238 The width of the bathroom door in a resident bedroom is a minimum of 32 inches

239 A door on the fire exit corridor must be 1 3/4 inches thick with a solid wood core and 2o minute fire rating

240 Lighting of the means of egress must be continuous with exit floor surfaces illuminated at the level of 1 foot candle light from the floor

241 Every facility must be divided into a minimum of 2 smoke compartments

242 Fire exists must be located remotely from each other

243 A fire exit corridor (hallway) cannot be longer than 150 feet

245 The distance from inside a resident’s room to the outside fire exit cannot exceed 200 feet

246 The emergency electrical generator must be inspected weekly.

247 The emergency generator must be tested under full load for 30 minutes every month

248 Food must be stored 6 inches off the floor

249 Cannot store any object above 18 inches from the ceiling

250 Must keep the resident contract for 5 years

251 Must keep the resident chart for 5years

252 The resident chart belongs to the facility.

253 Must make records available for inspection within 24 hours of request by a resident

254 Must provide copies of a resident’s records within 48 hours of request

255 you can specifically charge a resident a per page copy charge and the actual time required to copy the records

256 Cannot charge a resident for the time to locate records

257 Can charge a resident a per page photocopy charge

258 Cannot charge a resident for the time to locate records

259 Cannot charge for the time to type a bill

260 Air temperature is measured from just above the floor or 3 feet above the floor

261 Per OBRA 1987, the comfortable air temperature range in a facility is between 71-81 degrees

262 A handrail on a staircase must extend 12 inches beyond the bottom and top step?

263 The landing on a stair case must be a minimum of 60 square inches

264 A hallway or ramp must have a minimum width of 8 feet wide

265 A carpet cannot have a carpet pile higher than 1/2 inch

266 False – you cannot use extension cords in a facility

267 R-A-C-E means Rescue Alarm Contain and Extinguish

Final Exam Answer Key Copyright © 2005-2011 by Stan Mucinic. All rights reserved. 15 of 38 268 The facility emergency disaster plan must be approved by the county emergency management agency each year. The county has 60 days to approve the plan and the state surveyors will check to see if you have an approved plan during annual survey.

269 The local fire department must approve your fire plan annually

270 True – must have glass panels in the double doors of a smoke compartment

271 False – the double doors of a fire compartment must both swing in opposite directions

272 False – the Walls of a smoke compartment have a fire rating of 2 hours

273 Must have battery power to power the emergency lighting for 1 1/2 hours

274 The width of an interior staircase must be a minimum of 44 inches

275 Afire alarm is activated manually – by a manual pull station

276 The fire exit door swing outward – if the bodies pile up inside the door still swings open

277 The door that leads from a resident room to the main hallway must be a minimum of 44 inches wide – need clearance for a bed

278 False – the window in a resident’s room does not need to open

279 An incline or slope of more than ½ inch requires ramp treatment

280 An incline or slope of less than ½ inch requires a beveled edge

281 A semi private room with 4 residents would require 320 square feet

282 Every resident should have a physical exam at least quarterly – the MDS

283 A sidewalk must be a minimum of 3 feet wide

284 Skilled therapy that focuses on the lower body and strengthening weight bearing muscles is called physical therapy

285 Occupational therapists are concerned with the upper body and ADL’s

286 Speech therapists evaluate residents for speech and swallowing problems

287 Only a physician can prescribe skilled therapy

288 Only a pharmacist can dispense medication

289 The maximum number of residents you can have in a resident bedroom is 4 people

290 Occupational therapy uses heating pads

291 Name three types of liquid thickeners – nectar, pudding and honey

293 Only a physician can prescribe a therapeutic diet

294 Any diet other than the regular diet – low fat, low salt, mechanically altered, puree, etc

295 14 hours can pass from the evening meal till breakfast without a snack

296 16 hours can pass from the evening meal till breakfast with a snack

297 A registered dietician must prepare the menu

298 Palatable means taste of the food

299 Puree, mechanical softened, etc

300 3 ways food can be prepared or stored that destroys its nutritive value is over boil in water, add baking soda, and leave uncovered in the refrigerator

301 Officer’s and director insurance will cover a facility if a CEO is sued by shareholders for mismanaging the company and losing money.

302 Physical restraints are removed every 2 hours, leave residents out of restraints for one hour, and check them every 30 minutes

303 Incontinence is loss of urine and bowel control Stress incontinence

304 When urine is accidently released when an individual sneezes or laughs, this is called stress incontinence

305 Minimum daily nursing hours are set by the states with federal approval

306 Nosocomial (from “within”) infections are infections residents develop after they are admitted to a facility (infections not developed in hospital or the home)

307 Nursing home placement causes anxiety because of the fear of the unknown

308 A legally responsible person would exercise the rights of a person declared incompetent by a court (or court appointed guardian)

309 A resident cannot be required to sign an advance directive as a condition of admission

310 Attending physician must visit resident once every 30 days for the first 3 months (90days) and then every other month thereafter (once every 60days)

311 The facility must make dental services available, The resident or famly must pay for them

312 An Otologist deals with hearing loss

314 Activities should focus on resident enjoyment and participation

315 Reality orientation involves calendars, clocks and signs

316 Assessment of a resident’s condition produces a description of their current status – this the MDS that requires a physical exam every 3 months

317 Analgesics (aspirin) provides pain relief

318 Outdated, deteriorated or discontinued drugs should not be in the drug room

319 Ambulate means to walk

320 Active listening involves listening intently, connecting with the speaker and acknowledging you hear their concerns

321 Face to face communication is the most effective

322 The most you can earn each month and still be eligible for Medicaid is $1860

323 A garnishment is a court order to deduct monies from a worker’s paycheck to repay a debt

324 The main function of personnel management is staffing

325 Referrals from current employees is best source for new hires

326 Solid lines show line authority

327 Department managers have line authority.

328 A charge nurse has line authority

329 Straight line depreciation depreciates evenly over a set period of years

330 The medical director does not have line authority

331 The DON is responsible to supervise the nursing staff

332 The medical director coordinates physician services in the facility

333 The medical director can act in the place of an attending physician in an emergency

334 The administrator is responsible to ensure resident rights are respected

335 Overtime is required by the fair Labor Standards Act

336 Vacation, sick leave are employee benefits provided at the employers discretion

337 Personnel policies are found in the employee handbook

339 Accelerated depreciation claims most depreciation deduction in the first years of an assets life while straight line depreciation depreciates evenly over a set period of years

340 Assets appear on the balance sheet

341 Expenses appear on the profit and loss Statement

342 Liabilities appear on the balance sheet

343 Working capital = current assets – current liabilities

344 Assets equal liabilities + shareholders equity (this is the accounting equation ALC or Assets = Liabilities plus Capital

345 Your budget is your business plan

346 Perpetual is the best of the two because it perpetually keeps count of inventory supplies through the year

346A Periodic is where the inventory is only counted once a year

347 FIFO is first in and first out – older inventory used first

348 LIFO is last in and first out – newer inventory is used first

349 Current ratio is calculated by dividing current assets by current liabilities

350 Liquidity means your current assets can meet current liabilities

351 FUTA is federal unemployment tax act and refers to unemployment taxes

352 The Balance Sheet is prepared quarterly

353 The balance sheet summarizes the assets, liabilities and capital (or net worth or equity) on a certain date

354 If you wanted to know how much a business was worth you would look at the balance sheet

355 Annual audits are done by independent certified public accountants and are necessary to verify the information in financial statements

356 An effective maintenance program emphasizes preventative maintenance

357 Work orders must include location, problem and an authorized signature

358 The maintenance cost of aging machine justifies replacement in 10 years

359 Must close doors to contain smoke

361 The Terms “Lock out and tag out” refer to OSHA requirement to protect staff and residents from hazardous energy discharges (electrocution)

362 Pest control programs cannot use open traps, sticky fly paper poison bait

363 MSDS material sheets are required by OSHA

364 Under Respondeat superior, both the employer and the employee are liable for wrongful acts of employees to third parties (residents and visitors)

365 A no smoking sign must be posted outside a room where oxygen is in use

366 The general journal

367 Strategic planning prepares or anticipates future eventualities and uncertainties

368 Rookie managers make the mistake of over managing

369 Policies are general statements that guide thinking

370 Management by walking around

371 Leadership starts with visibility (management by walking around)

372 The ombudsman program is funded by the Administration on Aging

373 The general journal

374 Milieu therapy uses the environment as treatment

375 False - The aging continue to have a strong interest and need for intimacy and sex through out their lives

376 State survey process is outcome based

377 Marketing

378 Public relations is management of communication between the facility and the public and managing the facility’s image

379 Advertising in print media and TV ads is least effective way to market a facility

380 Word of mouth is the most effective way to market a facility

381 False - A facility is able to care for a resident with AIDS using universal precautions

382 Can discharge a resident if they 1. are a danger to themselves 2. are a threat to others, 3. The facility cannot meet their needs, 4. the resident has improved and longer requires SNF

383 A rationale or reason for the use of the anti-psychotic

384 Nursing, Physical Therapy, Dietary (sells meals)

385 Social Services, Nursing, Physical Therapy, Maintenance, etc.

386 CARF stands for Commission on Accreditation of Rehab Facilities

387 Must monitor physical restraints every 30 minutes

388 DON can serve as a charge nurse with 60 beds or less

389 False - the administrator must respond to such recommendations is not required to implement them

390 Should store supplies immediately. DO not leave supplies in the hallway or public areas that can be easily carried away

391 Check each item delivered against the invoice and manifest and confirm receipt. Items are almost always missing – demand a refund

392 Carcinoma is cancer

393 Pathologist is a doctor involved with causes of diseases

394 The medical director is responsible to implement resident care policies

395 Physicians must write, date and sign progress notes at each visit

396 Every facility must have a transfer agreement with one or more hospitals approved for participation under Medicare and Medicaid - To EXCHANGE MEDICAL INFORMATION PER HIPAA

397 Under OBRA, the quality improvement committee must meet at least quarterly

398 Significant weight loss for 1 month is 5 percent

399 Significant weight loss for 3 months is 7.5 percent

400 Significant weight loss for 6 months is 10 percent

401 The maximum in assets in you can have and qualify for Medicaid is $2000

402 Care plans address activities appropriate for each resident based on the comprehensive assessment

403 Main job of activity director is to complete assessments and identify interests

404 The use of an alarm, transmission of an alarm, a procedure to isolate and extinguish a fire, a

405 OBRA 1987

406 Request to see their medical records can be either orally or in writing

407 Topical drugs are for external use only

408 Drugs should be administered within one hour after they are prepared

409 STAT means immediately

410 Quality Improvement

411 Consultant pharmacist is responsible to ensure drug records are in order and accounted for

412 Nursing staff must store and record drugs self administered by residents

413 Residents have right to self administer drugs if approved by inter disciplinary team

414 If a medication has a stop order – the nurse must notify the physician before the last dose is administered

415 Must offer therapeutic activities based upon resident interests and hobbies

416 Management by walking around would not involve taking corrective action.

417 Prevent or minimize accidents and injuries

418 Administrator communication with residents and family is not privileged (protected from disclosure by law) (Attorneys, doctors and clergy do have confidential privilege and cannot be forced to disclose what you reveal to them)

419 HIPAA limits the exclusion period for pre existing conditions to 12 months

420 Under the family leave act, the employee can be required to use up leave time for the 12 weeks of FMLA they are entitled to each year

421 Under the ADA, employees can be required to submit to a fitness for duty exam relevant to their job after being hired

422 Can only require medical exams post hire

423 A job analysis determines job tasks, employee behavior and skills necessary for a job

424 A job is a collection of tasks that can be performed by one person

425 Affirmative action relates to hiring practices

426 A manager maintains the status quo and resists change whereas a leader is forward thinking

427 False - Employees not formally evaluated by their supervisor cannot be expected to make good progress

428 The Dept of Labors enforces the Fair Labor Standards Act

429 Employment at will provides an employer can fire an employee without cause

430 Budgets are based on past experience and future expectations

431 The owner of a public corporation is separate from the company and cannot take cash from the cash register and not record the transaction.

432 The accrual method of accounting is required by Medicare and Medicaid

433 Income and expenses are recorded in accrual method when incurred

434 Depreciation is correctly defined as the decrease in value due to wear and tear and obsolescence

435 Amortization is a schedule showing interest and principal owed to a creditor

436 Working capital equals current assets minus current liabilities

437 Fair Labor Standards Act

438 Risk management is identifying and solving problems before they get out of hand. Purchasing insurance decreases your risks

439 Workers compensation premiums on based on how many employees are collecting workers compensation benefits

440 The key to inventory control is to standardize supplies, organize a central purchasing department and control number of people authorized to purchase

441 A fiscal intermediary is an insurance company

442 Employees pay 50% of their FICA tax and the employer pays the other half

443 In the cash basis of accounting a transaction is recorded when a bill is actually paid or cash is actually received. In the accrual system the transaction is recorded when incurred or the date of the invoice

444 Employers pay payroll taxes quarterly on form 941

445 HIPAA requires written policies and procedures to protect patient info

446 Principal cause of odors in nursing homes is incontinence

447 Most common accident in nursing homes to employees is lacerations/cuts

Final Exam Answer Key Copyright © 2005-2011 by Stan Mucinic. All rights reserved. 23 of 38 448 All personal appliances brought into a facility must be inspected by maintenance ensure it is safe before it can be plugged in

449 Egress is outward

450 Ingress is inward

451 The Conservatism principle states that you must use the lower valuation when deciding which depreciation schedule to use calculate the value of your assets

452 The Objective Evidence Principle states you must use source documents to evidence your transactions

453 Disclosure of ownership requires licensees to notify the state licensing agency of changes in corporate officers, administrator and director of nursing

454 Corporations provide the most limited liability

455 False – For profit corporations own most nursing homes

456 Bylaws contain rules, regulations and mission statement

457 Other than an emergency, must give resident 30 days notice of transfer

458 A resident can work for the facility provided it is in the plan of care

459 Source documents include invoices, receipts and cancelled checks

460 Governing body does not create or implement procedures

461 A key role of the governing body is stewardship which the conscientious use of assets

462 The governing body does not hire staff – that is mostly done by dept heads

463 The Time Period Principle states that you must use the same time period from year to year (calendar or fiscal year)

464 A person who dies without a will is intestate

465 The Consistency Principle states that you must use the same accounting system year from year – can’t use accrual one year and cash system the next year

466 The Ombudsman cannot see resident records without the resident’s consent

467 Demographic information relates to population statistics

468 That a company will still be in business next year and the year after that

469 Marketing is concerned with filling your beds

471 Becoming neurotic is a psychological change

472 Slowed reflexes is a physiological change

473 Becoming incontinent is a physiological change

474 Autism is a developmental illness

475 50% of those residents selected to be interviewed during a survey must be interviewable (cognitive or able to speak

476 The purpose of a transfer agreement between facilities is to provide an interchange of medical information

477 A resident to be admitted to a nursing home must have a physical evaluation or examination done with 5 days prior to admission or 48 hours after admission

478 Adaptive feeding equipment must be prescribed by a physician or the occupational therapist

479 Ophthalmologist treats visual disorders and is a medical doctor

480 An optician grinds lenses for glasses

481 Resident councils give residents a sense of control over their lives s

482 The MDS has 18 triggers

483 The pharmacist consultant is responsible to check resident drug regimens monthly

484 The pharmacist consultant is responsible to verify drug records

485 The pharmacist consultant does not administer, dispense or dispose of drugs The pharmacy under contract does that

486 A private room, television, phone, reading materials, hair salon are not covered by Medicare or Medicaid

487 PRN means as requested

488 STAT means immediately

489 P.O. – means by mouth

490 NPO – means nothing by mouth

491 False - Internal and external meds must be kept in separate areas. They are stored in different drawers on med cart

493 A resident must be given a physical examination at least every 3 months to keep assessment accurate (MDS)

494 Discharge planning is started upon admission

495 Exposure to visitors and employees is most common cause of infections

496 Bedfast means being confined to a bed all of the time within the past 7 days Resident councils give residents a sense of control over their lives

497 Privacy considerations include privacy curtains, knocking on doors and understanding each individuals needs for privacy

498 Approximately 73% 87/120 = 87

499 Living will specifies an individuals preference for the use of life prolonging measures such as tube feedings and ventilators

500 A testator makes a will

501 An executor executes or carries out a will

502 A power of attorney deals only with financial affairs

503 A durable power of attorney covers both financial and health care

504 Tardives Dyskinesia

505 If an administrator notices a resident is deteriorating, he should ask the nurse to evaluate the patients overall condition and report it to the physician

506 Activities program must have volunteers working with them

507 Encourage them to socialize with other residents and get out of their room

508 Surveyors are less concerned with how often info is noted in chart than the sufficiency of that info to describe residents progress and care provided

509 Drug interaction occurs when two or more drugs are taken at the same time and produce unwanted side effects

510 ROM means range of motion

511 Private duty sitters and aides are not employees of the facility. They are hired by family members and need to follow facility rules while in the nursing home. The facility is liable for

512 Main goal of physical therapy is to help residents live life their fullest

513 Using labor pools can decrease continuity of care _ using temps

514 The interview is the best source of information regarding a job applicant

515 Cannot hire a non certified aide for more than 4 months

516 The results of all abuse investigations by facility staff must be reported to the state within 5 days

517 Must have a bachelors degree in social work or a related field and one year of supervised experience

518 OBRA requires 12 hours of nursing aide in services a year – one hour each month

519 Primary purpose of financial information is to enable administrators to make decisions

520 Weekend overtime wages are an operating expense – i.e. electricity bills, payroll, medical supplies and food costs are costs to operate the facility.

521 Buying a computer or repaving the parking lot are capital costs

522 All cost reports to Medicaid are due within 90 days of end of fiscal year

523 A hazard area need one hour fire protection of automatic extinguishing system

524 Hand washing is most effective to prevent spread of germs

525 An isolation room does not need a private bath or shower

526 The manufacturer determines the hazards of a product and prints the MSDS

527 A handicapped parking spot must be at least 13 feet wide

528 A walkway must be at least 3 feet wide

529 The fire rating of building materials is determined by the life safety code

530 Thee travel distance between a class b or C fire extinguisher cannot be more than 50 feet

531 The FDA enforces the SMDA

532 OSHA’s color is green

533 Ultimate mission of a nursing home is to provide quality resident care

534 GAAP is generally accepted accounting principles

Final Exam Answer Key Copyright © 2005-2011 by Stan Mucinic. All rights reserved. 27 of 38 535 Bylaws contains rules and regulations that detail purpose and mission, corporate membership and overall financial management

536 The attending physician, resident and legal rep must be notified in the event of a significant change

537 Medicare is an insurance program for Americans over 65

538 Medicaid provides health care for the poor and the elderly.

539 RUG (Resources Utilization Groups) is a resident classification system used by nursing homes to determine reimbursement from Medicare

540 Main job of the local ombudsman is to investigate and resolve complaints

541 The open market ruling in 1977 relates to advertising health services

542 If contacted by a union representative for collective bargaining call a lawyer who specializes in labor relations

543 Resident funds held in trust must be refunded to his or her estate within 30 days of death with a final accounting

544 Blood supply cut off to the tissues in the skin and muscle is the cause of a decubitus sore

545 The occupational therapist since they are familiar with ADL’s

546 A licensed nurse (RN or LPN)

547 Public relations deals with press releases and news conferences

548 OCR (office of Civil Rights) enforces HIPAA violations

549 Mental changes in elderly is usually caused by arteriosclerosis

550 A licensed practical nurse

551 A licensed vocational nurse

552 State and federal agencies cannot impose civil or criminal penalties – only a civil court or criminal court can do that

553 Must inform residents of their rights before or during admission

554 Depression is most common psychological problem of the elderly

556 The Code

557 Benign is non-malignant

559 Aphasia is difficulty speaking

560 Dysphasia is difficulty swallowing

561 Management by walking around is a management style and is the best way to communicate with staff

562 When the DON requests a meeting with the administrator this is upward communication

563 The immediate supervisor should be the first to resolve a worker grievance

564 Work should be assigned based on individual responsibilities

565 An employee wage evaluation program should be based on merit

567 Needs 50 percent plus one to vote for a union

568 Employees on medical leave must be given their jobs back when they return

569 Cannot request family leave for divorce or separation

570 Need a 3 day qualifying stay in a hospital to be admitted to a skilled nursing facility

571 A “C” corporation can choose any 12 month period as its fiscal year C*CALENDAR

572 Labor is largest single expense

573 Must complete a 1099 for employees receiving compensation other than regular salary

574 IRS records must be saved for 4 years

575 Must notify the state licensing authority if management changes the administrator changes of officers of the company change

576 Equities are the owners assets of a business

577 Medicare resident funds totaling less than $100 do need to be placed in an interest bearing account

578 The air in a nursing home must be changed every 6 minutes

579 House keepers do not clean the kitchen to prevent cross infection from resident rooms

580 Minimum width of a resident bedroom is determined by the state

582 Privacy curtain and all other obstacles must hang or sit 18 inches from the ceiling to avoid blocking the water sprinklers

583 ANSI establishes the standards for the width of a parking space for handicapped

584 The employer is required to develop a written hazard communication policy

585 Smoke is main cause of death from a fire

586 The facility was not in compliance with the life safety code

587 A facility with 60 parking space must have 3 handicapped spaced (1 to 25)

588 Handrails must be 30-34 inches from the floor on ramps and stairways

589 “Shall” means mandatory in laws and regulations

590 “May” means it is optional

591 An “N’ tag is a state tag of “Non-federal” tag

592 An organizational chart does not show informal relationships

593 Management by objectives is where the supervisor and worker jointly set the workers performance goals

594 A hallucination is a sensory experience that is independent of stimulation from the environment

595 Working capital is calculated by subtracting current assets from current liabilities

596 A tort is a civil wrong

597 subpoena requires personal appearance at a hearing or trial

598 Trial subpoena requires attendance at a trial to testify

599 False – A facility cannot require a resident to sign advanced directive

600 A regulation

601 A Job description outlines job duties

603 The complaint survey is an abbreviated standard survey

604 Milieu therapy uses the social environment

605 The financial statements collectively would include revenues, expenses, assets, liabilities and capital (the profit and loss statement and balance sheet both would have this information)

606 Wagner Act recognized workers right to bargain collectively

607 A statute

608 A legal document that spells out a person’s preferences concerning life sustaining treatment is a living will

609 Landrum Griffin Act provides union members a bill of rights

610 Norris LaGuardia Act recognized workers right to strike

611 Must provide resident 14 days advance notice of any changes in charges or policies

612 An OT provides training in adaptive feeding devices

613 Glaucoma is where fluid in the eye builds up pressure in the optic nerve causing intense pain and blindness

614 Federal regulations are published in the Federal Register

615 Have them get familiar with your building and its layout

616 Drug holiday is intentionally not providing a prescribed dose to lower concentration of drug in body

617 Must have a transfer agreement with each dialysis center to allow for sharing of medical information. Surveyors will demand to see that contract during survey.

618 The cash flow statement

619 30 nurses - 120 x 2 hours each = 240 hours divided by 8 = 30 nurses (30 x 8 hours – 240 hours)

620 $5 per resident per day. 100 x 30 days (30 days in June) = 3000 resident days in June. 15000 divided by 3000 = $5 per resident per day.

621 $3 per day. (100 residents on average per day. 100 x 30 days = 3000 resident days $9000 / 3000 = $3 per day per resident

623 Cash disbursements

624 Ramps and corridors must be a minimum of 8 feet wide

625 Apply soap fingertips to forearms, scrub under fingernails, wash under hot running water for a minimum of 20 seconds

626 Labor costs total between 50 to 60%

627 Social security is a payroll tax

628 FIFO and LIFO refer to inventory valuing methods

629 False – This not acceptable

630 Mirrors and towel racks mounted no more than 40 inches from floor

631 Less than 1.0 to 1.0

632 The Federal Fair Credit Act

633 The Consumer Credit Protection Act

634 Life safety code sets fire rating of buildings and was developed and published by the NFPA

635 Respondent Superior requires the employer to pay for injuries to third parties caused by employees

636 Federal Employer Liability Act requires the employer to pay for worker on the job injuries

637 A Standard license

638 A conditional license

639 Long term goals are for three or more years

640 A change in ownership, DON or management could trigger a Abbreviated standard survey

641 A state survey (N tags)

642 A stage 4 pressure sore that developed from a stage 1 or stage 2 while in your facility

643 Open ended questions is best in eliciting info during a job interview

644 The Life Safety Code

645 OBRA 1987

646 OBRA 1987

647 Admission medical evaluation must be done within 2 days unless examined within 5 days prior to admission

648 The Fair Labor Standards Act

649 The Fair Labor Standards Act

650 The formula to determine body weight loss is divide the usual weight – actual weight by the usual weight times 100

651 7 days

652 50

653 The Americans with Disabilities Act

654 Must provide residents emergency dental care

655 The nursing home administrator

656 The RAI is the Resident Assessment Instrument and is consists of the MDS, RAPS and instructions how to use the RAI

657 Immediately after hire and before they actually start working

658 None

659 None

660 Fair Labor Standards Act

661 COBRA

662 Ethics in Patient Referrals Act (cannot pay or give providers gifts, of free pens or pads as inducement for referrals)

663 COBRA provides workers the right to keep their insurance for 18 months after termination

665 Schedule 1 drugs are illegal narcotics and not allowed in facility

666 A syndrome is a group of symptoms which occur together

667 A Levin tube is a naso-gastric tube

668 Housekeepers have the least training

669 Salary increases should be based on performance/merit

670 Employee relationships with residents and co-workers main reason for retention. MONEY is not the primary motivator

671 The budget should be reviewed every 30 days and prepared annually

672 “S’ corporation

673 All doors in a facility except for bathroom and toilet must be 44 inches wide

674 Toilet seat for disabled must be between 17 and 19 inches high

675 Per resident per day standard to launder sheets, blankets etc is 8-10 pounds

676 The maximum corridor length allowed without a smoke stop is 150 feet

678 Must have one fire extinguisher every 2,500 square feet

679 The Robinson Patman Act

680 False – they are tax exempt and do not issue stock

681 Large print version of resident rights

682 If resident does not speak predominate language, must provide an interpreter or a written translation in their language

683 In Braille

684 Must inform residents of their rights both verbally and in writing

685 The employees immediate supervisor

686 The most basic order of needs is physical security

688 An Otologist

689 A cardiac recovery program

690 when all nursing staff report directly to the director of nursing, this is unity of command

691 Ambulatory and incompetent residents are most at risk for injuries because they are able to move around but exercise poor risk awareness

692 Beef

693 Hematoma is a dark area under the skin containing fluid

694 Chicken

695 Persons over 65 use an average of 7.2 drugs

696 Increased acuity and shorter resident stays

697 Anorexia is the loss of appetite

698 Current employee referrals

699 Should not exceed 5%

700 Overtime is an operating expense

701 The chart of accounts lists all accounts in the General Ledger

702 The debt to equity ratio should be less than 1.0 to 1.0

703 65 percent of resident accidents occur in the resident bedroom

704 In multi bed rooms the min distance between beds is 3 feet

705 60 inches

706 Stroke Recovery Program

707 Bathroom and toilet doors must be at least 32 inches wide

708 EEOC does not enforce FLSA – that is the Dept of Labor

709 Subrogation is substituting one person for another in regard to a lawful claim

711 Sharps must be discarded immediately after use

712 OBRA categorizes resident rights

713 A chemical restraint

714 Doxidan is a laxative

715 Schedule II drugs cannot be refilled without a physicians new prescription

716 Must provide sufficient room and space for residents to be able to maneuver around a room

717 Metastasis is where bacteria or cells (Cancer) move from one part of the body to another

718 Living space less the bathroom, vestibule or hallway

719 The need for physical restraints should be re-evaluated every 2 hours

720 Re-admit them and then re-assess their ability to self administer

721 To review he resident’s nutritional intake and weight loss and record their food preferences

722 Low sodium diets are for high blood pressure

723 15 months – since the last survey

724 All three shifts

725 Cash changes hands

726 Major cause of overtime is absenteeism

727 Best indicator of new hires ability to succeed in a job is prior job performance

728 Income and expenses are recorded when incurred (the date of the invoice)

729 One hour per day per employee per 1000 sq feet

730 Cash flow is decreased when inventory is increased

731 Nonprofits cannot pay dividends

732 Current ratio should be no less than 2.0 to 1.0

733 By nursing aides

735 Prior to hiring a nurses aide, the administrator must check the state nurse aide registry

736 The principal difference between Medicare and Medicaid is that Medicare is an insurance program based on age where insured pay premiums and co pays and Medicaid is an insurance for poor and elderly based on income

737 Medicare fraud is reported to the OIG or office of inspector general

738 Recreational therapist is not a specialized therapist

739 Per Theory X employees do no want to work

740 30 days after discharge

741 Connect to the colon through the stomach wall.

742 Long term residents are surveyed annually

743 Prevent the cells in the blood from clotting

744 A contusion is a bruise

745 8 hours a day

746 A sphygmomanometer is used to measure blood pressure

747 12 hours per year

748 Resident name, drug name, dosage, mode of administration, and how often to take

749 The manufacturers name

750 The Ledger

751 The Balance Sheet

752 The Balance Sheet

753 Medical director must implement resident care policies

754 Employment at will means that an employer can terminate a worker without cause

755 Profit and Loss Statement

756 The EEOC

757 Public Relations

759 121 or more beds

760 1 facility

761 Hazard Communication Standard

762 The federal register

763 21 days from admission

764 Urinary tract infection

765 An indwelling catheter

766 Hand washing

767 Must record employee injuries in the OSHA injury log within 7 days

768 The OSHA Year End report is form number 300A

769 The OSHA supplemental injury form is form number 301

770 Employee injuries must be recorded in OSHA Injury Log number 300