You have just completed your first week employed as assistant executive manager in a 180-bed skilled nursing facility, named Sanctuary Nursing Home. On your first day, the facility CEO gave you a tour of the facility, introducing you to staff and residents. Throughout the week, you have been observing and getting to know your staff and residents. Now, as your first full week on the job winds to a close, you are dismayed to notice a pattern of care indicative of some organizational deficiencies. Some of these problems are so serious that, were an inspection to happen today, Sanctuary would likely receive a number of citations. Most of these issues have the potential to cause at least minimal harm. The list of problems you have noticed includes:

• There is urine and/or feces on the bathroom floors of several incontinent patients.
• Less than 40% of staff and 70% of residents received an influenza vaccine this year.
• Medication patches ordered "discontinued" for a resident were found on the resident's shoulder one day after the discontinuation order was placed in chart.
• Four activities scheduled on the Recreation Calendar were cancelled within your first week without notice, leaving residents sitting in front of the television in the activity room.

As a new manager, you recognize a need to: 1) engage in an in-depth assessment of quality of care being provided at Sanctuary, and 2) develop a plan to proactively improve care quality and prevent citations or sanctions from external oversight entities.

First, let's start with a question based on your opinion

1. Do you think that the situation as described here at Sanctuary is typical of skilled nursing facilities, or do you think that nursing homes suffer from poor, inaccurate press based on a few isolated situations? For the rest of the questions you will need to read the text, articles, so you can meaningfully integrate into your posts what you are learning.
2. How do you think that oversight entities, such as the CMS, TJC, and your state health department, inspecting your facility would react to the problems at Sanctuary? What penalties might they impose and what would the impact of the penalty/penalties be on your nursing home? How could they be helpful in improving quality?
3. How could you/your team incorporate quality improvement tools described in your readings? What barriers do you anticipate and how might you overcome them? What would your first steps be?