SERVICES
Healthcare Services
Practical healthcare operations, compliance, quality, risk management, and training solutions designed around the needs of your organization.
COMPLIANCE SERVICES
Compliance Systems Built for Accountability
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Compliance Program Audit
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Assess existing compliance systems to identify strengths, gaps, and opportunities for improvement while retaining effective practices.
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Compliance & Ethics Program Development
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Develop or enhance compliance programs, policies, procedures, and customized auditing and monitoring systems.
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Compliance Committee Support
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Strengthen committee structure, meetings, documentation, corrective actions, follow-up, and program accountability.
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Annual Compliance Training
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Annual compliance and ethics education supporting workforce understanding, responsibilities, and reporting expectations.
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Anonymous Compliance Hotline Services
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Provide a confidential reporting resource integrated with established processes for receiving and responding to concerns.
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Concern Form Tracking & Corrective Action Documentation
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Track concerns through review, investigation, corrective action, follow-up, and closure to support accountability.
QUALITY ASSURANCE & PERFORMANCE IMPROVEMENT
Quality Systems Designed for Measurable Improvement
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QAPI Program Development & Support
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Develop and strengthen QAPI systems that identify concerns, establish accountability, and support sustainable quality improvement.
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Daily Rounding Audits & Zone Accountability
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In collaboration with facility leadership, facility-specific daily rounding audits enhance QAPI through defined zone assignments and structured methods for documenting audit findings and corrective actions. This approach supports tracking and trending of deficient practices identified during daily rounding for Quality Assurance monitoring purposes. Assigning zone accountability to managers and key personnel also strengthens coordination and oversight of programs such as the Missing Resident Program and provides department managers with defined areas of responsibility during regulatory activity.
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CMS Survey Critical Pathway Audits
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Use applicable CMS Survey Critical Pathways to evaluate practices, identify potential concerns, and strengthen ongoing Survey Readiness.
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Individualized QA Audit Planning
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Develop facility-specific QA audit plans based on risks, performance trends, survey history, operational concerns, and priorities.
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QAPI Committee Support
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Support committee structure, quality-data review, improvement priorities, documentation, follow-up, and accountability.
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Performance Improvement & Tracking/Trending
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Track and trend concerns and performance data to recognize patterns, evaluate corrective actions, and monitor sustained improvement.
OPERATIONAL SUPPORT & READINESS
Practical Systems for Reliable Operations
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Facility Assessment
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Develop, review, and update the Facility Assessment to reflect resident population, services, staffing, competencies, resources, and operational needs.
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Emergency Operations Program
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Strengthen Emergency Operations systems, policies, procedures, communication processes, and supporting documentation.
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Survey Ready Book
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Organize a customized Survey Ready resource that centralizes key information and documentation for efficient regulatory survey response.
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Missing Resident Program
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Develop systems supporting prevention, preparedness, immediate response, documentation, and follow-up for Missing Resident events.
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Customized Operational Programs
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Develop facility-specific Operational Programs and resources that address identified needs and strengthen existing systems.
RISK MANAGEMENT
Incident Response Built Around Accountability
Structured Risk Management support helps organizations respond appropriately to incidents, reduce recurrence risk, maintain organized documentation, and use identified trends to strengthen operations and quality outcomes.
Facility Reported Incidents (FRIs)
A key component of Risk Management, with required process elements organized from immediate response through ongoing quality improvement.
01 · Immediate Intervention
02 · Regulatory Reporting
03 · Investigation & Documentation
04 · Recurrence Risk Assessment
05 · Corrective Action Development
06 · Organized Investigation File
07 · QAPI Tracking & Trending
TRAINING & PROFESSIONAL DEVELOPMENT
Education That Supports Stronger Systems
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Annual Compliance Training
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Organization-wide Compliance and Ethics education supporting workforce responsibilities, reporting expectations, and organizational standards.
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Survey Readiness Training
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Practical education helping leadership and staff understand survey processes, strengthen Survey Readiness, and respond appropriately during regulatory review.
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QAPI Training
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Education focused on effective Quality Assurance, Performance Improvement, monitoring, documentation, and accountability.
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Emergency Preparedness Training
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Education supporting staff understanding of Emergency Preparedness responsibilities, procedures, communication expectations, and response processes.
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Customized Training & Education
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Facility-specific education developed around identified operational, regulatory, compliance, or quality needs.
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Administrator-in-Training Preceptor Services
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Licensed Nursing Home Administrator Preceptor services for approved Administrator-in-Training candidates. Additional information is available under Expert Services.