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Section 15
Assessment of Culture Change Non-Compliancel

Table of Contents

The purpose of this section is to provide you with a specific frame of reference for practical application of the ideas presented in this Manual.  By frame of reference, I mean you will be writing a listing of specific Department Heads and staff whose support you are currently seeking.  The names you list in this first Section will become your guideline for applying techniques proposed in the remainder of the Manual. 

If you have not read the Introductory Commentary to this course yet, you need to do so now.  My remarks provide a framework upon which this Manual and the CD Set were developed. 

Where are you right now concerning implementing Culture Change?  It’s been around for a while.  By this point in time, of course, your facility Administrator and Department Heads are aware of varying levels of CMS Culture Change guidelines regarding,
1. Residents are to be transported to Activities of their choice by CNAs.
2. Shower, therapy, and medication schedules are to accommodate residents’ attendance of Activities.
3. All staff are to provide residents with Activities per their Care Plan.

Ask yourself.  Have you discussed the above at Department Head meetings and at Care Plan conferences concerning individual residents for whom the above apply?  Have you provided Inservices for each shift regarding, for example, transportation?  Maybe that’s not appropriate in your facility.  If not, what have you done to implement the above three areas of change? 

Below write a few specific actions you have taken thus far to implement the above three areas of change.
For example, “I spoke to my Administrator about the application of these ideas in my facility.”

However, of course what this course is all about is: what do you do when you don’t get the support you are requesting?  Notice I said “when” rather than “if” you don’t get the support.  The reason I say “when” is because I’ve never worked with a facility that has 100% compliance with CMS requirements 100% of the time.  So let’s do some thinking about your areas of noncompliance for which you are currently seeking support.  If you cannot answer the questions in the rest of this section knowledgeably, postpone completing it and take a few days to observe what is and is not being done.

List three residents who are not being transported who need to be.

Resident’s Name

Activity he/she should have been transported to

CNA responsible


Bible Study











List three residents unable to attend an Activity or participate in an Activity to its fullest extent because of conflicting therapy, medication, shower, etc. schedules.  For example, medication, which caused Harry to become drowsy, was given to Harry prior to Men’s Discussion Group, causing him to sleep through the entire discussion group.

Resident’s Name

Activity not participated in

Conflicting schedule


Men’s Discussion Group

Meds made him drowsy










List three residents who have Activities left in their room.  However, staff outside the Activity Department is not providing the resident with this Activity.  (Note: The system proposed in our “Alzheimer’s and Low-Functioning” series of five courses is to tape a paper or plastic Activity Bag to the resident’s nightstand containing the Activity project.  A sample of this Activity Bag system is found at the beginning of this Manual.) 

Resident’s Name

Activity left in room




Yarn winding

Return from breakfast














In each case, I asked you to provide three names to give you a specific focus for the techniques provided in the rest of this Manual.

Forward to Section 16
Back to Instructor's Guide

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