Evaluations www.careandcompliance.com/eval We deeply value your feedback, and will utilize it in the ongoing development of our courses and services. RISK MANAGEMENT How to Protect Your Community INTRODUCTION • • • Assisted living and residential care has become an increasingly litigious environment. Outcomes from recent lawsuits have given a wakeup call to the industry about the importance of maintaining quality risk management programs. This course will explore the fundamental components of risk management that should be in place in your community. INTRODUCTION We will focus on practical strategies to address causes of lawsuits, responding to incidents, falls, documentation, compliance with CCL requirements, and insurance requirements. The session will wrap up with a deep-dive into three case studies adapted from actual lawsuits against providers in California. COURSE OBJECTIVES By the end of the course, you will be able to: 1. Describe how recent judgments against assisted living and residential care providers have ramifications for the entire industry. 2. Identify the most common causes of lawsuits in assisted living and residential care. 3. Implement five critical steps that should be included in every incident response. 4. Describe the key principals to include in a falls program. COURSE OBJECTIVES 5. 6. 7. 8. Describe the records that must be maintained in any RCFE or ARF. Implement ten steps for better documentation. Describe the type of insurance coverage assisted living and residential care providers should have/consider. Apply critical thinking to real-world case studies to identify ways to improve risk management and prevent the same types of outcomes in his/her community. Lawsuits in Assisted Living and Residential Care RECENT LAWSUITS IN THE NEWS… Emeritus – $23 million A California jury has awarded $23 million in punitive damages against Emeritus Corp., a nationwide chain of assisted living communities, following a wrongful death lawsuit brought by the family of woman who died in one of the company’s communities. See more at: http://www.aboutlawsuits.com/emeritus-nursinghome-lawsuit-punitive-damage-award42915/#sthash.dfmS2Cgk.pdf RECENT LAWSUITS IN THE NEWS… Mariner Health Care Inc – $400,000 Despite the assisted living community’s arguments, a jury found negligence for failing to properly treat pressure ulcers and awarded the family $80,000 for past mental anguish, $20,00 for past medical expenses and $300,000 for past disfigurement and impairment damages. http://www.nursinghomesabuseblog.com/litigation/settlementreached-with-hospital-assistedliving-facility-in-case-involvingamputation-of-womans-legs/ RECENT LAWSUITS IN THE NEWS… Santa Clara Special Care Community LLC - $3 million A north Eugene assisted living community, cited by state officials earlier this year for failing to protect a woman with Alzheimer’s disease from being sexually abused by another resident, now faces a $3 million lawsuit filed by the victim’s family. http://www.opb.org/news/article/assisted-livingcenter-hit-with-lawsuit/ CNA CLOSED CLAIMS CNA HealthPro Ins. released their Reducing Risk in a Changing Industry study, which revealed: 1. The severity of closed claims has increased at an average rate of 7.6 percent per year. 2. Assisted living facilities have the highest average severity within the for-profit business segment, followed by skilled nursing facilities. 3. The most frequent allegation is resident fall, which comprises approximately 44% of not-for-profit and 38% of for-profit open and closed claims. 4. Injuries with high severity include amputation, sexual assault, death, head injury, loss of organ and pressure ulcer. WHY DO RESIDENTS AND FAMILIES SUE? 1. 2. 3. 4. 5. To recover damages To punish or to get even with the provider Usually when there is poor communication between provider and family/resident Need for an explanation as to how and why this occurred How to prevent a similar event from occurring in the future What Happens When You Are Sued? WHAT HAPPENS WHEN YOU ARE SUED? They go fishing: • Attorneys can submit questions to both the plaintiff and the defendant, called “interrogatories” • Must be answered truthfully under oath • Also, “requests for admission”, which require the both parties to say which allegations they affirm and which they deny WHAT HAPPENS WHEN YOU ARE SUED? Request for Production of Documents: • Demands for production of documents by the parties involved • Resident records • Employee records • Health/medical records • Licensing reports WHAT HAPPENS WHEN YOU ARE SUED? Depositions: • The parties may be required to appear in the opposing attorney's office to answer questions under oath in front of a court reporter. • Depositions can also be taken from third parties, such as disgruntled former employees. Responding to Incidents TYPES OF INCIDENTS Falls: • Those 75 yrs and older who fall are four to five times more likely than those 65 to 74 yrs to be admitted to a long-term care facility for a year or longer • Rates of fall-related fractures among older women are more than twice those for men • Over 95% of hip fractures are caused by fall • Men are more likely than women to die from a fall • Many people who fall, even without an injury, develop a fear of falling. This fear may cause them to limit their activities, which leads to reduced mobility and loss of physical fitness, and in turn increases their risk of falling again and a change of condition. TYPES OF INCIDENTS Changes in Condition: • Can occur quickly or slowly over a long period of time • May be difficult to detect in those with cognitive impairment • May be due to infection, metabolic changes, medications, cognitive diseases, physical impairments, or emotional upset, etc • Triggers a service plan change and a visit to the doctor TYPES OF INCIDENTS Aggression: • Resident on resident • Resident on staff • Resident on visitor • If a cognitive deficit is present, it is usually an attempt to communicate a discomfort or unmet need • May trigger an eviction • Must be reported to the LPA/CCLD TYPES OF INCIDENTS Wandering/Elopement: • Cognitively impaired residents • Monitoring whereabouts • Technology can help but is not a guarantee • Notify CCL, responsible party, etc. • Update service plan TYPES OF INCIDENTS Sexual Inappropriateness: • Sexuality has no age limit • Often occurs with cognitive decline / dementia • Can be difficult to redirect when between two consenting adults • Cannot allow one person to sexually assault another; • Sexual advances towards staff must be addressed if resident is cognitively intact • If resident has dementia, staff must be trained to re-direct the inappropriate behavior; change of face EVERY RESPONSE MUST INCLUDE 1. 2. 3. Appropriate follow up care: doctor appointment, ER visit, Urgent Care, etc.; Resident Monitoring: visual checks every 15 minutes, visual checks every 30 minutes…every hour… Communication: notify family, primary care physician, licensing, Ombudsman, your insurance. Schedule a service plan meeting with the family to discuss the incident and what you are going to do from here. EVERY RESPONSE MUST INCLUDE 4. 5. 6. Documentation: Medical Emergency response protocols, updates to service plan, resident monitoring, elopement protocol, fall assessment and response, state reports, etc. Root Cause Analysis: who, what, when, where, how and why? Debrief your staff. Falls FALLS Comprehensive Falls Program • Falls Risk Assessment • Staff Education / Training • Exercise Program • Vit D/Calcium Supplementation • Increased Sunlight Exposure • Environmental Audit • Observation • Footwear Interventions • Medication Review FALLS • Definition of a Fall: An unexpected event in which a resident comes to rest on the ground, floor or lower level. CALCULATING FALL RATES Number of resident falls x 1000 Number of bed days FALLS Interventions: • Exercise program • Good nutrition and hydration • Appropriate footwear • Use of grab bars and night lights in bathrooms • Review of medications • Audit of environment for hazards • Eye exam • Encourage to call for assistance and/or use of DME FALLS A Team Approach: • Requires “buy in” of the residents to work, i.e., eye exams, appropriate footwear, use of DME, exercise, calling for assistance, reporting unwitnessed falls; • Ongoing and thorough training of caregiving staff to monitor for and report accurately all witnessed and suspected falls; • Activities that encourage, entice and enable the residents to remain active and speak to their specific interests; • Family involvement in reducing clutter and promoting the residents’ participation in activities. FALLS The Environment: • The location of falls remain the highest in the bedroom • The majority of falls occur between 6 am and 9 pm • Encourage the resident to recreate the bed to bathroom door orientation he/she is accustomed to • Reduce clutter on the floors, stairs and in doorways • Place often used items on lower shelves • Remove throw rugs and extension chords • Use of grab bars and even lighting FALLS Post Fall Follow-Up: • Receiving appropriate care • Call 911 • Communication • Investigation • Education FALLS Assessments • A fall assessment should be conducted post fall by an appropriately skilled professional to determine if an injury requiring medical intervention has occurred. • Ideally, a licensed nurse is in the community and can assess the resident. • If not, 911 can be called and a paramedic can perform the assessment. • Follow up with the primary care physician should occur as quickly as is feasible. Document, Document, Document… HOW IMPORTANT IS IT? • • • • The old adage, “If it wasn’t written, it didn’t happen” applies to assisted living as much as to any other care setting. With the number of lawsuits being filed in California alone, we cannot afford to not document in both a resident chart as well as a staff file. Who documents in which is going to be determined by your specific company and policy, however, do remember that once it is written, it cannot be altered. It is a permanent part of that record. Your documentation is also your proof of the care and service provided to your residents. TYPES OF RECORDS • • • • • Resident Records Medication Records Incident Reports Staff Records Volunteer Records RESIDENT RECORDS • • • • • • The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. Each record shall contain at least the following information: (1) Resident's name and Social Security number (2) Dates of admission and discharge (3) Last known address (4) Birthdate RESIDENT RECORDS • • • • • (5) Religious preference, if any, and name and address of clergyman or religious advisor, if any (6) Names, addresses, and telephone numbers of responsible persons to be notified in case of accident, death, or other emergency (7) Name, address and telephone number of physician and dentist to be called in an emergency (8) Reports of the medical assessment and of any special problems or precautions (9) The documentation required for residents with an allowable health condition RESIDENT RECORDS • • • • • (10) Ambulatory status (11) Continuing record of any illness, injury, or medical or dental care, when it impacts the resident's ability to function or the services he needs (12) Current centrally stored medications (13) The admission agreement and pre-admission appraisal (14) Records of resident's cash resources RESIDENT RECORDS • • • • • • • (15) Documents and information required by the following: (A) Section 87457, Pre-Admission Appraisal (B) Section 87459, Functional Capabilities (C) Section 87461, Mental Condition (D) Section 87462, Social Factors (E) Section 87463, Reappraisals (F) Section 87505, Documentation and Support RESIDENT RECORDS • • The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative. All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: CCL REMOVING RECORDS • Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident. CCL REMOVING RECORDS • • • • • • • • • • Licensing representatives shall not remove the following current records for current residents unless the same information is otherwise readily available in another document or format: (A) Religious preference, if any, and name and address of clergyman or religious advisor (B) Name, address, and telephone number of responsible person(s) (C) Name, address, and telephone number of the resident's physician and dentist (D) Information relating to the resident's medical assessment and any special problems or precautions (E) Documentation required for allowable health condition (F) Information on ambulatory status (G) Continuing record of any illness, injury, or medical or dental care (H) Records of current medications (I) Current emergency or health-related information CCL REMOVING RECORDS • • Prior to removing any records, a licensing representative shall prepare a list of the records to be removed, sign and date the list upon removal of the records, and leave a copy of the list with the administrator or designee. Licensing representatives shall return the records undamaged and in good order within three business days following the date the records were removed. MEDICATION RECORDS • When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. PRN AUTHORIZATION • • • Resident can determine and clearly communicate his/her need for prescription and nonprescription medication on a PRN basis. Resident cannot determine his/her own need for nonprescription PRN medication, but can clearly communicate his/her symptoms indicating a need for a nonprescription medication. Resident cannot determine his/her need for prescription and/or nonprescription PRN medication and cannot communicate his/her symptoms indicating a need for nonprescription medication. (Must contact physician before each dose) PRN ORDERS • • • • • • For every prescription and nonprescription PRN medication there shall be a signed, dated written order from a physician, and a label on the medication. Both shall contain at least all of the following: (1) The specific symptoms which indicate the need for the use of the medication. (2) The exact dosage. (3) The minimum number of hours between doses. (4) The maximum number of doses allowed in each 24-hour period. PRN RECORDS • • • • • A record of each dose is maintained in the resident's record The record shall include: Date and time the PRN medication was taken Dosage taken Resident's response MEDICATION ORDERS • • • • • For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. (1) The specific symptoms which indicate the need for the use of the medication. (2) The exact dosage. (3) The minimum number of hours between doses. (4) The maximum number of doses allowed in each 24hour period. CENTRAL STORAGE RECORDS • • • • • • • The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: (A) The name of the resident for whom prescribed. (B) The name of the prescribing physician. (C) The drug name, strength and quantity. (D) The date filled. (E) The prescription number and the name of the issuing pharmacy. (F) Instructions, if any, regarding control and custody of the medication. MEDICATION DESTRUCTION LOG • • • • • • Title 22, Reg. 87465 Medication Destruction Log (i) Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident's physician and documented in the resident's record nor disposed of according to the hospice's established procedures or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record, to be retained for at least three years, which lists the following: (1) Name of the resident. (2) The prescription number and the name of the pharmacy. (3) The drug name, strength and quantity destroyed. (4) The date of destruction. HOSPICE MEDICATION RECORDS • • Prescription medications no longer needed shall be disposed of in accordance with Section 87465(i). The licensee shall maintain a record of dosages of medications that are centrally stored for each resident receiving hospice services in the facility. REPORTING CHANGE OF ADMINISTRATOR • • • • The licensee shall notify the Department, in writing, within thirty (30) days of the hiring of a new administrator. The notification shall include the following: (1) Name and residence and mailing addresses of the new administrator. (2) Date he/she assumed his/her position. (3) Description of his/her background and qualifications, including documentation of required education and administrator certification. REPORTING CHANGE IN CHIEF CORP OFFICER • • Any change in the chief corporate officer of an organization, corporation or association shall be reported to the licensing agency in writing within fifteen (15) working days following such change. Such notification shall include the name, address and the fingerprint card of the new chief executive officer, as required by Section 87355, Criminal Record Clearance. EMPLOYEE RECORDS • • • • • The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (1) Employee's full name (2) Social Security number (3) Date of employment (4) Written verification that the employee is at least 18 years of age, including, but not necessarily limited to, a copy of his/her birth certificate or driver's license EMPLOYEE RECORDS • • • • (5) Home address and telephone number (6) Educational background For administrators this shall include verification that he/she meets the educational requirements in Sections 87405(b) and (c). (7) Past experience, including types of employment and former employers (8) Type of position for which employed EMPLOYEE RECORDS • • • • • (9) Termination date if no longer employed by the facility (10) Reasons for leaving (11) A health screening (12) Hazardous health conditions documents (13) Criminal Record Clearance or exemption STAFF TRAINING RECORDS • • • • • Documentation of staff training shall include: (A) Trainer's full name (B) Subject(s) covered in the training (C) Date(s) of attendance (D) Number of training hours per subject HOURS WORKED • In all cases, personnel records shall demonstrate adequate staff coverage necessary for facility operation by documenting the hours actually worked VOLUNTEER RECORDS • • • • Personnel records shall be maintained for all volunteers and shall contain the following: (1) A health statement (2) Health screening documents (3) Criminal record clearance or exemption for volunteers that are required to be fingerprinted RECORD RETENTION • All personnel records shall be retained for at least 3 years following termination of employment. Incident Reports INCIDENT REPORTS • • • Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. INCIDENT REPORTS • • • • Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. The use of an Automated External Defibrillator. Any incident which threatens the welfare, safety or health of any resident, such as physical or psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. INCIDENT REPORTS • • Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. Fires or explosions which occur in or on the premises shall be reported immediately to the local fire authority; in areas not having organized fire services, within 24 hours to the State Fire Marshal; and no later than the next working day to the licensing agency. Documentation Fundamentals DOCUMENTATION FUNDAMENTALS • • • • • • • • • Accurate and objective statements. (objective means ‘not influenced by personal feelings, interpretations, or prejudice; based on facts’.) Do not assign blame. Do not use abbreviations. Leave no blank spaces. Write, and sign your name, legibly. Use blue or black ink – colored ink does not copy. Do not document what you have not done yourself. Correct any errors by using a single line to mark through the error, initial, and write the correct word or phrase. Sign your name and date in ink. THE GOOD EXAMPLE • On June 30, at 0830, I entered Mr. Smith’s apartment, #3, to find him lying on his back on the kitchen floor. His walker was across the room. There was no visible blood. He was awake and stated, “Oh Thank God. I fell and think I am hurt.” I called for assistance from my co-worker, James, who called 911. I remained with Mr. Smith, on the floor, until the paramedics arrived. He was taken via ambulance to the emergency room at approximately 0900. His daughter, Margie, and his primary care physician, Dr. Bell, were both notified by phone once he was on his way. THE BAD EXAMPLE • Today at 8:30 I went into Mr. Smith’s apartment and he had tripped over that stupid cat again and fallen on his floor. I had James call 911 while I stayed with him. They came and took him to the emergency room because he was hurt. I called his daughter and his doctor. THE UGLY • That resident in #3 went to the ER because he fell or something. I think he was hurt real bad. Why do ya’ll let people live here if they can’t take care of themselves, anyway? I thought this was supposed to be a assisted living, not a nursing home. And don’t think I’m gonna take care of that nasty cat while he’s gone, ‘cause I ain’t. Insurance IMPORTANCE OF INSURANCE Besides being required by Licensing, what is the importance of having insurance? • Transfers financial risk from your company to the insurance company • Protects your property against damage by allowing you to have your property replaced or repaired if some type of damage occurs • Business liability insurance covers accidents that occur on the business premises and mishaps that occur during normal business operations on and off premises IMPORTANCE OF INSURANCE • • Replacement insurance protects a business in the event equipment is stolen, replacing the missing items and paying for repairs from damage caused by the theft. We live in a litigious society. Even the most frivolous lawsuit can be costly to defend; and in the event your community is on the losing end of a lawsuit, the awarded damages could exceed the business's capabilities to pay. Depending on the business entity structure, not only the business assets, but also the owner's personal assets could be at risk. Business liability insurance will cover at least part, if not all, of any damages. TYPES • • • • • • • Vehicle / Automobile Insurance Health Insurance Worker’s Comp Insurance Casualty Insurance Life Insurance Structural / Property Insurance Liability Insurance PARTNERSHIP • • • Many insurance companies offer risk management services, audits and self audit tools to assist you in mitigating the risk to your community. Some will offer safety resources, such as fact sheets, checklists, sample protocols, and best practices on topics such as documentation, management issues, property safety, resident safety and transportation safety. Many are offering online training topics accessible to clients for training staff as well. Case Studies INFECTED PRESSURE ULCERS What Happened • In 2006, a 51 year-old woman, Darletta Dean, who had trusted two of her local health care facilities passed away. The woman, who had cerebral palsy, died from multiple infected pressure ulcers on different parts of her body. The assisted living resident was being provided weekly medical treatment from a home health agency and roundthe-clock care from Totally Taxing Assisted Living. Nonetheless, she suffered such significant pressure ulcers that ultimately caused her death. INFECTED PRESSURE ULCERS The Lawsuit • The wrongful death lawsuit alleged that the home health agency and the assisted living community were only treating one of the victim’s pressure ulcers. They were negligent in providing the appropriate level of care for this resident and ensuring she received the proper medical care. INFECTED PRESSURE ULCERS The Evidence • Dean was 51 years old when she died from 3 avoidable pressure ulcers that had become infected. The jury found substantial evidence that Dean died from multiple infected pressure ulcers on different parts of her body. • The documentation from neither the home health agency nor the assisted living community described more than one decubitus ulcer. INFECTED PRESSURE ULCERS The Outcome • The jury awarded $4 million to Dean’s family for pain and suffering and $5.5 million for the wrongful death claim. The jury also awarded $2,683 in funeral expenses. INFECTED PRESSURE ULCERS Discussion • What Could Have Been Different? MULTIPLE FALLS What Happened • 88 year old Mary Pace, with a history of dementia and recurrent urinary tract infections, is moved into an assisted living. Within a year, staff are no longer assisting her with ADLs, claiming it is because she is combative. She suffers multiple falls. Her daughter requests she be checked for a UTI, which is not done. She falls and fractures both her shoulder and hip on the left side. Once in the hospital, she is also found to have a severe UTI, becomes septic and dies. MULTIPLE FALLS The Lawsuit • The family filed a lawsuit alleging gross negligence resulting in Mary’s death. MULTIPLE FALLS The Evidence • Documentation by staff of Mary’s combative behaviors with no follow up with her physician. • Documentation of multiple falls suffered by Mary with no physician follow up. • Depositions of staff members that they were told to leave her alone because she had dementia. MULTIPLE FALLS The Outcome • The community was found to be at fault for Mary Pace’s death and a judgment of $10 million was awarded to her family. MULTIPLE FALLS Discussion • What Could Have Been Different? SEXUAL RELATIONSHIP What Happened • Two residents with dementia living in an assisted living community, both without spouses, were engaged in an intimate relationship. Jim and Teresa told their adult children they were “in love” and wanted to marry. Jim’s family was not bothered by the relationship, however, Teresa’s daughter was “horrified” and moved her mother out of the community, claiming her mother was sexually abused by Jim. SEXUAL RELATIONSHIP The Lawsuit • Teresa’s daughter sued the assisted living community claiming her mother was sexually abused by Jim and the assisted living allowed it to occur, citing her mother’s inability to consent based on her diagnosis of dementia. SEXUAL RELATIONSHIP The Evidence • Teresa was conserved by her daughter due to her diagnosis of dementia. SEXUAL RELATIONSHIP The Outcome • The assisted living was found to be at fault for allowing the sexual relationship to occur between a consenting and non-consenting adult. The jury awarded Teresa’s family what amounted to the cost of her rent and care for the 5 years she resided at the assisted living, cost of bringing the suit, and suffering, for a total of $1.8 million. SEXUAL RELATIONSHIP Discussion • What Could Have Been Different? Quiz QUESTION #1 Why do resident families sue? a. b. c. d. e. To lose To make a point To recover damages For notoriety B&C QUESTION #1 Why do resident families sue? a. b. c. d. e. To lose To make a point To recover damages For notoriety B&C QUESTION #2 You are required to carry life insurance. a. b. True False QUESTION #2 You are required to carry life insurance. a. b. True False QUESTION #3 An example of objective information is: a. b. c. d. Color of hair Feelings for your spouse An opinion None of the above QUESTION #3 An example of objective information is: a. b. c. d. Color of hair Feelings for your spouse An opinion None of the above QUESTION #4 Educational background is included in personnel records. a. b. True False QUESTION #4 Educational background is included in personnel records. a. b. True False QUESTION #5 Medication records include: a. b. c. d. Central Storage Record Destruction Log PRN Authorization Form All of the above QUESTION #5 Medication records include: a. b. c. d. Central Storage Record Destruction Log PRN Authorization Form All of the above QUESTION #6 A comprehensive falls program includes a medication review. a. b. True False QUESTION #6 A comprehensive falls program includes a medication review. a. b. True False QUESTION #7 The resident record contains: a. b. c. d. Mother’s maiden name Favorite color Last known address Neighbor’s shoe size QUESTION #7 The resident record contains: a. b. c. d. Mother’s maiden name Favorite color Last known address Neighbor’s shoe size QUESTION #8 Workman’s Compensation Insurance is a required insurance in California for businesses. a. b. True False QUESTION #8 Workman’s Compensation Insurance is a required insurance in California for businesses. a. b. True False QUESTION #9 When documenting in the resident’s record: a. b. c. d. e. Use blue or black ink Write legibly Sign your name Don’t leave blank spaces All of the above QUESTION #9 When documenting in the resident’s record: a. b. c. d. e. Use blue or black ink Write legibly Sign your name Don’t leave blank spaces All of the above QUESTION #10 “Interrogatories” must be answered as if you are under oath. a. b. True False QUESTION #10 “Interrogatories” must be answered as if you are under oath. a. b. True False Evaluation www.careandcompliance.com/eval If you have not completed your evaluation please take time to complete when time permits, your feedback is greatly appreciated.