Preparing to be Prepared: Policies, Training and Staff

AUDIO CONFERENCE

Date/Time:

Thursday, August 15, 2013, 10:30 a.m. – noon

Speaker: Ray Miller, director of risks and safety solutions, Direct Supply

Packet Contents: Credit Instructions CEU Affidavit Evaluation/Credit Form Post-Test

Dial-In Instructions: Conference Phone Number: 866-380-9615

Participant Access Code: 761168# You may dial the toll-free number no sooner than

five minutes prior to the program.

LeadingAge New York/FLTC 13 British American Blvd. Suite 2 Latham, NY 12110 518.867.8385

CREDIT INSTRUCTIONS

Audio Conference: Preparing to be Prepared: Policies, Training and Staff Date/Time: Thursday, August 15, 2013, 10:30 a.m. - noon Credit Available: 1.5 hours of Licensed Nursing Home Administrator (NAB), Adult Care Facility (ACF), Assisted Living (AL) or CASP credit for up to 4 individuals from the same facility (no affiliates). Instructions for Obtaining Credit: Please complete and fax the following forms to 518.867.8386 or 518.867.8389 no later than August 29th:

CEU Affidavit

Evaluation/Credit Form

Post-Test Print the credit forms for each individual seeking credit. On each form, indicate the name of the person that your organization’s registration is under. Please note: Credit certificates will be issued approximately one month after the program if payment has been received in full. Credit Details: The FLTC is a certified sponsor of professional continuing education with the National Association of Boards of Examiners of Long Term Care Administrators (NAB). NAB has approved this program for 1.5 hours of continuing education credit. State licensure boards, however, have final authority on the acceptance of individual courses. A certificate of completion will be sent to adult care facility (ACF) and assisted living administrators with a maximum of 1.5 hours awarded. This program is applicable for CASP certification. Graduates certified by the Coalition for Leadership in Aging Services (CLAS) may use continuing education credits from this program toward their CASP certification renewal.

If you have any questions, please contact Linda Smith at 518.867.8385, ext. 154 or lsmith@leadingageny.org

PLEASE FAX TO FLTC: 518.867.8386 OR 518.867.8389

CEU Affidavit

Audio Conference: Preparing to be Prepared: Policies, Training and Staff Date/Time: Thursday, August 15, 2013, 10:30 a.m. - noon Credit: 1.5 hours of Licensed Nursing Home Administrator (NAB), Adult Care Facility (ACF), Assisted Living (AL) or CASP credit Organization: ________________________________________________________________________ Name of Registrant: ___________________________________________________________________ This form attests that _________________________________________________________________,

(Full name of person seeking credit)

____________________________________________, was in attendance for the full 1.5 hours of the (Title)

audio conference, Preparing to be Prepared: Policies, Training and Staff. Witness: (Print) _______________________________________________________________________

(Staff in attendance, other than the person seeking credit)

(Signature) _______________________________________________ Date: ______________

PLEASE FAX TO FLTC: 518.867.8386 OR 518.867.8389

Evaluation/Credit Form

Audio Conference: Preparing to be Prepared: Policies, Training and Staff Date/Time: Thursday, August 15, 2013, 10:30 a.m. - noon Credit: 1.5 hours of Licensed Nursing Home Administrator (NAB), Adult Care Facility (ACF), Assisted Living (AL) or CASP credit

EVALUATION

1. How many other staff from your organization were listening to the audio conference with you? _______________

2. Please check the box that best describes your rating: Excellent Good Fair Poor

a. Overall rating

b. Presenter’s knowledge of material/topic

c. Learning objectives & content material

d. Usefulness of the knowledge/skill required

e. Appropriateness of topic content

3. Was participating in this seminar a wise business decision? Yes No If not, why? ___________________________________________________________________________________ _____________________________________________________________________________________________

4. Is LeadingAge New York/FLTC your first choice for educational opportunities? Yes No 5. What new developments in the field do you believe will have an important future impact?

_____________________________________________________________________________________________

_____________________________________________________________________________________________

CREDIT INFORMATION - All fields MUST BE COMPLETED below in order for us to process your credit!

Name of Registrant for your Organization:______________________________________________________________

Name & Title of Person Seeking Credit:_________________________________________________________________

Organization: ____________________________________________________________________________________

Address: _________________________________________________________________________________________

City: _______________________________________________________State: ____________Zip: _________________

Telephone: ( ) ____________________________E-Mail: ______________________________________________

Place a check next to the type of credit you are seeking: ____ NAB ____ACF ____AL ____CASP

NYS NH Administrator License No.:____________________________________________________________________

I am also licensed in other states with license numbers as follows:___________________________________________

This program has been reviewed and approved by NAB/NCERS. NCERS strives to approve only quality programs whose content can reasonably contribute to the professional development of long-term care administrators. If you have any confidential comments concerning this program, which

you would like to make to NCERS administrators, please direct them to cecomments@nabweb.org.

PLEASE FAX TO FLTC: 518.867.8386 OR 518.867.8389

Post-Test Audio Conference: Preparing to be Prepared: Policies, Training and Staff Date/Time: Thursday, August 15, 2013, 10:30 a.m. - noon Credit: 1.5 hours of Licensed Nursing Home Administrator (NAB), Adult Care Facility (ACF), Assisted Living (AL) or CASP credit

Name of Registrant:__________________________________________________________________________ Name of Person Seeking Credit:________________________________________________________________

PLEASE CIRCLE THE CORRECT ANSWER:

1. An example of a natural hazard would be one which involved a nuclear power plant. a. True b. False

2. In defining events, one must consider the time, scope and means of evacuation. a. True b. False

3. Residents can remain safe even when close to a fire IF smoke and sound barriers have been installed. a. True b. False

4. Your training will determine how effective your emergency or disaster plan will be. a. True b. False

5. A written plan should include training, testing and hazard analysis. a. True b. False

6. Federal regulation F466 (Water supply) is not required for an emergency plan. a. True b. False

7. In 2004, the DSS rolled out the National Incident Management System (NIMS). a. True b. False

8. A written health care occupancy fire safety plan shall provide for the evacuation of immediate area and smoke compartment.

a. True b. False