Master Cheat Sheet

Split three ways: what crosses both exams, what’s RCAL-heavy, and what’s CORE-heavy. Skim cross-cutting daily; drill RCAL before Sat, CORE before Mon.

CROSS-CUTTING — TESTED ON BOTH CORE & RCAL

Mnemonics: RACE = Rescue·Alarm·Confine·Extinguish · PASS = Pull·Aim·Squeeze·Sweep · PDSA = Plan·Do·Study·Act · PPE DON gown→mask→goggles→gloves / DOFF gloves→goggles→gown→mask.
Resident rights: dignity, privacy, choice, refuse treatment, manage own finances, grievances w/o retaliation, unopened mail, private visitors/phone, free from abuse & unnecessary restraints.
Abuse/neglect: physical, verbal, sexual, financial exploitation, neglect, abandonment. Response = report immediately + investigate + protect the resident first. Never delay or cover up.
Infection control: hand hygiene #1 · alcohol rub ≥60% · soap & water for C. diff / visible soil · standard precautions for everyone.
Advance directives: disclose at/before move-in. POA = chosen before incapacity; guardian = court-appointed when legally incompetent. HIPAA protects health-info privacy/security.
Ethics/integrity: wrongdoing (falsified records, abuse) → investigate, correct, discipline, report. Covering it up or “waiting for the next survey” is ALWAYS wrong.
Restraints = last resort: physician order, documented reason, time-limited, monitored, least-restrictive.
Emergency prep: 4 CMS core elements (risk assessment · policies · communication plan · training & testing), reviewed annually. Fire drills 1/shift/quarter.
Quality & survey: Mission = WHY · Vision = WHERE · Strategy = HOW. QAPI 5 elements; TQM/CQI = continuous, customer-focused, data-driven (PDSA). Scope & Severity J/K/L = Immediate Jeopardy; C+ needs a Plan of Correction (~10 days). Five-Star = inspection + staffing + quality measures.
Governance: Governing body (legal authority/policy) → Administrator (operations) → dept heads. Medical Director = clinical oversight (NOT daily admin).

Key Numbers — physical plant, safety, food

Corridor / room door / min clear	8 ft / 44 in / 32 in
Dead-end corridor	30 ft max
Single / shared room	100 sf / 80 sf per resident
Room temp	71–81°F
Hot water at fixtures	105–120°F
Handrail / grab bar	34–38 in / 33–36 in
Ramp slope / turning circle	1:12 / 60 in
Smoke compartment	≤22,500 sf (1-hr barrier)
FIRE wall doors	1-hr→45-min · 2-hr→90-min
SMOKE wall door	20-min
Extinguisher reach	75 ft (A) / 30 ft (kitchen K)
Emergency lighting / generator	≥90 min / 10 sec
Food danger zone / cook	41–135°F / 165°F
Cold / hot hold	≤41°F / ≥135°F
Dish sanitize / med fridge	180°F / 36–46°F
OSHA report death / hosp.	8 hr / 24 hr

Fire & Life Safety Code (NFPA 101 / LSC)

Corridor clear width (new HC)	8 ft (96 in)
Resident room door	44 in (41.5 in clear)
Min clear width — egress door	32 in
Stair / exit door	36 in
Stairwell width	≥44 in
Dead-end corridor (new)	30 ft max
Travel to exit — sprinklered / not	200 ft / 150 ft
Exits per floor / compartment	≥2 remote
Wall protrusion into corridor	4 in max
Handrail / guardrail	34–38 in / ≥42 in
Smoke compartment max	22,500 sq ft
Smoke barrier rating / door	1-hr / 20-min self-closing
Refuge per bed	≥30 net sq ft
1-hr FIRE wall door	45-min (¾-hr)
2-hr FIRE wall door	90-min (1½-hr)
Stair enclosure ≤3 / 4+ stories	1-hr / 2-hr
Extinguisher A / K travel	75 ft / 30 ft
Emergency lighting / egress light	≥90 min / ≥1 foot-candle
Generator restore / fuel	≤10 sec / ≥90 min
Fire drills	1/shift/quarter (12/yr)
Sprinklers (new HC)	required throughout

Fire vs smoke door: 1-hr FIRE wall→45-min door · 2-hr FIRE wall→90-min door · 1-hr SMOKE wall→20-min door.
Hazardous areas (soiled linen/trash >64 gal, storage >100 sq ft, boiler, kitchen): 1-hr enclosure OR sprinklers + self-closing door — bigger/higher-hazard need both.
Defend-in-place: relocate residents horizontally across the smoke barrier — do NOT evacuate the building first.
Extinguisher classes: A ordinary · B liquids · C electrical · D metals · K kitchen grease. Service: monthly visual + annual maintenance.
Testing: fire alarm annual · generator monthly under load (~30 min) + annual · exit signs ≥6-in letters, illuminated.

CROSS-CUTTING — CLINICAL & SAFETY

Pressure injury: St.1 intact red · St.2 partial-thickness (dermis/blister) · St.3 full-thickness + visible fat · St.4 bone/tendon/muscle · Unstageable = slough/eschar · DTI = maroon/purple.
Falls: assess → intervene → document; repeated falls → reassess care plan + document acceptance/refusal.
Delegation: RN may delegate tasks but NOT assessment, judgment, teaching, or unstable residents; delegator keeps accountability.
Precautions: standard for all; transmission-based = contact, droplet, airborne. Documentation: factual, timely; never falsify.
End of life: hospice = comfort, terminal (~6 mo); palliative = comfort any stage; honor DNR/advance directives. Transfer trauma = relocation stress.
OSHA: bloodborne-pathogen plan, SDS/hazard communication, sharps, Hep B within 10 days, safe lifting.

CROSS-CUTTING — NUTRITION, DIETARY & MED SAFETY

Therapeutic diets: low-sodium (cardiac/renal) · consistent-carb/diabetic · renal · mechanical-soft & pureed + thickened liquids (dysphagia) · NPO. RD assesses; honor preferences.
Red flags: unintended weight loss, poor intake, dehydration. Aspiration prevention: upright, swallow eval, supervised meals.
Food safety: FIFO rotation · separate boards · handwashing · exclude sick workers · 41–135°F danger zone · cook 165 · sanitize 180.
Med safety: 6 rights · high-alert & look-alike/sound-alike · non-punitive error reporting · controlled-substance count & locked storage · polypharmacy/Beers caution · gradual dose reduction for antipsychotics.

CROSS-CUTTING — BEHAVIOR, DEMENTIA & RESTORATIVE

Dementia behaviors (wandering, sundowning, agitation): find the trigger, redirect, validate, adjust environment — non-drug before restraints/antipsychotics.
Tell apart: delirium = acute, reversible · dementia = chronic, progressive · depression = mood. Sudden confusion → work up delirium.
Restorative: ROM, ambulation, prevent contractures, gait belt, safe transfers — maintains function.
Pain: assess verbally and nonverbally (PAINAD) for those who can’t self-report.

RCAL FOCUS — Social / Residential Model (≈75% Care)

Model = SOCIAL/RESIDENTIAL. Signals: Assisted Living, Residential Care, Service Plan/ISP, social model, negotiated risk, aging in place. Governed by STATE licensure (MN 144G) — not CMS/OBRA.
Service Plan/ISP: from an assessment; reviewed annually AND on any condition/needs change (NOT quarterly — that’s SNF/MDS).
Negotiated Risk Agreement: signature RCAL doc — resident makes an informed risky choice (desserts w/ diabetes); educate, document, honor autonomy.
Aging in place driven first by health conditions/care needs. Move-out only when needs exceed what the community can safely provide.
Self-determination wins: a capable resident’s wishes outrank family/POA preferences (e.g., choosing a roommate).
Activities: social/history assessment on admission + periodic; match to individual preferences. Dementia activities = short & varied.
Meds in AL: self-administer if assessed safe; adverse event → reassess ability, don’t auto-revoke. Repackaging per state regs.
Services: RC/AL provides transportation, meals, activities, ADL support — NOT skilled nursing/PT/dental in-house. Neighborhood model = most beneficial.
Resident council: residents recommend how concerns are addressed (doesn’t run management). Mail delivered unopened.

RCAL FOCUS — ADMISSIONS, RIGHTS & MED HANDLING

Residency agreement: discloses services, fees, move-out criteria, rights — at/before move-in.
Move-out/termination: written notice + valid reasons (needs exceed capacity, nonpayment, danger) + relocation help/appeal.
Med distinctions: self-administration vs assistance (cueing/opening/steadying) vs administration (staff gives) — varies by state.
Person-centered: resident directs routine, dining, activities; service plan flows from initial assessment, updated on change.

RCAL FOCUS — LEVELS OF CARE, MEMORY CARE & TRAINING

Levels of care: service tiers tied to assessed needs; reassess on change.
Memory care: controlled egress, specialized dementia training, structured enrichment, disclosed philosophy.
Staff training: orientation before resident care, ongoing in-service, dementia-specific, med-assistance per state.
Tenant rights: privacy of the apartment, notice before entry — it’s the resident’s home.

CORE FOCUS — Finance, HR, Operations & Leadership

Four statements: Balance sheet (snapshot; Assets = Liabilities + Equity) · Income statement (over a period; revenue−expenses) · Cash flow · Statement of changes in equity.
Cash flow reflex: A/R ↓ = cash up (collected) · A/P ↑ keeps cash longer · buying inventory uses cash · more census helps future revenue (delayed).
Budgets: operating (day-to-day) · capital (long-term assets) · zero-based (justify from scratch). Variance = budget vs actual.
Payers: Medicare = short-term skilled (A/B/C/D); SNF 100 days, 3-day stay, 1–20 full / 21–100 copay, new period after 60 days out. Medicaid = primary for long-term NH care; HCBS = community. PPS = fixed prospective payment.
Motivation: Maslow · Herzberg (hygiene vs motivators) · McGregor (X/Y). Progressive discipline: verbal→written→suspension→termination. Fringe benefits NOT legally required.

Employment laws

FLSA	min wage; OT >40 hr/wk
FMLA	12 wk unpaid; 50+ emp; 1,250 hr/yr
COBRA	own cost +2%; 18 mo; 20+ emp
ADA	reasonable accommodation
Title VII	no race/sex/religion bias
ADEA	protects age 40+
OSHA	workplace safety; 8 hr death / 24 hr hosp.
NLRA	right to organize

COBRA trap: employee pays the FULL premium (their share + employer’s) + up to 2%. Employer pays nothing.

Finance trigger words (stem cue → answer)

snapshot / point in time / assets = liab + equity	Balance sheet
over a period / revenue − expenses / net income	Income statement
cash in & out / operating-investing-financing	Cash flow statement
spreads an asset’s cost over its useful life	Depreciation
fixed costs ÷ (price − variable cost)	Break-even point
does NOT change with volume (rent, salaries)	Fixed cost
changes with volume (food, supplies)	Variable cost
budget vs actual / favorable or unfavorable	Variance analysis
justify every dollar from zero	Zero-based budget
current assets ÷ current liabilities	Current ratio
(current assets − inventory) ÷ current liab	Quick / acid-test
money owed TO the facility / uncollected	Accounts receivable
short-term, skilled, 100 days, 3-day stay	Medicare Part A
long-term NH care / means-tested	Medicaid
fixed prospective payment regardless of cost	PPS

Every calculation you can be asked (formula → example)

Working capital = CA − CL	$500k − $300k = $200,000
Current ratio = CA ÷ CL	$500k ÷ $300k = 1.67
Quick = (CA − Inventory) ÷ CL	($500k−$50k) ÷ $300k = 1.5
Debt-to-equity = Liabilities ÷ Equity	$400k ÷ $200k = 2.0
Equity = Assets − Liabilities	$1.0M − $600k = $400,000
Net income = Revenue − Expenses	$1.0M − $880k = $120,000
Operating margin = Op Income ÷ Revenue	$125k ÷ $1.0M = 12.5%
Contribution margin = Price − Variable	$5,000 − $2,000 = $3,000
Break-even census = FC ÷ (Price − Variable)	$500k ÷ $3,000 = 167 residents
Depreciation (SL) = (Cost − Salvage) ÷ Years	($45k−$5k) ÷ 8 = $5,000/yr
Variance = Actual − Budget	over budget on expense = unfavorable
Patient days = residents × days	35 × 30 = 1,050 days
Avg Daily Census = Patient Days ÷ Days	1,050 ÷ 30 = 35
Occupancy = Patient Days ÷ (Beds × Days)	1,050 ÷ 1,200 = 87.5%
Cost per resident day = Cost ÷ Patient Days	$4,200 ÷ 1,050 = $4.00/day
A/R = (Occupied − Prepaid) × Rate	(35−4) × $2,000 = $62,000
FTEs = Total Annual Hours ÷ 2,080	1 FTE = 40×52 = 2,080 hr/yr
Nursing hours = HPPD × census	3.5 × 60 = 210 hr/day
Payback = Initial Cost ÷ Annual Savings	$20k ÷ $5k = 4 years
ROI = (Gain − Cost) ÷ Cost	($12k−$10k) ÷ $10k = 20%

Two trap-catchers: (1) always subtract salvage first in depreciation. (2) prepaid residents aren’t in A/R and empty beds aren’t billed → A/R = (occupied − prepaid) × rate.

CORE FOCUS — HR, LEGAL & RISK

HR cycle: job analysis → description → recruitment → selection → orientation → appraisal. At-will employment; document discipline. EEOC enforces.
Harassment: quid pro quo vs hostile work environment; employer can be liable. Workers’ comp = work injuries; unemployment = involuntary loss.
Negligence = duty + breach + causation + damages. Know informed consent, False Claims Act, Anti-Kickback, Stark. Risk mgmt: incident reports, root-cause analysis, sentinel events, liability insurance.
Leadership styles: autocratic · democratic · laissez-faire; transformational (inspires) vs transactional (rewards/penalties). SWOT for strategy. Policy = what/why; procedure = how.

CORE FOCUS — REIMBURSEMENT & STRATEGY

Cost-sharing: deductible (pay first) · coinsurance (% share) · copay (flat). SNF payment = PDPM (case mix from MDS); value-based purchasing & quality reporting affect payment.
Capital budgeting: payback period & NPV. Depreciation methods: straight-line (even) vs accelerated/declining-balance.
Marketing 4 Ps: Product · Price · Place · Promotion. Census development = referral relationships.
Strategic planning: mission/vision/values → SWOT → goals → objectives → action plans. MBO, balanced scorecard.

CORE FOCUS — GOVERNANCE, LEGAL & ENFORCEMENT

Structures: for-profit · nonprofit · LLC. Governing board = fiduciary duty, sets policy, hires administrator — not daily ops.
Three credentials: licensure = state · certification = Medicare/Medicaid · accreditation = voluntary (Joint Commission, CARF).
Enforcement remedies: directed POC · civil money penalties · denial of payment · temporary management · termination. Immediate Jeopardy = fastest/most severe.
Disputing deficiencies: IDR / Independent IDR. Compliance program (7 elements) + whistleblower protection.

If the stem says…	→ Answer
snapshot / point in time / what we own & owe	Balance sheet
assets = liabilities + equity	Balance sheet
over a period / revenue − expenses / net income / P&L	Income statement
cash in & out / operating-investing-financing	Cash flow statement
spreads an asset’s cost over its useful life	Depreciation
fixed costs ÷ (price − variable cost)	Break-even point
where revenue crosses total cost	Break-even point
does NOT change with volume (rent, salaries)	Fixed cost
changes with volume (food, supplies)	Variable cost
budget vs actual / favorable or unfavorable	Variance analysis
justify every dollar from zero each cycle	Zero-based budget
big purchase / building / equipment	Capital budget
day-to-day operating revenue & expenses	Operating budget
current assets ÷ current liabilities	Current ratio
(current assets − inventory) ÷ current liab.	Quick / acid-test ratio
money owed TO the facility / uncollected	Accounts receivable
money the facility OWES to others	Accounts payable
short-term, skilled, 100 days, 3-day stay	Medicare Part A
primary payer for long-term NH care / means-tested	Medicaid
fixed prospective payment regardless of cost	PPS
cost per unit / total cost ÷ census-days	Per-diem cost

Key Numbers & Diagrams

Physical plant, Life Safety Code, ADA, CMS, clinical & finance — the figures and visuals the exam asks for.

When codes conflict, the most stringent standard governs. The Life Safety Code (NFPA 101) is surveyed separately.

Most-tested visuals

Scope & Severity Grid (A–L)

Use the grid to find the risk level of a survey finding.

JKL

Immediate Jeopardy

Serious risk to health/safety.

GHI

Actual Harm

Harm has occurred.

DEF

Potential > minimal

ABC

Potential minimal

A,B = substantial compliance.

💡

How to read: severity on the left, scope across the top; the box where they cross (A–L) is the risk level. J/K/L are the worst (Immediate Jeopardy). A/B = substantial compliance; C and up need a Plan of Correction.

Medicare SNF Coverage — 100 Days

Benefit period timeline

Requires a 3-day qualifying inpatient hospital stay first.

✓ Days 1–20: fully paid
✓ Days 21–100: daily copay/coinsurance
✓ After day 100: no coverage in the benefit period

ℹ

Key reminders: up to 100 days per benefit period; a new benefit period starts after 60 consecutive days out of a hospital/SNF; nothing is covered after day 100.

Resident Room & Bath — Key Dimensions

PHYSICAL PLANT · ACCESSIBILITY

Grab bars

33–36″ high

60″ wheelchair turn

clear turning diameter

Door 44″

32″ min clear width

Area

100 sq ft single / 80 shared

Break-Even Point

FINANCE · BREAK-EVEN

⚖ Break-even = fixed costs ÷ (price − variable cost)

Below the point you lose money; above it you profit. Where revenue crosses total cost is break-even.

Physical plant & safety

Life Safety — Corridors & Egress

NFPA 101 health care

🔥

Corridors 8 ft clear; resident-room doors 44″ (bed fits); stair doors 36″; minimum clear egress 32″. Dead-end corridors 30 ft max. Travel to exit 200 ft; smoke compartment 22,500 sq ft.

Accessibility (ADA)

grab bars & ramps

♿

Grab bars mount 33–36″ above the floor. Ramps max slope 1:12 (1″ rise per 12″ run), max 30″ rise per run. Wheelchair turning circle 60″; door clear 32″.

Key Temperatures

water & food safety

🌡

Resident taps 105–120°F (anti-scald); heater ≥120°F for Legionella. Food danger zone 41–135°F; cook/reheat to 165°F; dish sanitizing rinse 180°F.

Smoke Compartments

life safety / defend-in-place

🚬

Each smoke compartment ≤22,500 sq ft (nursing home); travel to a smoke-barrier door ≤200 ft; barrier walls are 1-hour; at least 2 compartments per floor. Adjacent compartment holds residents (30 sq ft each).

Fire Safety — RACE, PASS & the Fire Triangle

emergency response

🔥

Fire triangle: heat + fuel + oxygen. RACE = Rescue, Alarm, Confine, Extinguish/Evacuate. PASS = Pull, Aim, Squeeze, Sweep. Extinguisher reach 75 ft; fire drills 1 per shift per quarter.

Clinical & operations

MDS / RAI Assessment Timeline

resident assessment

📅

Admission MDS within 14 days; quarterly review ≤92 days; full annual ≤366 days; significant-change within 14 days. Care plan within 7 days of the assessment.

Survey → Deficiencies → Plan of Correction

enforcement flow

📋

Surveyors cite deficiencies on the CMS-2567. The facility responds with a Plan of Correction (POC), generally due within 10 calendar days. Immediate Jeopardy gets the fastest remedies.

Five-Star Quality Rating

Care Compare

⭐

CMS rates facilities 1–5 stars from 3 sources: health inspections, staffing, and quality measures. Health inspection carries the most weight.

Chain of Command

organization & governance

🏢

The governing body holds ultimate legal authority and sets policy; the administrator implements it and reports up. Span of control = how many people report to one manager.

Progressive Discipline

HR / corrective action

⚙️

Discipline normally escalates step by step: verbal → written → suspension → termination. Document each step. Gross misconduct can skip steps.

Life Safety Code (NFPA 101)

Corridor width (new)	8 ft clear
Room / exit-access door	44 in
Stair / exit door	36 in
Min clear egress door	32 in
Dead-end corridor (new)	30 ft max
Travel distance to exit	200 ft
Smoke compartment (NH)	22,500 sq ft
Smoke barrier wall	1-hour
Hazardous-area door	¾-hr self-closing

ADA / Accessibility

Ramp slope (max)	1:12
Ramp max rise/run	30 in
Handrail height	34–38 in
Grab bar height	33–36 in
Door clear width	32 in min
Wheelchair turning circle	60 in
Toilet seat height	17–19 in

CMS Physical Environment

Single room	100 sq ft
Multi-resident room	80 sq ft/resident
Max residents/room (exist/new)	4 / 2
Resident-area temperature	71–81°F
Hot water at fixtures	105–120°F
Dining + activity space	~25 sq ft/resident

Food Safety Temperatures

Cold / hot holding	≤41°F / ≥135°F
Danger zone	41–135°F
Cook poultry / reheat	165°F
Refrigerator / freezer	≤41°F / 0°F
Dish sanitizing rinse	180°F

Fire & Emergency

Fire extinguisher reach	75 ft (Class A)
Fire drills	1/shift/quarter (12/yr)
Emergency lighting	90 min
Generator restores power	10 sec
RACE	Rescue-Alarm-Confine-Extinguish
PASS	Pull-Aim-Squeeze-Sweep

OSHA

Report fatality	8 hours
Report hospitalization	24 hours
OSHA 300 log retention	5 years
Exposure/SDS records	30 years
Hep B vaccine offered	within 10 days
Noise PEL	90 dBA

Memory hooks: 8-ft halls, 44″ doors, 32″ minimum, 1:12 ramp, 33–36″ grab bars, 71–81°F rooms, 41–135°F danger zone, 165°F cook, 8 hr fatality / 24 hr hospitalization, J/K/L = Immediate Jeopardy.

Domain	% of exam	~ # Q
1 – Care, Services & Supports	39%	~39
2 – Operations	37%	~37
3 – Environment & Quality	13%	~13
4 – Leadership & Strategy	11%	~11

Domain	NHA	RCAL	HCBS
1 – Care, Services & Supports	45%	75%	47%
2 – Operations	28%	12%	28%
3 – Environment & Quality	27%	13%	25%

Care-Model Signal Words

Master Cheat Sheet

Finance Trigger Words

Visual Reference — Photos & Numbers

Key Numbers & Diagrams

Most-tested visuals

Physical plant & safety

Clinical & operations

Life Safety Code (NFPA 101)

ADA / Accessibility

CMS Physical Environment

Food Safety Temperatures

Fire & Emergency

OSHA

What Your NAB Score Means

Raw score vs. scaled score

How many questions actually count

The raw cut score moves with form difficulty

CORE — domain weighting

LOS exams — domain weighting (NHA / RCAL / HCBS)