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0938-0391 STATEMENT OF DEFICIENCIES X1 PROVIDER/SUPPLIER/CLIA AND PLAN OF CORRECTION IDENTIFICATION NUMBER 151586 X2 MULTIPLE CONSTRUCTION A. BUILDING X3 DATE SURVEY COMPLETED 12/20/2011 B. WING STREET ADDRESS CITY STATE ZIP CODE NAME OF PROVIDER OR SUPPLIER 6431 S EAST ST INDIANAPOLIS IN46227 VISTACARE HOSPICE X4 ID SUMMARY STATEMENT OF DEFICIENCIES ID PREFIX EACH DEFICIENCY MUST BE PERCEDED BY FULL TAG REGULATORY OR LSC IDENTIFYING INFORMATION ...

How to fill out statement of deficiencies and

How to fill out STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

1. Begin by gathering information about the deficiencies observed during the inspection.
2. Clearly identify and describe each deficiency, including specific regulations or standards that were not met.
3. For each deficiency, provide a detailed plan of correction that outlines the steps that will be taken to rectify the issues.
4. Include responsible parties and timelines for each corrective action to ensure accountability.
5. Make sure to review the document for clarity and completeness before submission.
6. Submit the completed Statement of Deficiencies and Plan of Correction to the appropriate regulatory body by the deadline.

Who needs STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION?

1. Healthcare facilities that are subject to inspections and need to address deficiencies reported by regulatory agencies.
2. Providers and organizations seeking to maintain compliance with health and safety regulations.
3. Any entity required to submit a formal response to regulatory deficiencies to avoid penalties or sanctions.

People Also Ask about

What are the levels of deficiency in CMS?

There are three scope levels assigned to a deficiency: isolated, pattern, or widespread. The survey agency determines the scope and severity levels for each deficiency cited on a survey.

Which of the following elements must your plan of correction include?

Element 1: How the corrective action will be accomplished for identified affected individuals. Element 2: How will other individuals with the potential to be affected or in similar situations be identified and protected. Element 3: What systemic changes will ensure that the deficient practice will not recur.

What level is a plan of correction not required for?

There are three scope levels assigned to a deficiency: isolated, pattern, or widespread. The survey agency determines the scope and severity levels for each deficiency cited on a survey.

How do you write an acceptable plan of correction?

An acceptable Plan of Correction will include both immediate corrective actions to correct the violation and long-term quality improvement actions, with each element including who is responsible, when it will be done, and what action has been or will be taken.

In which case would a facility not have to submit a plan of correction?

A facility is not required to submit a plan of correction when it has deficiencies that are isolated and have a potential for minimal harm, but no actual harm has occurred.

How long does an IJ last?

In all cases of immediate jeopardy, the provider agreement must be terminated by CMS or State Medicaid Agency no later than 23 calendar days from the last day of the survey if the immediate jeopardy is not removed.

How to write a statement of deficiency?

To write a Statement of Deficiencies, three elements must be completed: • Gather enough strong evidence. Differentiate finding and deficient practice or noncompliance. Based on a regulation/requirement, recognize what the entity failed to do. Don't wait until near the end of the survey.

For pdfFiller’s FAQs

What is STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION?

The Statement of Deficiencies and Plan of Correction is a document that outlines the deficiencies identified during a facility's inspection and provides a plan for how those deficiencies will be addressed and rectified.

Who is required to file STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION?

Licensed healthcare facilities, such as hospitals, nursing homes, and assisted living facilities, are required to file a Statement of Deficiencies and Plan of Correction when deficiencies are identified during state or federal inspections.

How to fill out STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION?

To fill out the Statement of Deficiencies and Plan of Correction, facilities must list each deficiency identified, provide a detailed explanation of the issue, outline corrective actions they will take, and state the timeline for implementation.

What is the purpose of STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION?

The purpose of the Statement of Deficiencies and Plan of Correction is to ensure that facilities address problems affecting the quality of care and safety of patients, thereby improving overall compliance with health regulations.

What information must be reported on STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION?

The information reported must include the specific deficiencies, the regulatory citations related to those deficiencies, the proposed corrective actions, assigned responsibilities for implementation, and the timeframe for action.