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This document outlines the deficiencies found during a state licensure survey of Duncan Manor Group Home, along with the provider's plan of correction for the identified issues.

How to fill out statement of deficiencies and

How to fill out STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

1. Begin with the facility or organization name and address.
2. Include the date of the statement and the relevant survey or inspection reference number.
3. List the deficiencies identified during the survey in detail.
4. For each deficiency, provide a clear plan of correction that outlines the steps to be taken.
5. Assign responsibilities for each corrective action to specific individuals.
6. Specify timelines for the implementation of each corrective measure.
7. Include a section for staff training, if applicable, on changes made.
8. Review the document for accuracy and completeness before submission.
9. Sign and date the document by the responsible party.

Who needs STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION?

1. Healthcare facilities seeking compliance with state or federal regulations.
2. Organizations undergoing inspections or surveys from regulatory bodies.
3. Providers aiming to improve the quality of care by addressing identified deficiencies.
4. Facilities that wish to maintain or restore their accreditation status.

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 formal document used by healthcare facilities to report violations of regulatory standards and outline the steps the facility will take to address and correct these deficiencies.

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

Healthcare facilities that receive federal funding or are regulated by state health departments are required to file a Statement of Deficiencies and Plan of Correction following an inspection that identifies deficiencies.

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

To fill out the Statement of Deficiencies and Plan of Correction, facilities must accurately detail each deficiency noted during an inspection, provide a plan for correction which includes actions to be taken, timelines for implementation, and the person responsible for each corrective action.

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 compliance with regulatory standards, improve the quality of care provided to patients, and minimize the risk of harm by addressing identified deficiencies promptly.

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

The information that must be reported includes the specific deficiencies identified, a detailed plan of correction, timelines for corrective actions, responsible individuals, and any supporting documentation or evidence of compliance efforts.