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This document outlines the deficiencies identified during a state licensure survey conducted at Duncan Manor Group Home, along with the provider's plan of correction for those deficiencies. It includes

How to fill out statement of deficiencies and

How to fill out STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

1. Begin with the facility's name, address, and identification number at the top of the document.
2. Clearly state the date of the deficiency survey and the specific citation numbers.
3. Describe each deficiency identified during the survey in detail, referencing the appropriate regulations.
4. For each deficiency, outline the plan of correction, specifying the actions that will be taken to resolve the issue.
5. Include a timeline for when each corrective action will be implemented.
6. Designate a responsible party for overseeing the implementation of each corrective action.
7. Review the completed document for accuracy and completeness before submission.
8. Submit the document to the appropriate regulatory body by the specified deadline.

Who needs STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION?

1. Healthcare facilities seeking compliance with regulatory standards.
2. Administrators and managers responsible for quality assurance in healthcare settings.
3. Regulatory agencies conducting inspections and surveys.
4. Staff involved in developing and implementing quality improvement plans.

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?

A Statement of Deficiencies and Plan of Correction is a formal document that outlines any deficiencies identified during an inspection of a healthcare facility and details the plan to correct those deficiencies.

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

Healthcare facilities that undergo inspections by regulatory agencies, such as nursing homes, hospitals, and assisted living facilities, are required to file a Statement of Deficiencies and Plan of Correction.

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

To fill out a Statement of Deficiencies and Plan of Correction, a facility must review the deficiencies noted in the inspection report, develop a specific plan addressing each deficiency, assign responsibility for correction, and establish a timeline for completion.

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

The purpose of a Statement of Deficiencies and Plan of Correction is to ensure that healthcare facilities take corrective action to address identified deficiencies, improve quality of care, and comply with regulatory standards.

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

The information that must be reported includes the specific deficiencies identified, the corrective actions planned, responsible individuals for each action, timelines for implementation, and any supporting documentation required.