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This document outlines deficiencies identified during a survey of the Res Care Community Alternatives SE IN facility, along with the provider's plan of correction regarding these deficiencies.

How to fill out statement of deficiencies and

How to fill out STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

1. Identify the specific deficiencies noted during the inspection.
2. Provide clear and concise descriptions of each deficiency in the corresponding sections of the form.
3. Include the regulatory citation or standard related to each deficiency.
4. Outline a plan of correction for each deficiency, detailing steps to be taken to address the issue.
5. Assign responsibility for implementing the plan of correction to specific staff members.
6. Establish a timeline for completion of the corrective actions.
7. Include any relevant supporting documentation or evidence of compliance.
8. Review the completed form for accuracy and clarity before submission.

Who needs STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION?

1. Healthcare facilities undergoing inspections by regulatory agencies.
2. Providers receiving citations for non-compliance with healthcare regulations.
3. Organizations that need to demonstrate their commitment to quality improvement.
4. Facilities seeking to rectify issues in order to maintain or regain accreditation.

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 used primarily in healthcare and regulatory environments to report any deficiencies identified during inspections or audits and outline a corrective action plan to address these deficiencies.

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

Facilities, organizations, or providers that are subject to regulatory inspections, such as healthcare facilities and nursing homes, are required to file a STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION when deficiencies are identified.

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

To fill out the STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION, the entity must provide a detailed account of the deficiencies noted, including specific regulatory criteria that were not met, and outline a corrective action plan that specifies how each deficiency will be addressed, including timelines and responsible parties.

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 document areas of non-compliance, ensure accountability in rectifying these issues, and facilitate continuous improvement in service quality and safety within the organization.

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

The information reported must include the specific deficiencies identified, relevant regulatory citations, a detailed plan of correction for each deficiency, target completion dates, and the person responsible for implementing the corrections.