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This document outlines the results of a Life Safety Code Recertification Survey conducted for Occazio Inc., detailing compliance with Medicaid requirements and life safety regulations.
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How to fill out STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

01
Start with the title 'Statement of Deficiencies and Plan of Correction' at the top of the document.
02
Include the name of the facility and the date of the assessment.
03
List each deficiency identified during the assessment, providing a clear description of the issue.
04
For each deficiency, specify the regulatory requirement that was not met.
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Describe the root cause of each deficiency to provide context.
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Outline the corrective actions that will be taken to address each deficiency.
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Set a timeline for the implementation of each corrective action.
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Assign responsibility for the completion of each corrective action to specific staff members.
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Include a system for monitoring progress and effectiveness of the corrective actions.
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Review the document for accuracy and completeness before submission.

Who needs STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION?

01
Healthcare facilities that are subject to regulatory compliance assessments.
02
Administrators and management responsible for quality assurance and improvement.
03
Staff involved in the implementation of corrective actions.
04
Regulatory agencies reviewing compliance with health and safety standards.
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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.
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.
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.
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.
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.
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.
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.

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A Statement of Deficiencies and Plan of Correction (SOD & POC) is a formal report that outlines the deficiencies found during regulatory inspections of healthcare facilities and the corresponding plans to correct these deficiencies.
Healthcare facilities and providers that are subject to regulatory oversight, including nursing homes, hospitals, and other long-term care facilities, are required to file a Statement of Deficiencies and Plan of Correction after receiving notice of deficiencies.
To fill out an SOD & POC, facilities need to review the deficiencies cited, outline a detailed plan for correcting each deficiency, establish a timeline for correction, assign responsible parties, and ensure that the plan addresses the issues raised in the inspection.
The purpose of the SOD & POC is to ensure that healthcare facilities identify and address deficiencies in their operations, thereby improving the quality of care provided and ensuring compliance with health regulations.
The SOD & POC must report information including the specific deficiencies identified, a description of corrective actions to be taken, responsible individuals for implementing those actions, timelines for correction, and mechanisms for monitoring progress.
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