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0938-0391 X2 MULTIPLE CONSTRUCTION A. BUILDING B. WING 291500 NAME OF PROVIDER OR SUPPLIER 05/13/2011 STREET ADDRESS CITY STATE ZIP CODE 4141 S SWENSON NATHAN ADELSON HOSPICE X4 ID PREFIX TAG X3 DATE SURVEY COMPLETED LAS VEGAS NV 89119 SUMMARY STATEMENT OF DEFICIENCIES EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION L 000 INITIAL COMMENTS PROVIDER S PLAN OF CORRECTION EACH CORRECTIVE ACTION SHOULD BE CROSS-REFER...

How to fill out statement of deficiencies and

How to fill out STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

1. Read the instructions provided with the Statement of Deficiencies and Plan of Correction (SDPC).
2. Identify the areas of deficiencies that need to be reported based on the facility's self-assessment or inspection outcomes.
3. Fill out the Statement of Deficiencies section, detailing each deficiency observed, referencing relevant regulations.
4. Specify the dates and locations where deficiencies were identified.
5. In the Plan of Correction section, outline specific actions that will be taken to address each deficiency.
6. Assign responsibilities to individuals or teams for implementing the plan.
7. Set a timeline for completing the corrective actions.
8. Include any necessary resources needed to implement the plan.
9. Review the completed document for accuracy and completeness before submission.
10. Ensure the document is signed and dated by the appropriate authority.

Who needs STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION?

1. Healthcare facilities seeking to demonstrate compliance with regulatory standards.
2. Providers undergoing inspections or surveys by regulatory agencies.
3. Organizations required to address identified deficiencies in service delivery.
4. Stakeholders involved in quality assurance and improvement processes.

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 (SOD/PAC) is a formal document used by healthcare facilities to identify deficiencies found during inspections and outline their plans to address these deficiencies to meet regulatory standards.

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

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

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

To fill out the SOD/PAC, the facility must review the deficiencies identified during the inspection, develop a corrective action plan for each deficiency, and provide timelines for implementation as well as assign responsible staff for each action.

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

The purpose of the SOD/PAC is to ensure that healthcare facilities acknowledge their deficiencies, take responsibility, and establish a clear plan to correct the issues in order to maintain compliance with safety and quality standards.

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

The SOD/PAC must report details including the specific deficiencies identified, the actions to be taken to correct each deficiency, timelines for completion, and the individuals responsible for ensuring the corrective measures are implemented.