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This document outlines the deficiencies identified during a state licensure survey of Creekside Hospice, detailing required corrective actions and compliance with regulatory standards.

How to fill out statement of deficiencies and

How to fill out STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

1. Obtain the STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION template from the relevant authority.
2. Fill out the facility name and address at the top of the document.
3. List the specific deficiencies identified during the inspection in clear and concise terms.
4. For each deficiency, provide a detailed plan of correction, including the steps that will be taken to address the issue.
5. Assign responsibilities for implementing the correction plan to specific staff members.
6. Set timelines for completing each corrective action.
7. Include any supporting documentation that may help clarify the correction plan.
8. Review the document for accuracy and completeness.
9. Sign and date the statement to verify its authenticity before submission.

Who needs STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION?

1. Healthcare facilities undergoing inspections
2. Organizations required to comply with health regulations
3. Providers seeking to maintain or regain accreditation
4. Facilities aiming to improve quality of care

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 (SOD/PAC) is a formal document that outlines areas where a facility, typically in healthcare or social services, does not meet regulatory standards. It also includes a plan to address these deficiencies and ensure compliance.

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

Facilities that are subject to regulatory inspections and findings, such as nursing homes, hospitals, and other healthcare providers, are required to file a Statement of Deficiencies and Plan of Correction when deficiencies are identified during surveys or audits.

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

To fill out the SOD/PAC, facilities should identify each deficiency, provide an explanation of the circumstances surrounding the deficiency, outline corrective actions taken or planned, assign responsibility, and set target dates for completion of these actions.

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

The purpose of the SOD/PAC is to document compliance issues, outline corrective actions to address these issues, and promote accountability within the facility to improve care and services provided to patients or clients.

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

The SOD/PAC must report information such as the specific deficiency citation, a description of the problem, immediate corrective actions taken, long-term strategies for preventing recurrence, staff responsible for implementation, and timelines for correction.