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This document outlines deficiencies found in the nursing services at Kindred Hospital Northwest Indiana during a state survey, along with the provider's plan of correction for addressing these deficiencies.

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 and the date of the survey.
2. Clearly identify each deficiency, including the citation and the relevant regulation.
3. Provide a detailed description of the deficiency, explaining the specific circumstances.
4. Outline the plan of correction for each deficiency, including steps that will be taken to rectify the issue.
5. Assign responsibilities to staff or team members for implementing the corrections.
6. Set a timeline for when the corrections will be completed.
7. Include a systemic analysis indicating how the deficiencies will be prevented in the future.
8. Ensure that the plan is signed and dated by an authorized representative of the facility.

Who needs STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION?

1. Healthcare facilities undergoing surveys from regulatory bodies.
2. Facilities that need to demonstrate compliance with health and safety regulations.
3. Organizations seeking to improve quality of care and patient safety.

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 that outlines non-compliance findings identified during an inspection or audit of a healthcare facility, along with a plan detailing how the facility intends to address and rectify these deficiencies.

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

Healthcare facilities that receive a notice of deficiencies following an inspection or audit are required to file a Statement of Deficiencies and Plan of Correction. This includes nursing homes, hospitals, and other care facilities that are subject to regulatory oversight.

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

To fill out the Statement of Deficiencies and Plan of Correction, facilities should identify each deficiency cited during the inspection, describe the specific corrective actions they will take, establish a timeline for completion of those actions, and assign responsibility for implementation. Additionally, facilities must provide a summary of how these actions will ensure compliance with regulations.

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 formally acknowledge non-compliance with regulatory standards and to provide a structured approach for the facility to correct those deficiencies, ultimately improving care quality and ensuring patient safety.

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

The information that must be reported includes a detailed list of deficiencies identified, the facility's proposed corrective actions for each deficiency, timelines for implementation, responsible parties for each action, and any necessary resources required to achieve compliance.