1. Lisa Thomas RN-BC State Training Coordinator November 6, 2014

2.   Briefly review the 10 most frequently cited deficiencies for long term care providers from standard and complaint surveys for 2013  Discuss how many times each deficiency was cited on standard surveys  Discuss how many times each deficiency was cited on complaint surveys OBJECTIVES

3.   F282- Be provided by qualified persons in accordance with each resident’s written plan of care.  Appeared in the Top Ten Deficiencies list 10 times  Cited 51 times on standard surveys  Cited 19 times on complaint surveys §483.20(k)(3)(ii)

4.   F309 – Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care  Appeared in the Top Ten Deficiencies list every month of 2013.  Cited 91 times on standard surveys  Cited 34 times on complaint surveys §483.25 Quality of Care

5.   F312 – A resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene  Appeared in the Top Ten Deficiencies list 7 times.  Cited 52 times on standard surveys  Cited 20 times on complaint surveys §483.25 (a)(3)

6.   F314- Based on the comprehensive assessment of a resident, the facility must ensure that – (1)A resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable; and (2) A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing. §483.25 (c) Pressure Sores

7.   F314-  Appeared in the Top Ten Deficiencies list 11 times  Cited 66 times on standard surveys  Cited 20 times on complaint surveys §483.25 (c) Pressure Sores

8.   F323- The facility must ensure that- (1)The resident environment remains as free from accident hazards as is possible; and (2) Each resident receives adequate supervision and assistive devices to prevent accidents  Appeared in the Top Ten Deficiencies list 12 times  Cited 128 times on standard surveys  Cited 40 times on complaint surveys §483.25 (h) Accidents

9.  F328- The facility must ensure that residents receive proper treatment and care for the following special services:  Injections  Parenteral and Enteral Fluids  Colostomy, Ureterostomy, or Ileostomy Care  Tracheostomy Care  Standard: Tracheal Suctioning  Standard: Respiratory Care  Foot care  Prosthesis §483.25 (k) Special Needs

10.  F328-  Appeared in the Top Ten Deficiencies list 6 times  Cited 38 times on standard surveys  Cited 13 times on complaint surveys §483.25 (k) Special Needs

11.   F333- Residents are free of any significant medication errors  Appeared in the Top Ten Deficiencies list 8 times  Cited 49 times on standard surveys  Cited 14 times on complaint surveys §483.25 (m) Medication Errors

12.   F363 – Meet the nutritional needs of residents in accordance with recommended dietary allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences;  Be prepared in advance; and  Be followed  Appeared in the Top Ten Deficiencies list 9 times  Cited 45 times on standard surveys  Cited 17 times on complaint surveys §483.35 (c) Menus and Nutritional Adequacy

13.   F371-The facility must procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food under sanitary conditions  Procure food from sources approved or considered satisfactory by Federal, State or local authorities; and  Store, prepare, distribute and serve food under sanitary conditions  Appeared in the Top Ten Deficiencies list 12 times  Cited 86 times on standard surveys  Cited 11 times on complaint surveys §483.35 (i) Sanitary Conditions

14.   F441- The facility must establish and maintain an Infection Control Program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of disease and infection §483.65 Infection Control

15.  §483.65(a) Infection Control Program:  The facility must establish an infection Control Program under which it- (1)Investigates, controls, and prevents infections in the facility; (2)Decides what procedures, such as isolation, should be applied to an individual resident; and (3)Maintains a record of incidents and corrective actions related to infections §483.65 Infection Control

16.   §483.65(b) Preventing Spread of Infection (1)When the infection Control Program determines that a resident needs isolation to prevent the spread of infection, the facility must isolate the resident. (2)The facility must prohibit employees with a communicable disease or infected skin lesions from direct contact with residents or their food, if direct contact will transmit the disease §483.65 Infection Control

17.  §483.65(c) Linens – Personnel must handle, store, process and transport linens so as to prevent the spread of infection  Appeared in the Top Ten Deficiencies list 12 times  Cited 101 times on standard surveys  Cited 18 times on complaint surveys §483.65 Infection Control

18.   F157- notification  F225- Abuse Prohibition  F226- P&P on Abuse  F241- Dignity  F287- MDS records not electronically transmitted  F315- B&B program, restore, UTI’s  F322- tube feeding care  F329- unnecessary medications  F332- medication error rate 5% or greater  F364- loss of nutritive value, taste and appearance  F502- performed, timely, received promptly Miscellaneous Deficiencies