Survey Process and Citations Flashcards

A Plan of Correction (PoC) submitted by a facility must include which of the following elements?

Answer: How the deficiency will be corrected, a completion date, and how compliance will be maintained

A valid PoC must address correction of the specific deficiency, the completion date, and ongoing monitoring to maintain compliance.

Which of the following triggers an Immediate Jeopardy (IJ) declaration during a survey?

Answer: A situation where a facility's noncompliance has caused or is likely to cause serious injury or death

Immediate jeopardy requires that noncompliance caused or is likely to cause serious harm, injury, impairment, or death.

During a revisit survey, the surveyor's primary goal is to:

Answer: Verify that previously cited deficiencies have been corrected

A revisit is a targeted follow-up to confirm that deficiencies cited in the prior survey have been corrected.

The closed record review task during a nursing home survey examines records of residents who:

Answer: Were discharged or died during a defined look-back period

Closed records are those of recently discharged or deceased residents and are reviewed to identify care issues not visible in current residents.

Which regulatory tag is associated with nursing home residents' rights to be free from abuse, neglect, and exploitation?

Answer: F600

F600 covers the requirement that residents are free from abuse, neglect, misappropriation, and exploitation.

A surveyor discovers that a facility failed to investigate and report an allegation of resident-to-resident abuse. The MOST appropriate action is to:

Answer: Cite deficiencies under abuse prohibition and reporting requirements

Failure to investigate and report abuse allegations constitutes a citable deficiency independent of local law enforcement action.

What is the significance of the 'kitchen sink' approach in surveying, and why is it discouraged?

Answer: It means citing every minor issue observed, which dilutes focus on serious deficiencies

Citing trivial deficiencies alongside serious ones reduces the impact of significant findings and misallocates enforcement resources.