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Date ArticleType
3/5/2018 Regulatory
IJ/SSQC/G Citations Update – Knowing the trends might help you avoid high scope and severity tag citations.

There was a total of 42 recertification surveys completed by the Indiana State Department of Health in the month of January.  Of those, six (14.29%) were found to be deficiency free.  Six (6) providers received a total of 6 IJ/SSQC citations. The IJ/SSQC tags are as follows:

F678 (3 times) Cardio-Pulmonary Resuscitation (CPR)

§483.24(a)(3) Personnel provide basic life support, including CPR, to a resident requiring such emergency care prior to the arrival of emergency medical personnel and subject to related physician orders and the resident’s advance directives. 
The facility failed to initiate Cardiopulmonary Resuscitation (CPR) for a resident who was found unresponsive with no respirations or pulse.  The resident had chosen no advanced directive and would have been a full code. 
The facility failed to initiate Cardiopulmonary Resuscitation (CPR) on a resident with a full code status, who showed signs of Cardiac and Respiratory arrest which resulted in death of a resident.
The facility failed to immediately initiate CPR (Cardiopulmonary Resuscitation) for a resident who was found, unresponsive, whose code status was unclear, and to promptly notify the physician of the resident’s change in condition.
F686 (2 times) Treatments/Services to Prevent/Heal Pressure Ulcer

§483.25(b) Skin Integrity

§483.25(b)(1) Pressure Ulcers

Based on the comprehensive assessment of a resident, the facility must ensure that (i) A resident receives care, consistent with professional standards of practice, to prevent ulcers and does not develop ulcers unless the individual’s clinical condition demonstrates that they were unavoidable; and (ii) A resident with pressure ulcers receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infections and prevent new ulcers from developing.

The facility failed to prevent, identify, assess and treat pressure ulcers and DTI (Deep Tissue Injury) wounds. 
The facility failed to ensure interventions and treatments were in place for one resident who was at an increased risk for developing pressure ulcers and developed, in house, one unstageable pressure ulcer to the left heel and one stage four pressure ulcer to the left medial foot which resulted in above the knee amputation of the left leg.  Another resident with a healed pressure ulcer that reopened to a stage 3 pressure ulcer on the coccyx and a resident who developed a stage 3 pressure ulcer in the right gluteal fold acquired in the facility. 
F689 (2 times) Free of Accident Hazards/Supervision/Devices

§483.25(d)(1)(2)

The facility must ensure that the resident receives adequate supervision and assistance devices to [prevent accidents. 

The facility failed to provide supervision to an intrusive wandering resident and respond to residents’ complaints regarding and intrusive wandering resident. 
The facility failed to adequately supervise residents who resided on a locked Alzheimer’s Unit and had to be moved to an unsecured unit/wing.
There were a total of 22 G level citations as follows:

F689 (10 times) – Free of Accident Hazards/Supervision/Devices

The facility failed to ensure a gait belt was used during a transfer resulting in a fall with fracture.
The facility failed to ensure adequate safety procedure during personal care resulting in a fall.
The facility failed to ensure hot water temperatures were maintained within a safe range.
The facility failed to ensure a resident who required extensive assistance was provided supervision to prevent the resident from falling on the bed to the floor resulting in a neck fracture.
The facility failed to provide adequate supervision related to not providing care in pairs during a transfer resultin in a laceration requiring sutures.
The facility failed to use an appropriate and safe transfer method for a resident, resulting in a fractured shoulder. 
The facility failed to ensure services were provided to prevent falls for a resident who required assist for transfers and ambulation.  Resident fell while in the bathroom, call light sounding and resident was unattended.
The facility failed to ensure intervention were not implemented to prevent the resident from falling.  Resident fell, hospitalized for a subarachnoid hemorrhage head injury. 
The facility failed to provide adequate supervision to prevent a resident from burning his arm on a baseboard heater.
The facility failed to correctly assess a resident at risk for falls and failed to develop and implement a plan to prevent falls, resulting in a fall and fractured hip. 
F684 (4 times) – Quality of Care

The facility failed to provide adequate monitoring and treatments to a surgical incision resulting in hospitalization for an incision and drainage of a MRSA abscess. 
The facility failed to ensure that a resident’s vascular wounds were measured and assessed weekly; and failed to clarify physician orders and perform dressing changes and apply antibiotic ointment as recommended by the wound clinic. The resident was hospitalized for a wound infection and treatment.
The facility failed to notify the physician of abnormal sodium levels which prevented medical interventions and resulted in hospitalization for severe hypernatremia, severe dehydration, acute renal failure and rhabdomyolysis associated with renal failure.
F686 (4 times) Treatments/Services to Prevent/Heal Pressure Ulcer

The facility failed to notify the physician to obtain treatment, and to assess a pressure ulcer.
The facility failed to ensure a dependent resident admitted without pressure ulcers was provided effective interventions to prevent the development of an unstageable pressure ulcer on the left lateral foot and a stage 3 pressure ulcer on the bottom of the left foot.  
The facility failed to ensure a pressure ulcer was identified, assessed and monitored.
The facility failed to follow prevention interventions related to pressure development and the resident developed a pressure ulcer to the sacral region and deteriorated to a stage 3 and became infected. 
F688 (1 time) – Increase/Prevent Decrease in ROM/Mobility

The facility failed to ensure a dependent resident with limited range of motion (ROM) received appropriate treatment and services to prevent further decrease in range of motion related to splints not applied as ordered.
F697 (1 time) – Pain Management

The facility failed to ensure a resident’s pain was reassessed and managed effectively for a resident receiving comfort care. 
F600 (1 time) – Free from Abuse and Neglect

The facility failed to ensure resident to resident abuse did not occur.  Resident was injured.
F580 (1 time) – Notify of Changes (Injury, Decline, Room, etc.)

The facility failed to ensure the Medical Doctor was notified timely when resident had a significant change of condition. 
Resident cried out in pain for several days before her death without physician intervention.
Resident had multiple days of health complaints without physical intervention. Resident was transferred to the hospital and admitted with Congestive Heart Failure.

If you have questions or need assistance, email ldavenport@ihca.org.