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Date ArticleType
4/27/2017 Regulatory
Residential Care Citations and Regulatory Update

The Indiana State Department of Health conducted 18 surveys in the month of March. There was a total of 59 residential tag citations including 11 offense tags.

Nine facilities received an offensive tag for tag 0241 – Health Services for failure to ensure the administration of medications and the provision of residential nursing care was as ordered by the physician and supervised by a licensed nurse on the premises or on call. Medications shall be administered by licensed nursing personnel or qualified medication aides.

Two providers received offensive tag 052 – Resident Rights for failure to ensure the resident was free from (1) sexual abuse; (2) physical abuse; (3) mental abuse; (4) corporal punishment; (5) neglect; and (6) involuntary seclusion.

The most frequently cited residential tag (10 times) continues to be 0273 – Food and nutrition for failure to ensure all food preparation and serving areas (excluding areas in residents’ units) are maintained in accordance with state and local sanitation and safe food handling standards.

Four providers received residential tag 036 – Residents Rights for failure to ensure the facility immediately consulted with the resident’s physician and the resident’s legal representative when the facility noticed: (1) a significant decline in the resident’s physical, mental, or psychosocial status; or (2) a need to alter treatment significantly, that is a need to discontinue an existing form of treatment due to adverse consequences or to commence a new form of treatment.

Four providers received tag 117 – Personnel Deficiency for failure to ensure staff was sufficient in number, qualifications, and training in accordance with applicable state laws and rules to meet the 24-hour scheduled and unscheduled needs of the residents and services provided. The number, qualifications, and training of staff shall depend on skills required to provide for the specific needs of the residents. A minimum of one awake staff person, with current CPR and first aid certificates, shall be on site. If 50 or more residents of the facility regularly receive residential nursing services or administration of medication, or both, at least one 1 nursing staff person shall be on site always. Residential facilities with over 100 residents regularly receiving residential nursing services or administration of medication, or both, shall have at least one additional staff person awake and on duty always for every additional 50 residents. Personnel shall be assigned only those duties for which they are trained to perform. Employee duties shall conform with written job descriptions.

Tag 0217 – Evaluation Deficiency was cited in four locations for failure to ensure assessments were completed and identified and documented services to be provided by the facility as follows: (1) The services offered to the individual resident shall be appropriate to the: (A) Scope; (B) frequency; (C) need; and (D) preference; of the resident. (2) The services offered shall be reviewed and revised as appropriate and discussed by the resident and facility as needs or desires change. Either the facility or the resident may request a service plan review. (3) The agreed upon service plan shall be signed and dated by the resident, and a copy of the services plan shall be given to the resident upon request. (4) No identification and documentation of services provided is needed if evaluations after the initial evaluation indicate no need for a change in services. (5) If administration of medications or the provision of residential nursing services, or both, is needed, a licensed nurse shall be in involved in identification and documentation of the services to be provided.

Other residential tags cited during March are as follows:
Tag 090 – Administration and Management for failure to inform the division within twenty-four (24) hours of becoming aware of an unusual occurrence that directly threatens the welfare, safety, or health of a resident. Unusual occurrences include, but are not limited to: (A) epidemic outbreaks; (B) poisonings; (C) fires; or (D) major accidents.
Tag 0247 – Health Services for failure to ensure any error in medication administration was noted in the resident’s record. The physician was notified of the error in medication administration when there were actual or potential detrimental effects to the resident.
Tag 302 – Pharmaceutical Services for failure to ensure over-the-counter medications were identified with the following: (A) Resident name (B) Physician name (C) expiration date (D) Name of Drug (E) Strength.

If you have any questions or would like assistance in preparing for your upcoming survey, contact ldavenport@ihca.org.