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Date ArticleType
7/31/2017 Regulatory
G/IJ/SSQC Citation Update

The Indiana State Department of Health conducted a total of 55 Annual Recertification Surveys in June. Of those, five (9.09%) were deficiency-free. There was a total of 16 G level federal tags cited in 16 locations throughout Indiana. The G Level tags were as follows: F323 (5 times), F309 (4 times), F314 (4 times) F329 (1 time) and F315 (1 time).

F323 – Free of Accidents Hazards/Supervision/Devices for failure to provide the following:
• 1:1 supervision as was indicated by assessments to maintain resident’s safety from falls which resulted in a fall with injury that required acute medical intervention.
• Ensure the resident had on proper foot ware and devices were in place to prevent a fall from bed. The fall resulted in a facial injury.
• Ensure a safe transfer for a resident which resulted in a fracture of the resident’s upper arm.
• Ensure a resident was transferred properly with a Hoyer lift, resulting in a fall from the lift and a fractured hip.
• Ensure a resident received sufficient supervision to prevent an accident resulting in broken ribs because of a fall.

F309 – Provide Care /Services for Highest Well Being for failure to provide the following:
• Ensure timely assessments for a newly identified bruise and pain of a dependent resident with moderate cognitive impairments, for whom a lower leg fracture was later identified.
• Ensure timely physician notification and intervention after a fall for a resident who has sustained a fall that resulted in hospitalization and surgical repair of a left hip.
• Ensure end of care needs were provided to a resident receiving end of life care. This resulted in increased, persistent severe anxiety regarding death.
• Ensure resident reviewed for UTI received the appropriate treatment and care which resulted in the resident’s admission for six days in the intensive care unit and a diagnosis of severe dehydration, acute urinary tract infarction and acute hypernatremia.

F314 – Treatment/Services to Prevent/Heal Pressure Sores for failure to provide the following:
• Ensure physician orders and care plan interventions were followed to prevent the worsening of a stage 2 and unstageable pressure areas to stage 4 wounds.
• Ensure residents who were admitted with no pressure ulcers, did not develop pressure ulcers.
• Ensure interventions were in place for residents who were at an increased risk for developing pressure ulcers which resulted in a stage 3 pressure ulcer to the right heel and unstageable pressure ulcers to both heels.
• Ensure a resident admitted without a pressure ulcer, did not develop pressure ulcers. Resident developed a stage IV ulcer to the left buttock area and an unstageable would to the left heel. The facility failed to comprehensively assess and implement interventions to treat and promote healing after development of these wounds.

F329 – Drug Regimen is Free from Unnecessary Drugs for failure to provide the following:
• Ensure monitored blood glucose levels were completed as indicated by the hospital discharge orders resulting in hypoglycemia and required medical intervention.

F328 – Treatment/Care for Special Needs for failure to provide the following:
• To follow physician orders for the maintenance of a PICC line and failed to contact a physician with a significant change resulting in rehospitalization due to a clotted PICC line and pain for the resident.

F315 – No Catheter, Prevent UTI, Restore Bladder for failure to provide the following:
• To prevent an ulcer from forming at the site of catheter insertion resulting in pain.

There were four IJs and five SSQC citations for the month of June issued to five separate facilities. The SSQC or IJ citation are as follows:

F257 (QC/IJ) – Comfortable and Safe Temperature Levels for failure to implement effective interventions in a timely manner to maintain resident room and common area temperatures at or below 81 degrees F, placing residents at risk for adverse reactions to the high temperatures.

F257 (QC) – Comfortable and Safe Temperature Levels for failure to maintain comfortable temperatures between 71 and 81 degrees F.

F314 (QC/IJ) – Treatments to Prevent /Heal Pressure Sores for failure to prevent and treat unstageable/Stage 4 pressure ulcers resulting in 3 unstageable pressure ulcers to the left medial foot/ankle, left plant foot, and left lateral foot the progressed to Stage 4 with left lateral foot wound requiring IV antibiotic therapy for a wound infection.

F323(QC/IJ) – Free of Accident Hazards/Supervision/Devices for failure to immediately and completely investigate an observation of sexual encounter between two cognitively impaired residents and failed to provide adequate supervision to prevent a second encounter from occurring.

F223 (QC/IJ/) – Free from Abuse/Involuntary Seclusion for failure to ensure a resident was free from physical, verbal, and mental abuse resulting in potential psychological harm by staff videotaping a resident.

F225 (QC/IJ) – Investigate/Report/Allegations/Individual for failure to immediately report allegations of staff to resident abuse.

F226 (QC/IJ) – Develop/Implement Abuse/Neglect Etc. Policies for failure to implement their abuse policy regarding immediately reporting two allegations of staff to one resident abuse.

Contact Lori Davenport, ldavenport@ihca.org, with any questions.