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Date ArticleType
10/2/2017 Regulatory
G/IJ/SSQC Citation Update – August 2017

The Indiana State Department of Health conducted a total of 62 Annual Recertification Surveys in August.  Of those, two (3.23%) were deficiency-free. There was a total of 19 G Level tags cited in 16 locations throughout Indiana. The G Level tags were as follows:  F314 (7 times), F323 (5 times), F325 (3 times), F223, F318, F511, and F309 were cited one time each. 

F314 – Treatment/Services to Prevent/Heal Pressure Sores for failure to provide the following:
• Prevent the development of a pressure ulcer for a resident with a known risk for skin breakdown.
• Ensure a resident admitted with a Stage 3 pressure ulcer did not worsen resulting in admission to hospital for diagnosis of osteomyelitis and sepsis related to MRSA (Methicillin-resistant Staphylococcus) in the wound and to ensure a resident did not develop a suspected deep tissue pressure area after admission.
• Properly assess and treat pressure ulcers, resulting in an unstageable pressure ulcer developing from an ACE wrap on the ankle and a pressure ulcer worsening to an unstageable pressure ulcer for a resident related to an inaccurate assessment completed on a stage 2 pressure ulcer. 
• Ensure interventions were implemented to prevent pressure injuries.
• Notify the attending physician of multiple pressure ulcers present on resident’s admission to the facility, obtain treatment orders to promote healing and prevent infection of the pressure ulcers; develop a plan of care for two pressure ulcers; implement measures to prevent deterioration of the pressure ulcers; and notify the physician of the abnormal albumin results.
• Ensure a resident with a pressure ulcer received the necessary treatment and services to promote healing related to not staging the pressure ulcers appropriately and providing the correct treatment for areas with necrotic tissue which resulted in worsening of the unstageable pressure ulcer and hospitalization. 

F323 – Free of Accident/Hazards/Supervision/Devices for failure to provide the following:
• Safely transfer a resident resulting in a fall with probable rib fractures and the resident experiencing ongoing pain.
• Follow policy related to assessment and notification of the physician for a resident who was cognitively impaired and sustained a fall which resulted in the being hospitalized with an acute impacted and angulated fracture of left hip. 
• The facility utilized alarms in place of supervision.  Ensure alarms used for fall prevention were working properly and were positioned correctly, and failed to ensure a resident’s bed was in the low position.  The resident fell and obtained a fractured hip.
• Ensure a resident was supervised while outside to prevent a fall.  The resident fell from wheel chair while unattended outside in the courtyard, resulting in a fractured hip and arm. 
• Ensure interventions were implemented to prevent falls while administering peri-care for a resident who required extensive dependent assistance with activities of daily living.  The resident fell from the bed and sustained fractures to both lower extremities. 

F325 – Maintain Nutrition Status Unless Unavoidable for failure to do the following:
• Prevent a severe weight loss resulting in the resident losing greater than 7.5 pounds of body weight over a 3-month period.
• Reassess interventions, implement new interventions and follow the physician’s recommendations which resulted in a significant weight loss.  Resident was not evaluated by speech therapy as recommended by the physician and new interventions were not implemented to prevent the weight loss.
• Ensure acceptable parameters of nutritional status were maintained related to failure to monitor weights as recommended by the Registered Dietician.  Residents continued to have continued weight loss. 

F223 – Free from Abuse/Involuntary Seclusion for failure to ensure a resident was not slapped, knocked to the ground and free from having sustained a left eye laceration and left knee abrasion as indicated by the Abuse Prohibition policy.

F318 – Increase/Prevent Decrease in Range of Motion for failure to prevent a decline in range of motion, which resulted in a resident having pain to the contracted appendage.  No splint devices and pain was not being managed. 

F511 – Radiology Findings- Promptly Notify Physician for failure to ensure the physician was notified of abnormal X-ray results after falls and resulted in delay of treatment of a hip fracture. 

F309 – Provide Care/Services for Highest Well Being for failure to manage Gastrostomy status for a resident with tube feedings.  The resident was hospitalized for significant weight loss. 

Four providers received three SSQC and four IJ citations in August. The SSQC/IJ citations are as follows:

F226 (2 times) – Develop/Implement Abuse/Neglect Policies for failure to do the following:
• Follow the facility policy related to reporting and thoroughly investigating injuries of unknown origin/pain.
• Follow facility policy related to investigating allegations of abuse.

F225 (2 times) – Investigate/Report Allegations/Individuals for failure to do the following:
• Thoroughly investigate and report an injury of unknown origin.
• Investigate an allegation of abuse.

F309 (1 time) – Provide Care and Services for The Highest Well Being for failure to provide dementia care, to prevent psychosocial harm and physical abuse.

F223 (1 time) – Fee from Abuse/ Involuntary Seclusion for failure to protect a resident from verbal, physical and mental abuse.

F224 (1 time) – Prohibit Mistreatment /Neglect/Misappropriation for failed to provide adequate pain control for a resident experiencing severe pain, failed to ensure ultrasound was completed in a timely and failure to have resident evaluated by a medical professional in a timely manner.

F314 (1 time) – Treatments/Services to Treat Pressure Sores for failure to ensure worsening pressure ulcers and development of a new pressure area was monitored and reported to the physician for treatment.  The resident was transferred to the hospital and admitted to ICU. 

F157 (1 time) – Notify of Changes (Injury/Decline/Room for failure to ensure worsening pressure ulcers and development of new pressure area was reported to the physician for a change of treatment.  Resident was sent to the emergency department and admitted to the hospital. 

F203 (1 time) – Notice Requirements Before Transfer/Discharge for failure to safely plan and give a 30-day discharge notice to the resident.