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15 Most Frequently Cited Deficiencies Comparative Standard Complaint Life Safety Tennessee Nursing Home Complaint Surveys MOST FREQUENTLY CITED DEFICIENCIES Comparative Tag # Fiscal Year 2009 - Date Tennessee % Surveys TN'09 TN'08 Nation'09 F0323 FACILITY IS FREE OF ACCIDENT HAZARDS 3.80% 6.30% 4.70% F0281 SERVICES PROVIDED MEET PROFESSIONAL STANDARDS 3.20% 3.30% 2.60% F0157 INFORM OF ACCIDENTS/SIG CHANGES/TRANSFER/ETC 1.40% 2.50% 2.50% F0225 NOT EMPLOY PERSONS GUILTY OF ABUSE 1.40% 0.90% 2.40% F0514 CLINICAL RECORDS MEET PROFESSIONAL STANDARDS 1.20% 2.50% 1.80% F0272 COMPREHENSIVE ASSESSMENTS 1.20% 2.00% 0.80% F0309 PROVIDE NECESS CARE FOR HIGHEST PRAC WELL BEING 1.20% 3.80% 3.40% F0279 DEVELOP COMPREHENSIVE CARE PLANS 0.60% 1.00% 1.30% F0502 FACIL PROVIDES/OBTAINS LAB SERVICES 0.60% F0250 MEDICALLY RELATED SOCIAL SERVICES 0.60% F0226 POLICIES, PROCEDURES PROHIBIT ABUSE, NEGLECT 0.60% 1.70% 1.30% F0322 PROPER CARE & SERVICES FOR RES W/ NG TUBE 0.60% F0315 RES NOT CATHETERIZED UNLESS UNAVOIDABLE 0.60% F0333 RESIDENTS FREE FROM SIGNIFICANT MED ERRORS 0.60% F0312 ADL CARE PROVIDED FOR DEPENDENT RESIDENTS 0.30% Tennessee Nursing Home Standard Health Surveys MOST FREQUENTLY CITED DEFICIENCIES Comparative Tag # Fiscal Year 2009 - Date Tennessee % Surveys TN ’09 TN ’08 Nation’09 F0323 FACILITY IS FREE OF ACCIDENT HAZARDS 30.00% 38.50% 36.20% F0371 STORE/PREPARE/DISTRIB FOOD UNDER SANITARY CONDS 28.50% 23.00% 34.60% F0431 PROPER LABELING OF DRUGS & BIOLOGICALS 23.10% 17.50% 15.60% F0444 WASH HANDS WHEN INDICATED 23.10% 24.60% 12.70% F0332 MEDICATION ERROR RATES OF 5% OR MORE 22.30% F0441 FACILITY ESTABLISHES INFECTION CONTROL PROG 18.50% 20.20% 18.40% F0281 SERVICES PROVIDED MEET PROFESSIONAL STANDARDS 18.50% 26.20% 26.40% F0280 DEVELOPMENT/PREP/REVIEW OF COMP CARE PLAN 17.70% F0315 RES NOT CATHETERIZED UNLESS UNAVOIDABLE 16.90% 18.70% 18.00% F0514 CLINICAL RECORDS MEET PROFESSIONAL STANDARDS 16.20% 13.90% 17.20% F0309 PROVIDE NECESS CARE FOR HIGHEST PRAC WELL BEING 14.60% 26.60% 25.40% F0221 RIGHT TO BE FREE FROM PHYSICAL RESTRAINTS NOT REQ'D FOR TREATMENT 14.60% F0322 PROPER CARE & SERVICES FOR RES W/ NG TUBE 13.10% F0164 PERSONAL PRIVACY/CONFIDENTIALITY OF RECORDS 12.30% F0328 PROPER TREATMENT/CARE FOR SPECIAL CARE NEEDS 12.30% Tennessee Nursing Home Life Safety Code Surveys MOST FREQUENTLY CITED DEFICIENCIES Comparative Tag # Fiscal Year 2009 - Date Tennessee % Surveys TN ‘09 Region ‘09 Nation ‘09 K0147 ELECTRICAL WIRING AND EQUIPMENT 40.00% 22.10% 27.20% K0062 SPRINKLER SYSTEM MAINTENANCE 33.60% 15.70% 28.50% K0067 VENTILATING EQUIPMENT 22.40% 8.10% 12.20% K0029 HAZARDOUS AREAS - SEPARATION 21.60% 19.90% 27.00% K0025 SMOKE PARTITION CONSTRUCTION 21.60% K0018 CORRIDOR DOORS 20.80% 16.10% 27.80% K0052 TESTING OF FIRE ALARM 20.80% 10.20% 13.70% K0050 FIRE DRILLS 18.40% 7.70% 17.50% K0038 EXIT ACCESS 16.80% 11.00% 19.90% K0064 PORTABLE FIRE EXTINGUISHERS 16.00% K0130 OTHER 14.40% 7.30% K0069 COOKING EQUIPMENT 11.20% 10.10% 11.50% K0056 AUTOMATIC SPRINKLER SYSTEM 10.40% 12.70% 14.70% K0054 SMOKE DETECTOR MAINTENANCE 8.80% K0066 SMOKING REGULATIONS 8.80% 19.80% Regulation for Admission Agreements 42 CFR 489.22(d)(2) The facility is in violation of its provider agreement – if they charge an individual for failure to remain an inpatient for any agreed-upon length of time or for failure to give advance notice of departure from the provider’s facility. Registered Nurse Surveyors http://state.tn.us/dohr/JobSearch/Employm ent.html Click on Current Openings Go to page 3 Click on Public Health Nurse Consultant 1 [email protected] [email protected]