“The Grading System Has Arrived”
By Wendy Simons
Last year I wrote an
article advising the public about a new system of “Report Cards” for the
Residential/Assisted Living industry. While the implementation did not
occur in the timeframe discussed in the article….. the day has finally
arrived for consumers to have knowledge of how a facility faired during
it’s annual survey by the Bureau of Health Care Quality and Compliance,
an agency of the Nevada State Health Division.
Effective January
1, 2009, each facility will be issued a “grade” during its annual survey
and that “grade placard” must be posted in a prominent place in the
facility. Keep in mind you will only see a grade posted when the
facility has its survey, so some will not receive a grade until later in
the year, depending on their annual survey date.
Each facility
will receive a grade of “A”, “B”, “C”, or “D” based on the sum of their
scope and severity scores with regard to compliance with the regulations
that govern Residential Care/Assisted Living Facilities. The grade
“placard”, clearly identifies the criteria of each grade under the NAC
449.170 category of regulations.
I think it is
beneficial to revisit the actual explanation in the regulations I
offered last year.
Scope and
Severity scores
are determined by NAC 449.4486 in accordance with NAC 449.99839.
Basically, the scope is a scale defined as follows in
Regulations:
1. The scope
scale must be used to assess the scope of a particular deficiency in or
by the facility.
2. The
basis for the assessment is the actual or potential harm to recipients
as shown by:
(a) The
frequency of the deficiency;
(b) The
number or percentage of recipients affected;
(c) The
number or percentage of staff involved; and
(d) The
pattern or lack of pattern of the deficiencies.
And, deficiency
of scope level one consists of one or an isolated number of unrelated
incidents in the sample surveyed. A deficiency is of this scope if it
involves 20 percent or less of the recipients sampled in a facility.
3. A
deficiency is scope level two if the Bureau identifies a pattern of
incidents at the facility, including any deficiencies involving
recipients who require particular kinds of care, treatment or service.
The number or percentage of recipients or staff involved in the
incidents or the repeated occurrences of incidents in short succession
may also establish a pattern by indicating a reasonable degree of
predictability of similar incidents. A deficiency is also of this scope
if it involves more than 20 percent but not more than 50 percent of the
recipients sampled in a facility.
4. A
deficiency is of scope level three if it occurs in a sufficient number
or percentage of recipients or staff or with sufficient regularity over
time that it may be considered systemic or pervasive in or by the
facility. A deficiency is also of this scope if it involves more than 50
percent of the recipients sampled in a facility.
The Severity is
determined by:
1. The
severity scale must be used to assess the severity of a particular
deficiency pertaining to the facility. The basis for the assessment must
be the actual or potential harm to recipients.
2.
Deficiencies of severity level one concern requirements promulgated
primarily for administrative purposes. No harm is likely to occur to a
recipient. No negative recipient impact has occurred or is likely to
occur. The ability of a recipient to achieve the highest practicable
physical, mental or psychosocial well-being has not been and is not
likely to be compromised.
3.
Deficiencies of severity level two indirectly threaten the health,
safety, rights, security, welfare or well-being of a recipient. A
potential for harm, as yet unrealized, exists. If continued over time, a
negative impact on one or more recipients or a violation of one or more
recipients’ rights would occur or would be likely to occur or the
ability of one or more recipients to achieve the highest practicable
physical, mental or psychosocial well-being would be, or would likely
be, compromised.
4. Deficiencies of severity level three create a condition or incident
in the operation or maintenance of a facility that directly or
indirectly threatens the health, safety, rights, security, welfare or
well-being of one or more recipients. A negative impact on the health,
safety, rights, security, welfare or well-being of one or more
recipients has occurred or can be predicted with substantial probability
to occur or the ability of recipients to achieve the highest practicable
physical, mental or psychosocial well-being has been or is about to be
compromised and requires intervention and correction of the deficiency.
Violation of a partial or complete ban on admissions imposed on a
facility, violation of a limitation on occupancy of a residential
facility or failure to implement a directed plan of correction is
presumed to be a deficiency of this level of severity.
5. Deficiencies of
severity level four create a condition or incident that has resulted in
or can be predicted with substantial probability to result in death or
serious harm to a recipient. As used in this subsection, “serious harm”
includes serious mental harm, serious impairment of bodily functions,
serious dysfunction of any bodily organ or part, life-threatening harm
or death.
While all of this
is rather wordy, it will be the system used to determine the total sum
of severity and scope scores, which will ultimately lead to a report
card or “placard” grade of “A”, “B”, “C”, or “D” that must be posted in
the facility for consumers to see. If a facility receives a “B”, they
have an option to submit an application and fee for a resurvey
for a fee. If a facility receives a “C” or “D” the facility must
submit an application and fee for a resurvey. The advantage to this new
system will assure that facilities do not continue to operate in a sub
standard fashion.
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By the end of
February, it has been stated by the BHCQC, that facility survey reports
will be posted on their website at
http://health.nv.gov/HCQC.htm. Some surveys from the fall are
currently on the website should you wish to familiarize yourself with
how to read them. Just check the window that looks like this:
|
facility services |
Statements
of Deficiency and Plans of Correction
Note: This list
currently only contains surveys done in August, 2008, and we
are unable to make any updates at this time. For information
on recent surveys, please contact us at (775) 687-4475. |
The BHCQC has
also conducted numerous workshops state wide to advise the Residential
Care/Assisted Living providers how to prepare for this new system.
Additional workshops will be held in Las Vegas, February 18th
& 19th and in Reno on February 26th.
By the way, this
grading system was the joint effort of the Assisted Living Advisory
Council, comprised of representatives of the provider industry and the
State Health Division. This is a good example of an industry
recognizing the public needed a way to verify they were selecting a
facility for their loved ones that was meeting state regulations. It is
one additional component all consumers should consider as well as their
own impression when selecting a facility.
If you find this
all too confusing, don’t hesitate to contact me for clarification.
wendy.simons.consult@gmail.com
