The State and CMS can impose multiple remedies once an Immediate Jeopardy situation is identified. These include a Directed Plan of Correction and Directed InService, which may occur before your facility receives monetary penalties. While you are surely familiar with nursing home Plans of Correction and InService training for your staff, the way the State views them in light of an Immediate Jeopardy makes them worth delving in to further.
Part 3: Plan of Correction, Directed Plan, Directed InService
Plan of Correction
As we mentioned in Part 2 of our discussion on nursing home Immediate Jeopardy situations, the Plan of Correction that your facility submits in a non-Immediate Jeopardy situation has several specific requirements (SOM 7304.4). For those of you who missed that post, the Plan must address each cited deficiency included in the 2567, specifically stating:
- How corrective action will be implemented to correct the deficiency for each affected resident
- How the facility plans to address proactively identifying other residents that may be at risk of being affected by the same deficient practice
- What measures and practices will be put into place to ensure that the deficient practice will not occur again
- How the facility will monitor its performance in the deficient practice area
- The specific dates that the corrective actions will be completed on. These dates must meet the requirements of the State
Directed Plan of Correction
Unlike a Plan of Correction in non-Immediate Jeopardy situations, the Directed Plan is one that is imposed by the State, with the responsibility being placed on the facility to follow its direction in order to restore compliance. In an immediate jeopardy situation, a Directed Plan of Correction can be imposed 2 days after the facility receives notice. The State may select a Directed POC, a category 1 remedy, under a variety of circumstances, but it is often imposed when there is an indication of a broad system failure such as not having a system in place to prevent a choking event after a choking death results or a resident identified as at risk for elopement being able to exit the building or reach an unsafe area of the building where he/she should not be without authorization.
A Directed Plan of Correction needs to include all of the elements required for a facility-developed Plan of Correction. If you fail to achieve substantial compliance after complying with a Directed Plan of Correction, the State or RO may impose another remedy until you reach substantial compliance or are terminated from the Medicare or Medicaid programs (SOM – Chapter 7 7500.2). The State may choose to direct the facility to obtain the services of an outside consultant, who is not employed by the facility, to develop and implement to the Directed Plan of Correction.
Another remedy that the State may impose in order to address your facility’s Immediate Jeopardy deficiency/s is Directed InService training. Directed InService training requires that you provide specific education to your staff as outlined by the State. Notice of Directed InService training being imposed is provided 2 calendar days after the facility receives notice in immediate jeopardy situations.
Using the choking death as an example again, education on choking prevention and facility procedures may be required for the nursing staff as well as the dietary and kitchen staff. Often times, an outside consultant will be brought in (at the facility’s cost) to provide this education session.
In our next update, we’ll provide you with everything you need to know about non-compliance – stay tuned for next week’s post.