State Operations Manual - CMS

State Operations Manual Appendix J - Guidance to Surveyors: Intermediate Care Facilities for Individuals with Intellectual Disabilities Table of Contents (Rev. 178, 04-13-18) Transmittals for Appendix J Part 1 - Survey Protocol for Intermediate Care Facilities for Individuals with Intellectual Disabilities I - Introduction II - Survey Levels A - Focused Fundamental Survey B - Extended Survey C - Full Survey III - Entrance IV - Task One - Sample Selection V - Task Two - Review of Facility Systems to Prevent Abuse, Neglect and Mistreatment and To Resolve Complaints A - Task Two Phase One 1. Phase One Observations 2. Phase One Interviews 3. Phase One Record Reviews B - Task Two Phase Two VI - Task Three - Focused Observation VII -Task Four - Required Interviews with Individuals and/or Family/Advocate Direct Care Staff A - Purpose B - Interview Procedure C - Content of In-depth Interviews 1 - General Impressions 2 - Specific Activities and Interactions 3 - Individuals in Sample 4 - Areas for Further Observation D - Suggested Interview Questions E - Interviews to Clarify Observations F - Documentation VIII - Task Five - Drug Pass Observation A - Purpose B - Interview Procedure C - Content of In-depth Interviews D - Suggested Interview Questions E - Interviews to Clarify Observations F - Documentation IX - Task Six - Visit to Each Area of Facility Serving Certified Individuals A - Purpose B - Protocol X - Task Seven - Record Review of Individua

Key Standard(s) Regulatory Reference within the CoP W-tag associated with the key standard regulation Corresponding standard(s) under the key standard (W-tag reference) (W102) 42 CFR 483.420 Client Protections (W122) 42 CFR 483.420(a)(5) Ensure that clients are not subjected to physical, verbal, sexual or psychological abuse or punishment

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