Nursing Facility Scope and Severity Grid, P-02055

1 Nursing Facility Scope AND Severity GRID. Department of Health Services / Division of Quality Assurance / Bureau of Nursing Home Resident Care P-02055 (06/2020). SHADED AREAS = SUBSTANDARD QUALITY OF CARE for select regulations pertaining to federally-certified Nursing facilities (NFs) and skilled Nursing facilities (SNFs): Resident Rights (F550, F558, F559, F561, F565, F584), Pharmacy Services (F757-F760), Behavioral Health Services (F742-F745), Infection Control (F883), Administration (F850), and all regulations under Freedom from Abuse, Neglect, and Exploitation (F600-F610), Quality of Life (F675-F680), and Quality of Care (F684-F700) which constitute either immediate jeopardy to resident health or safety, a pattern of or widespread actual harm that is not immediate jeopardy, or a widespread potential for more than minimal harm, but less than immediate jeopardy, with no actual harm.

2 (Note: CMP = Civil Money Penalty.). Severity Scope . ISOLATED: One or a very limited PATTERN: More than a limited WIDESPREAD: Situation was number of residents affected, number of residents affected, pervasive throughout the Facility or and/or one or a very limited and/or more than a limited number represented a systemic failure that number of staff involved, and/or of staff involved, and/or the affected or had the potential to the situation occurred only situation occurred in several affect a large portion or all of the occasionally or in a very limited locations Facility 's residents. number of locations (4) Immediate jeopardy to J K L. resident health, safety, or REQUIRED REQUIRED REQUIRED.

3 Welfare Temporary manager Temporary manager Temporary manager Deficient practice caused or 23-day termination 23-day termination 23-day Termination created a reasonable CMP $6,808 - $22,320 per day or CMP $6,808 - $22,320 per day or CMP $6,808 - $22,320 per day or expectation of causing $2,233 - $22,320 per instance $2,233 - $22,320 per instance $2,233 - $22,320 per instance serious harm, serious injury, OPTIONAL OPTIONAL OPTIONAL. serious impairment, or death; immediate corrective Denial of payment for new admits Denial of payment for new admits Denial of payment for new admits action is needed to prevent Directed plan of correction Directed plan of correction Directed plan of correction serious harm from occurring Directed inservice Directed inservice Directed inservice or reoccurring.

4 State monitor State monitor State monitor (3) Actual harm that is not G H I. immediate jeopardy REQUIRED REQUIRED REQUIRED. Deficient practice led to a CMP $6,808 - $22,320 per day or CMP $6,808 - $22,320 per day or CMP $6,808 - $22,320 per day or negative outcome that has $2,233 - $22,320 per instance $2,233 - $22,320 per instance $2,233 - $22,320 per instance compromised the resident's Denial of payment for new admits Denial of payment for new admits Denial of payment for new admits ability to maintain and/or Temporary manager Temporary manager Temporary manager reach his/her highest Termination Termination Termination practicable physical, mental, and/or psychosocial well- OPTIONAL OPTIONAL OPTIONAL.

5 Being. Directed plan of correction Directed plan of correction Directed plan of correction Directed inservice Directed inservice Directed inservice State monitor State monitor State monitor (2) No actual harm with D E F. potential for more than REQUIRED REQUIRED REQUIRED. minimal harm that is not Directed plan of correction Directed plan of correction CMP $112 - $6,695 per day or immediate jeopardy Directed inservice Directed in-service $2,233 - $22,320 per instance Deficient practice has led to State monitor State monitor (mandatory if SQC; otherwise minimal physical, mental, optional). OPTIONAL OPTIONAL. and/or psychosocial dis- Denial of payment for new admits CMP $112 - $6,695 per day or CMP $112 - $6,695 per day or Temporary manager comfort to resident and/or a $2,233 - $22,320 per instance $2,233 - $22,320 per instance Termination yet unrealized potential for Denial of payment for new admits Denial of payment for new admits compromising resident's Temporary manager Temporary manager OPTIONAL.

6 Ability to maintain and/or Termination Termination Directed plan of correction reach his/her highest Directed in-service practicable level of physical, State monitor mental, and/or psychosocial well-being. (1) No actual harm with A B C. potential for no more SUBSTANTIAL COMPLIANCE SUBSTANTIAL COMPLIANCE SUBSTANTIAL COMPLIANCE. than minimal harm Plan of correction Plan of correction Deficient practice has the potential for causing no more than minor negative impact on residents.