Home Nursing Deficiency Information

Following passage of the federal nursing home reform provisions of 1987, the federal oversight agency devised a system for increasing sanctions based on the seriousness of the deficiency cited. While all deficiencies found during a survey will be cited, a “scope and severity” scale is used by the surveyors to determine whether or not the facility is in substantial compliance or what remedies will be imposed.

 

Scope and Severity of Deficiencies

Surveyors use the scope and severity scale to assess the level of harm the deficiency has imposed on the resident or resident(s), and the extent to which the harm has occurred within the facility. An isolated incident that caused no actual harm, for example, would result in a deficiency that carries a less serious penalty than a violation that is widespread throughout the facility and that has caused actual harm to the residents.

The Scope scale has three levels:

  • Isolated
  • Pattern
  • Widespread

The Severity scale has four levels:

  • Level 1: no actual harm with potential for minimal harm
  • Level 2: no actual harm with potential for more than minimal harm that is not immediate jeopardy
  • Level 3: actual harm that is not immediate jeopardy
  • Level 4: immediate jeopardy to resident health and safety

The type of enforcement action taken against a particular facility depends upon the seriousness of the deficiency based upon the scope and severity scale.

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