September 25, 2003
Max Tardiveau
Ombudsman
Alameda County

Every Skilled Nursing Facility (SNF) that participates in Medicare or Medicaid is required by law to keep, and have readily available, a form called a Statement of Deficiencies and Plan of Correction, commonly referred to by its number: 2567.

This form contains a wealth of information about the facility, and any Ombudsperson should consider consulting it to be better informed of potential problems.

Obtaining this form

If you are comfortable on the Internet, summaries of these reports are available on the Medicare web site. Connect to www.medicare.gov, and click "Nursing Home Compare". However, these are only summaries – you will get much more information from looking at the actual reports at the facility or at DHS.

In a well-run facility, the 2567 should be available in a public area such as the lobby. The regulations say that a notice must be posted in a commonly used area, indicating where to find it. Normally, it takes the form of a binder. The heft of the binder is a good first indication of how much you'll find in this report.

If you cannot find it yourself, contact an administrator and ask for "the 2567" – they'll know exactly what you mean. They have to make it available to you on the spot. Any delay should be viewed with suspicion.

The Office of the Inspector General did a survey in 1999, and their findings were not encouraging: "Most of the 32 sampled nursing homes visited by OIG staff did not fully meet the requirements for making survey results available. In 17 of the
nursing homes, the notice identifying the location of the survey results was not posted; the OIG staff had to ask for the survey results in 24 of them; and for 17 of the nursing homes, the survey results were in locations directly observed by staff, contrary to regulations. Twenty seven of the 32 nursing homes visited did, ultimately, make available the nursing home’s survey results."

Reading the form

The bulk of the report will look a lot like this:

Right under the ID tag is the "SS code", where SS means Scope and Severity. This is crucial! This code indicates how serious the violation is. It is graded from A to L (A is never written down because it is never serious), and the grades' meaning is as follows:

B and C deficiencies are minor, and are normally more in the categories of annoyances. D through F are more serious, but can still happen even in a good facility. If the report contains any G or above deficiency, then the facility has "failed" the inspection, and DHS will have to come back within 90 days. Anything starting from G is a serious hint that there may be something wrong. J and above deficiencies would be extremely serious.

Then comes the quote of the regulation that is being violated. The quote normally begins with a reference to the actual regulation, which, in case you're interested, is (typically) from 42 CFR. You can consult the CFR (Code of Federal Regulations) yourself at your local library, or online at www.fpo.gov. In this example, you'd be looking for "42 CFR 483".

The right side of the form is also separated into two columns. The first column contains a reference to the deficiency. That may not be aligned with the left column, which is why the ID is repeated.

In the right column is the facility's stated intent to correct the deficiency. Normally, there should also be a date (which must be within 30 days after the inspection) specifying when the facility intends to correct the deficiency.

On top of the report, there should also be a re-visit sheet listing the violations, and the date at which they were resolved, and how they were resolved.

What to look for

Interpreting the deficiencies is not as easy as it sounds, so you need to take everything with a grain of salt. Some deficiencies may sound worse than they really are, and vice versa.

For instance, an error rate of 5% on medications may sound bad, but it's actually the upper limit for federal regulations. In addition, a medication error may be as simple as giving someone 323mg of iron instead of the prescribed 300mg.

However, deficiencies in the area of patients rights should be viewed with a lot of suspicion.

Once again, these are only indications. If any one specific deficiency bothers you, you can discuss it with the administrator – this is, after all, public record.

Other documents

In the same binder as the 2567, you should also find a list of the complaints that have been filed against the facility (you will not get the text of the complaint, only its follow-up and resolution).

You should also find all the citations that have been recently issued against the facility.

Conclusion

In theory, a facility that is not in substantial compliance within 3 months after being found out of compliance must be denied Medicare/Medicaid payments for new admissions.

Although Ombudspersons have no legal authority to do anything about this report, reading it and understanding it will give you some good insights as to where the problems might be, and also will show the management that you know what you're doing. It will also help you communicate more effectively with management, DHS and similar parties.