How to read health facility inspection results

 
Inspection process
 
We visit facilities and agencies to inspect, or survey, them to make sure they are providing care in a way that does not violate established standards. These standards are called regulations. If we find a violation, or deficient practice, we will issue a citation, sometimes called a "tag." All the citations combined are called a deficiency list. Medicare refers to the list of citations as a statement of deficiency or "2567."
 
The facility or agency then tells us how it is going to fix the citation with a plan of correction (PoC). Once a facility or agency has submitted an acceptable plan of correction, we publish the findings to our website within a week.
 
We will then revisit the facility to make sure the facility or agency fixed the citation. This process will repeat until the facility or agency gets zero citations.
 
If a facility or agency can not voluntarily bring itself into compliance, we will progress it through the appropriate enforcement process until it is citation free. This is uncommon.
 
Complaint investigations
 
When people feel they are receiving bad care at a health facility, they can call us and complain. We will investigate the complaint to find evidence of the allegation. If there is no evidence, or not enough evidence of the allegation, the complaint is unsubstantiated. If we find enough evidence, the complaint is substantiated and we issue a citation. We have no authority to investigate billing complaints.
 
Occurrence findings
 
Facilities and agencies need to let us know about certain events that are happening there. When they report them to us, it means they have identified an issue and have already begun working to fix the issue. Occurrences are facilities and agencies working to improve themselves, instead of improving because we cited them during an inspection.
 
Regulations
 
When we inspect a facility or agency, we are using state licensing standards. Medicare and Medicaid also have hired us to inspect their providers. When we inspect a facility or agency, we may be using three different sets of standards: state licensing, state Medicaid and federal Medicare.
 
Citation severity
 
Some citations are used as notes and do not require any response from the facility or agency. A "0000" citation is a summary of our inspection. A "9999" citation is used as note to the provider.
 
Some citations are determined to be single, isolated events in which no one could have been hurt. These citations usually do not require a plan of correction. These citations generally do require that the facility or provider acknowledge the citation.
 
Most facilities and agencies can be cited with more severe types of violations. These violations usually result from someone being harmed by the violation. These types of citations can be called "harm level tags" or "condition of participation tags." There are more severe consequences for these types of citations and faster time frames for a facility or agency to correct the issue. These violations may affect the facility’s or agency’s ability to participate with Medicare or Medicaid.
 
Reading inspection results
 
When we issue a citation, we provide the text of the regulation the facility is violating. We then provide our inspector’s findings detailing how the facility or agency violated the regulation. We also include the provider's plan to correct the citation.
 
Deeming
 
Medicare allows some facilities and agencies to hire private inspection organizations. This is referred to as "deeming." If a provider is deemed, we do not have inspection results to publish. If we receive a complaint about a deemed facility or agency, Medicare has to first give us permission to investigate using the federal Medicare standards. We can inspect a facility or agency using the state licensing standards even if it is deemed.