Nursing Home Scope & Severity Rules

by Patti on February 2, 2007

in Educational Articles

Scope and Severity

The federal government’s enforcement process requires the Health Facilities Division to assign scope and severity levels for deficiencies. After these have been determined, they are given a letter designation.

The level of the deficiency is determined both by scope, how widespread the problem is, and severity, how much potential or actual harm it has caused to residents.

Level Scope Severity
A Isolated No actual harm, potential for minimal harm
B Pattern No actual harm, potential for minimal harm
C Widespread No actual harm, potential for minimal harm
D Isolated No actual harm, potential for more than minimal harm
E Pattern No actual harm, potential for more than minimal harm
F Widespread No actual harm, potential for more than minimal harm
G Isolated Actual harm that is not immediate jeopardy
H Pattern Actual harm that is not immediate jeopardy
I Widespread Actual harm that is not immediate jeopardy
J Isolated Immediate jeopardy to resident health or safety
K Pattern Immediate jeopardy to resident health or safety
L Widespread Immediate jeopardy to resident health or safety

Scope:

Assesses how widespread the deficiency is in the nursing home. There are three levels of scope:

An isolated problem-when one or a very limited number of residents are affected

A pattern of problems-when more than a limited number of residents are affected or when the same problem has occurred in several locations in the facility and/or the same number of residents have been affected by repeated occurrence of the deficient practice;

Widespread scope means the problems causing the deficiencies are found throughout the facility and/or there are systemic failures in the nursing home that have affected or have the potential to affect a large proportion of the residents.
Severity:

Assesses how much harm may occur or has occurred to residents as a result of the deficiency.

There are four levels of severity:

Level 1: Represents no actual harm but has potential for minimal harm;

Level 2: Represents no actual harm, but potential for more than minimal harm. A level 2 deficiency could result in minimal physical, mental or psychosocial discomfort or has the ability to compromise the resident’s ability to maintain or achieve highest possible function;

Level 3: Represents actual harm that is not immediate jeopardy (i.e. life-threatening). A level 3 deficiency means a resident has been negatively impacted and his/her ability to maintain or reach the highest functional level has been compromised;

Level 4: Represents immediate jeopardy to resident health or safety. A Level 4 deficiency requires immediate corrective action because serious injury, harm, impairment or death has been caused, or could be caused to residents.
Deficiencies are cited at the highest severity level. If a deficient practice has minimal impact on most affected residents, but has a severe impact on only one of the residents, that deficiency will be cited at the highest severity level observed.

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