All skilled nursing homes are subject to state and federal inspections. State licensing requires inspections (every nine to fifteen months on average) while participation in the federal Medicare/Medicaid program requires a home be made available for surveys. State licensing standards generally follow Federal certification standards making the regulation of skilled nursing homes largely uniform between states. State employees do most of the inspections, making sure the homes are in compliance with licensing and certification. Federal inspectors do periodic inspections to check on the performance of the various state inspectors. The Federal Oversight and Support Surveys (FOSS) are the results of their inspections. The State Operations Manual (SOM) regulates skilled nursing homes in most states, using the compliance with the federal inspection process and the requirements mandated by the Center for Medicare and Medicaid Services (CMS) as its basis (www.ascp.com).
The following is a list of the ten most frequently cited deficiencies in the nation (Dec 2008) courtesy of the Desk Reference for the City of Detroit, SNF Operators. The percentage of homes cited follows the description of the violation.
- Accidents, hazards (36.9%)
- Store, prepare, distribute and serve food (34.5%)
- Each resident must receive care for highest well-being (27.1%)
- Services must meet professional standard of quality (27.0%)
- Facility must develop a comprehensive care plan with objectives/timetables (22.3%)
- Housekeeping and maintenance services (18.9%)
- Unnecessary drug: in excessive dose (18.8%)
- Resident’s clinical condition demonstrates catheterization necessary (18.1%)
- Investigates, controls/prevents infections (17.9%)
- Resident does not develop pressure sores (17.7%)