It's a dreary Monday morning, and the state surveyors walk into your facility to conduct a Focused Infection Control survey. You and your team have been trying your hardest to comply with infection control procedures throughout the pandemic. At the end of the survey, you are issued several citations and the state is requiring the facility to institute a Directed Plan of Care (DPOC). What should you do now?

I recently discussed this question with Barbara Bates, RN, MSN, RAC-CT, QCP-MT, DNS-MT and Linda J. Winston, RN, MSN, BS, QCP-MT, DNS-MT, RAC-CT of  MDS Consultants.

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Background

CMS relies on State Survey Agencies to prioritize Focused Infection Control surveys of nursing homes across the country since March of 2020. CMS is also enhancing the penalties for noncompliance with infection control to provide greater accountability and consequence for failures to meet these requirements.  Barbara Bates explains

"The facility must know and follow the strictest regulation, be that the state or federal regulation. It may become very costly for a facility that does not comply with these regulations. CMS and surveyors are really focusing on these citations due to the seriousness of the issue and effects of Covid-19."

Citation Enforcements

The more serious citations enforcements are as follows;

  • For facilities with noncompliance for infection control deficiencies cited twice or more in the last two years cited for current noncompliance with Infection Control requirements that is widespread (Level F) - Directed Plan of Correction, Discretionary Denial of Payment for New Admissions, 30-days to demonstrate compliance with Infection Control deficiencies, $20,000 Per Instance CMP (or per day CMP may be imposed, as long as the total amount exceeds $20,000)
  • Level G, H, I regardless of past history - Directed Plan of Correction, Discretionary Denial of Payment for New Admissions with 30 days to demonstrate compliance with Infection Control deficiencies. Enforcement imposed by CMS Location per current policy, but CMP imposed at highest amount option within the appropriate (non-Immediate Jeopardy) range in the CMP analytic tool
  • Immediate Jeopardy Level (Level J, K, L) regardless of past history – In addition to the mandatory remedies of Temporary Manager or Termination, imposition of Directed Plan of Correction, Discretionary Denial of Payment for New Admissions, 15-days to demonstrate compliance with Infection Control deficiencies. Enforcement imposed by CMS Location per current policy, but CMP imposed at highest amount option within the appropriate (IJ) range in the CMP analytic tool

Preparation

One of the best ways to do well during a Focused Infection Control survey is to prepare. Consider the following actions and tools:

  • Create an Infection Control Survey book containing all necessary infection information
  • Focused Infection Control Survey tool found here, COVID-19 Preparedness Checklist for Nursing Homes and other Long Term Care Settings found here,  and the CDC ICAR tool found here
  • Identify knowledge gaps for all staff and re-educate often
  • Update Infection Prevention and Infection Control Policies and Procedures

The key to a successful survey is to ensure all staff are aware of and following the facility's Infection Control Policies and procedures. Barbara Bates mentions,

"Infection prevent was an area of focus for CMS before Covid-19, now it has become the highest priority. A facility must ensure that they are following their policies and procedures."

It is also a good idea to already have a qualified clinical consultant in mind in cases where a Directed Plan of Care may be required as the facility will only have 15 days to demonstrate compliance with Infection Control deficiencies. It is important to note that the imposition of this DPOC does not replace the requirement that the facility must submit a complete POC for all cited deficiencies within ten days after receipt of CMS Form 2567.

Conclusions

When will it end: If you think that the Focused Infection Control survey will be ending soon, now that the Covid-19 vaccine has been released, you would be wrong. Linda Winston adds,

"I would expect that CMS will continue to focus on infection prevention for years to come. The pandemic has taught us so much about infection prevention and best infection control practices in nursing facilities."

This survey is not going anywhere anytime soon. Starting in FY 2021, CMS asks states to perform annual Focused Infection Control surveys of 20 percent of nursing homes based on the state's discretion or additional data that identifies facility and community risks.

 

  1. Contact MDS Consultants for assistance with a Directed Plan of Care and in servicing or assistance preparing for Focused Infection Control survey.
  2. For more information on LTC surveys: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes
  3. For more information on this topic:  https://www.cms.gov/files/document/qso-20-31-all-revised.pdf