What is a Class I citation? According to 408.813 F.S., Class “I” violations are those conditions or occurrences related to the operation and maintenance of a provider or to the care of clients which the agency determines present an imminent danger to the clients of the provider or a substantial probability that death or serious physical or emotional harm would result therefrom. The condition or practice constituting a Class I violation shall be abated or eliminated within 24 hours, unless a fixed period, as determined by the agency, is required for correction. The agency shall impose an administrative fine as provided by law for a cited Class I violation. A fine shall be levied notwithstanding the correction of the violation.
Obviously, these are not citations of little impact. Recently, there has been several Class I citations in the areas of resident care and supervision under A0025.
For reference 429.26(7) FS states:
“The facility must notify a licensed physician when a resident exhibits signs of dementia or cognitive impairment or has a change of condition in order to rule out the presence of an underlying physiological condition that may be contributing to such dementia or impairment. The notification must occur within 30 days after the acknowledgment of such signs by facility staff. If an underlying condition is determined to exist, the facility shall arrange, with the appropriate health care provider, the necessary care and services to treat the condition.”
In 58A-5.0182 (d, e and f):
“(d) Contacting the resident’s health care provider and other appropriate party such as the resident’s family, guardian, health care surrogate, or case manager if the resident exhibits a significant change.
(e) Contacting the resident’s family, guardian, health care surrogate, or case manager if the resident is discharged or moves out.
(f) Maintaining a written record, updated as needed, of any significant changes, any illnesses that resulted in medical attention, changes in the method of medication administration, or other changes that resulted in the provision of additional services.”
Meeting the Requirements
Is there a delay in communicating to physicians or physician extenders? Is your staff aware of what a “significant change” is? A significant change can be as simple as sudden or major shift in the behavior or mood of a resident that is inconsistent with the resident’s diagnosis. This type of situation can occur when the administrator is not in the building, so does the staff understand the importance of communicating promptly? Delay in communication with the health care providers and responsible party until the morning or Monday may be too slow of a response. If the resident has a fall and does not go to the hospital for evaluation, when do you notify the physician, family, guardian, health care surrogate or case manager? These are frequent situations that can lead to a Class I citation if not handled promptly and documented.
Another area that is a focus with several Class I citations recently is A0030, Resident Care – Rights & Facility Procedures. For review of all resident rights, click here. Focused areas that have been cited recently have been related to abuse and lack of cardiopulmonary resuscitation (CPR). It is clear that abuse cannot be tolerated in an assisted living facility. According to 58A-5.0191 FAC, staff who provide direct care to residents, who have not taken the core training program, shall receive a minimum of 1 hour in-service training within 30 days of employment that includes, resident rights in an assisted living facility, recognizing and reporting resident abuse, neglect, and exploitation. The facility must use its abuse prevention policies and procedures when offering this training. Although it is not required, it is good practice to review the facility policy with the staff about recognizing abuse and reporting more than the minimum.
According to 58A-5.0186 FAC, each assisted living facility must have written policies and procedures that explain its implementation of state laws and rules relative to Do Not Resuscitate Orders (DNROs). The responsibility to withhold CPR is just as important as initiating CPR in a timely and accurate manor. This is an area that has caused more Class I citations in recent weeks.
Training is an ongoing process. Take the steps to be sure that your facility is not at risk for a Class I citation by training and focusing on high risk areas.