Attachment L CLC Deidentifed Survey Report Template.pdf
PDF 133 KB Posted
- Solicitation number
- 36C10G24R0017
About this file
This is a Department of Veterans Affairs Community Living Centers Unannounced Survey Report documenting deficiency findings from a facility inspection. The report has been de-identified in accordance with HIPAA Privacy Rule requirements to remove protected health information.
The survey identified one deficiency under VA Regulation §51.120(n) concerning Medication Errors. The facility failed to administer nasal spray as recommended for one of four residents reviewed for medication administration. The deficiency was classified as "No Actual Harm, with potential for more than minimal harm," affecting a small number of residents ("Few"). The regulation requires facility management to ensure medication errors are identified and reviewed timely, and that strategies for preventing medication errors and adverse reactions are implemented. The report does not provide specific facility identification details, survey dates, bed capacity, or census information, as these fields appear as blank template fields in the document.
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Department of Veterans Affairs Community Living Centers Report
This de-identified survey report and the information contained herein, resulted from the Community Living Center (CLC) Unannounced Survey as a Summary Statement of Deficiencies. This report has been de-identified to remove individually identifiable health information (also known as protected health information) in accordance with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule and other federal and state laws.
General Information:
Facility Name:
Onsite / Virtual: Virtual or Onsite
Dates of Survey:
Total Available Beds:
Census on First Day of Survey:
VA Regulation Deficiency Findings
§51.120 (n) Medication Errors The facility management must ensure that—
(1) Medication errors are identified and reviewed on a timely basis; and
(2) strategies for preventing medication errors and adverse reactions are implemented
Level of Harm – No Actual Harm, with potential for more than minimal harm.
Residents Affected - Few
Based on observation, interview, and record review, the facility failed to administer nasal spray as recommended for one (1) of four (4) residents reviewed for medication administration.
File details come from the government source that posted it. Updated .