CMS Manual System - Louisiana Department of Health and Hospitals

1. Presence of harm/negative outcome(s) or potential for negative outcomes because
of lack of appropriate treatment and care, such as decline in function or failure to
achieve the highest possible level of well-being.
2. Degree of harm (actual or potential) related to the non-compliance. Identify how
the facility practices caused, resulted in, allowed or contributed to the actual or
potential for harm:
If harm has occurred, determine if the harm is at the level of serious injury,
impairment, death, compromise, or discomfort to the resident(s); and
If harm has not yet occurred, determine the potential for serious injury,
impairment, death, compromise, or discomfort to occur to the resident(s).
3. The immediacy of correction required. Determine whether the noncompliance
requires immediate correction in order to prevent serious injury, harm,
impairment, or death to one or more residents.
The survey team must evaluate the harm or potential for harm for F309 based upon the
four levels of severity. First, the team must rule out whether Severity Level 4, Immediate
Jeopardy to a resident‘s health or safety, exists by evaluating the deficient practice in
relation to immediacy, culpability, and severity. Follow the guidance in Appendix Q,
Determining Immediate Jeopardy. If specific guidance and examples have not been
established elsewhere for the concern having been reviewed, follow the general guidance
in Appendix P regarding Guidance on Severity and Scope Levels and Psychosocial
Outcome Severity Guide.
Interpretive Guidelines for Selected Specific Quality of Care Issues at §483.25.
The following sections describe some specific issues or care needs that are not otherwise
covered in the remaining tags of §483.25, Quality of Care. These are only some of the
issues that may arise with a resident's quality of care. Surveyors should consider any
quality of care issue that is not covered in a specific Quality of Care tag to be covered
under this tag, F309.
Review of a Resident with Non Pressure-Related Skin Ulcer/Wound.
Residents may develop various types of skin ulceration. At the time of the assessment
and diagnosis of a skin ulcer/wound, the clinician is expected to document the clinical
basis (e.g., underlying condition contributing to the ulceration, ulcer edges and wound
bed, location, shape, condition of surrounding tissues) which permit differentiating the
ulcer type, especially if the ulcer has characteristics consistent with a pressure ulcer, but
is determined not to be one. This section differentiates some of the different types of skin
ulcers/wounds.