State Inspection

On the right hand side of each table are a set of performance measures. The performance in each category is indicated by stars. The more stars (up to 5) that are shown, the better the facility scored on that particular measure. The broadest measure of performance is Overall Inspection. The eight other categories represent different pieces of the Overall Inspection rank.

Each of the performance measures represents how a nursing home ranked within its geographic region. The regions are defined as follows:

North
Region
Counties
1
Escambia, Okaloosa, Santa Rosa, Walton
2
Bay, Calhoun, Franklin, Gadsden, Gulf, Holms, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, Washington
3
Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumpter, Suwannee, Union
4
Baker, Clay, Duval, Flagler, Nassau, St. Johns, Volusia

 
Central
Region
Counties
5
Pasco, Pinellas
6
Hardee, Highlands, Hillsborough, Manatee, Polk
7
Brevard, Orange, Osceola, Seminole

 
South
Region
Counties
8
Charlotte, Collier, De Soto, Glades, Hendry, Lee, Sarasota
9
Indian River, Martin, Okeechobee, Palm Beach, St. Lucie
10
Broward
11
Dade, Monroe

As stated above, these ranks indicate only relative rankings within a region. All of the nursing homes in a particular region could perform better than the statewide average. Therefore, a low rank does not necessarily indicate a "low quality" facility. Similarly, all of the nursing homes in a particular region could perform lower than the statewide average. Therefore, receiving a high rank does not necessarily indicate a "high quality" facility. All facilities listed in this guide have met the requirements for being licensed as a nursing home.

Any performance measure will have strengths and weaknesses. These are discussed below.

Inspection

The goal of the Inspection measures is to assess how well the nursing home complies with the federal laws governing nursing homes that accept Medicare or Medicaid payments. While the laws are federal, the state of Florida conducts the actual inspections as a subcontractor to the federal Centers for Medicare and Medicaid Services (CMS).

For the 6 nursing homes that accept neither Medicare nor Medicaid these federal laws do not apply. Therefore, they can only be inspected for compliance with state of Florida laws. The scoring procedure for these 6 nursing homes is very similar to that used for the other nursing homes. On average, less then 2% of nursing homes do not accept Medicare nor Medicaid. The differences are discussed below in the section titled Scoring and Ranking Algorithm . For the nursing homes that do accept Medicare or Medicaid, the general scoring procedure is discussed next.

Complete inspections are conducted on average once per year. They are unannounced, and typically last three to four days. In addition, AHCA may conduct additional inspections of nursing homes, if concerns or complaints of regulatory violations arise.

If the nursing home is found to be out of compliance during an inspection, deficiencies are issued to the facility. The deficiencies are assigned a severity (e.g. is a resident merely at risk for being harmed, or has a resident experienced actual harm) as well as a scope (e.g. is only one resident affected or are many residents affected). Deficiencies are given points according to the level of the scope and severity (the more serious the deficiency, the more points assigned). Points are doubled for deficiencies that represent substandard quality of care.

Total deficiency points are used to compute a score for the nursing home. This score takes into account the number of deficiencies, their scope, and their severity over the past 30 months.

The ranks shown in this guide are based on the facility's score over the past 30 months divided by the number of complete inspections. This time period will typically encompass at least two inspections. If the ownership of the facility has changed within the past 30 months, then the ranks will include deficiencies involving both the new owner and the previous owner(s).

Five stars overall indicates that the facility had a lower score relative to most other facilities in its region. Having only one star indicates that the facility had a higher score relative to most other facilities in its region.

Facilities have the right to appeal the deficiencies. The underlying scores do not include deficiencies that were overturned after appeal at the federal level.

The overall score is broken down into the three categories: Quality of Care, Quality of Life, and Administration. The combination of all three categories contains all 255 possible deficiencies that comprise the Overall Inspection rank.

Some of the more common deficiencies in the Quality of Care category involve the unsanitary storage, preparation, and distribution of food; improper treatment to prevent and treat pressure ulcers; and failing to maintain a resident's nutritional status.

Some of the more common deficiencies in the Quality of Life category involve improper use of physical or chemical restraints, failing to treat the resident with dignity, and failing to accommodate resident needs and preferences.

Some of the more common deficiencies in the Administration category involve the inaccuracy of comprehensive assessments of the residents' health status, and failing to develop adequate comprehensive care plans for the residents. The Administration category also includes physical aspects of the facility such as inaccessible fire exits and lack of fire prevention.

There were many specific areas of interest expressed by consumers while developing this guide. The five of greatest interest are included as the Components of Inspection. Because of their narrow focus, these components collectively represent 18 out of the 255 possible deficiencies. However, in many cases they represent the more frequently cited deficiencies at the higher severity and scope levels.

The Nutrition and Hydration component includes three possible deficiencies for failure to comply with:
F325: Facility must ensure that residents maintain their nutritional status
F326: Facility must provide therapeutic diet when necessary
F327: Facility must provide sufficient fluid intake

The Restraints and Abuse component includes four possible deficiencies for failure to comply with:
F221: Residents must not be physically restrained for discipline or convenience
F222: Residents must not be chemically restrained for discipline or convenience
F223: Residents must not be verbally, mentally, or physically abused
F224: Residents must be free of mistreatment and neglect

The Pressure Ulcers component includes one possible deficiencies for failure to comply with:
F314: Residents must receive proper treatment to prevent and heal pressure sores

The Decline component includes six possible deficiencies for failure to comply with:
F309: Facility must provide necessary care for highest practicable well being
F310: Facility must ensure that ADLs do not decline unless unavoidable
F311: Facility must give each resident treatment to improve or maintain ADLs
F312: Facility must provide proper services for ADL dependent resident
F317: Residents must receive proper therapy to prevent reduced range of motion
F318: Residents with limited range of motion must receive appropriate treatment

ADL stands for Activities of Daily Living and include the resident's ability to move, walk, dress, eat, toilet, comb hair, brush teeth, etc.

The Dignity component includes four possible deficiencies for failure to comply with:
F241: Facility must treat residents with dignity and respect
F242: Residents are free to choose their activities, health care, and visitors
F245: Residents are free to participate in their chosen religious and social activities
F246: Facility must accommodate reasonable preferences of each resident

Star Summary (Review):

The more stars a facility receives in any of these categories or components, the more the facility was found to be in compliance with the regulations governing nursing homes.

The fewer stars a facility receives, the more the facility was found to be in noncompliance with the regulations governing nursing homes.

Months will typically pass between inspections. Much could change for the better or worse in a facility between inspections. Therefore, you must always inspect the facility yourself before making such an important decision.


Scoring and Ranking Algorithm Details