Washington State Did Not Ensure That Selected Nursing Homes Complied With Federal Requirements for Life Safety, Emergency Preparedness, and Infection Control

Why OIG Did This Audit

In 2016, CMS updated its life safety and emergency preparedness regulations related to health care facilities to improve protections for all individuals enrolled in Medicare and Medicaid, including those residing in long-term care facilities (nursing homes). The updates expanded requirements related to sprinkler systems, smoke detector coverage, and emergency preparedness plans. Additionally, facilities were required to develop an infection control program.

Our objective was to determine whether Washington State ensured that selected nursing homes in Washington that participated in the Medicare or Medicaid programs complied with Federal requirements for life safety, emergency preparedness, and infection control.

How OIG Did This Audit

Of the 200 nursing homes in Washington State that participated in Medicare or Medicaid, we selected a nonstatistical sample of 20 nursing homes for our audit based on certain risk factors, including multiple high-risk deficiencies that Washington reported to CMS.

We conducted unannounced site visits at each of the 20 nursing homes from September through November 2022. During each site visit, we checked for life safety, emergency preparedness, and infection control deficiencies.

What OIG Found

Washington State did not ensure that selected nursing homes in Washington that participated in the Medicare or Medicaid programs complied with Federal requirements for life safety, emergency preparedness, and infection control. During our onsite inspections, we identified deficiencies related to life safety, emergency preparedness, or infection control at all 20 nursing homes that we audited, totaling 525 deficiencies. Specifically, we found 91 deficiencies related to life safety, 155 deficiencies related to emergency preparedness, and 279 deficiencies related to infection control. As a result, residents, staff, and visitors at the 20 nursing homes are at an increased risk of injury, significant illness, or death during a fire or other emergency, or in the event of an infectious disease outbreak.

The identified deficiencies occurred because nursing homes lacked adequate management oversight and had frequent management turnover. In addition, although nursing home management and staff are ultimately responsible for ensuring resident safety, Washington has a role in helping nursing homes reduce the risk of resident injury, significant illness, or death through its oversight of nursing homes' compliance with Federal requirements. However, Washington did not consistently identify deficiencies related to life safety, emergency preparedness, and infection control during surveys and take enforcement action to ensure that nursing homes complied with the requirements. Furthermore, Washington did not ensure that nursing home management was educated about life safety and emergency preparedness training resources available to nursing home staff that could be used to train staff on how to comply with Federal requirements.

What OIG Recommends and Washington's Comments

We recommend that Washington State follow up with the 20 nursing homes reviewed in this audit to ensure that these nursing homes have taken corrective actions to address the deficiencies identified. We also make procedural recommendations for Washington to provide training to State surveyors and educate nursing home management that training resources are available.

Washington concurred with all our recommendations and described actions that it had taken or planned to take to address our recommendations. Among other actions, Washington stated that it had implemented a plan to complete a review of all 20 nursing homes and had created plans to assure ongoing continuing education for staff and providers.