Scope and Severity Definitions


S/S	Scope	Severity	Description
A	Isolated	Level 1	No actual harm, potential for minimal harm
B	Pattern	Level 1	No actual harm, potential for minimal harm
C	Widespread	Level 1	No actual harm, potential for minimal harm
D	Isolated	Level 2	No actual harm, potential for more than minimal harm
E	Pattern	Level 2	No actual harm, potential for more than minimal harm
F	Widespread	Level 2	No actual harm, potential for more than minimal harm
G	Isolated	Level 3	Actual harm that is not immediate jeopardy
H	Pattern	Level 3	Actual harm that is not immediate jeopardy
I	Widespread	Level 3	Actual harm that is not immediate jeopardy
J	Isolated	Level 4	Immediate jeopardy to resident health or safety
K	Pattern	Level 4	Immediate jeopardy to resident health or safety
L	Widespread	Level 4	Immediate jeopardy to resident health or safety

A. General Objective
After the survey team determines that a deficiency (ies) exists, assess the effect on resident outcome (severity level) and determine the number of residents potentially or actually affected (scope level). Use the results of this assessment to determine whether or not the facility is in substantial compliance or is noncompliant. When a facility is noncompliant, consider how the deficient practice is classified according to severity and scope levels in selecting an appropriate remedy. (See §7400 for discussion of remedies.) Scope and severity determinations are also applicable to deficiencies at §483.70(a), Life Safety from Fire.

B. Scope Levels
Isolated: Scope is isolated when one or a very limited number of residents are affected and/or one or a very limited number of staff are involved, and/or the situation has occurred only occasionally or in a very limited number of locations.

Pattern: Scope is a pattern when more than a very limited number of residents are affected, and/or more than a very limited number of staff are involved, and/or the situation has occurred in several locations, and/or the same resident(s) have been affected by repeated occurrences of the same deficient practice. The effect of the deficient practice is not found to be pervasive throughout the facility.

Widespread: Scope is widespread when the problems causing the deficiencies are pervasive in the facility and/or represent systemic failure that affected or has the potential to affect a large portion or all of the facility’s residents. Widespread scope refers to the entire facility population, not a subset of residents or one unit of a facility. In addition, widespread scope may be identified if a systemic failure in the facility (e.g., failure to maintain food at safe temperatures) would be likely to affect a large number of residents and is, therefore, pervasive in the facility.

C. Severity Levels
Level 1: is a deficiency that has the potential for causing no more than a minor negative impact on the resident(s).

Level 2: is noncompliance that results in no more than minimal physical, mental and/or psychosocial discomfort to the resident and/or has the potential (not yet realized) to compromise the resident’s ability to maintain and/or reach his/her highest practicable physical, mental and/or psychosocial well-being as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services.

Level 3: is noncompliance that results in a negative outcome that has compromised the resident’s ability to maintain and/or reach his/her highest practicable physical, mental and psychosocial well-being as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. This does not include a deficient practice that only could or has caused limited consequence to the resident.

Level 4: is immediate jeopardy, a situation in which immediate corrective action is necessary because the facility’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident receiving care in a facility.