Section 300.200  Inspections, Surveys, Evaluations and Consultation


The terms survey, inspection and evaluation are synonymous.  These terms refer to the overall examination of compliance with the Act and this Part.


a)         All facilities to which this Part applies shall be subject to and shall be deemed to have given consent to annual inspections, surveys or evaluations by properly identified personnel of the Department, or by such other properly identified persons, including local health department staff, as the Department may designate.  An inspection, survey or evaluation, other than an inspection of financial records, shall be conducted without prior notice to the facility.  A visit for the sole purpose of  consultation may be announced. The licensee, or person representing the licensee in the facility, shall provide to the representative of the Department access and entry to the premises or facility for obtaining information required to carry out the Act and this Part.  In addition, representatives of the Department shall have access to and may reproduce or photocopy at its cost any books, records, and other documents maintained by the facility, the licensee or their representatives to the extent necessary to carry out the Act and this Part.   A facility may charge the Department for such photocopying at a rate determined by the facility not to exceed the rate in the Department's Freedom of Information Code (2 Ill. Adm. Code 1126).  Sections 3-212 and 3-213 of the Act)


b)         In determining whether to make more than the required number of unannounced inspections, surveys and evaluations of a facility, the Department shall consider one or more of the following:


1)         previous inspection reports;


2)         the facility's history of compliance with the Act and this Part:


A)        correction of violations;


B)        penalties or other enforcement actions;


3)         the number and severity of complaints received about the facility;


4)         any allegations of resident abuse or neglect;


5)         weather conditions;


6)         health emergencies;


7)         other reasonable belief that deficiencies exist; and


8)         requirements pursuant to the "1864 Agreement" (42 U.S.C.A. 1395aa) between the Department and U.S. Health and Human Services (HHS) (e.g., annual and follow-up certification inspections, life safety code inspections and any inspections requested by the secretary of HHS).  (Section 3-212(b) of the Act)


c)         The Department shall not be required to determine whether a facility certified to participate in the Medicare program under Title XVIII of the Social Security Act, or the Medicaid Program under Title XIX of the Social Security Act,  and which the Department determines by inspection to be in compliance with the certification requirements of Title XVIII or XIX, is in compliance with any requirement of the Act that is less stringent than or duplicates a federal certification requirement. (Section 3-212(b-1) of the Act, see P.A. 88-278, effective August 10, 1993)


d)         The Department shall, in accordance with Section 3-212(a) of the Act, determine whether a certified facility is in compliance with requirements of the Act that exceed federal certification requirements. (Section 3-212(b-1) of the Act, see P.A. 88-278, effective August 10, 1993)


e)         If a certified facility is found to be out of compliance with federal certification requirements, the results of the inspection conducted pursuant to Title XVIII or XIX of the Social Security Act (Section 3-212(b-1) of the Act, see P.A. 88-278, effective August 10, 1993) shall be reviewed to determined which, if any, of the results shall be considered licensure findings, as follows:


1)         The result identifies potential violations of the Nursing Home Care Act and this Part; and


2)         The result, based on available information, would likely represent a Type A or Type B violation if tested against the factors described in Sections 300.272 and 300.274.


f)         All results of an inspection conducted pursuant to Title XVIII or XIX of the Social Security Act that the Department considers licensure findings shall be provided to the facility at the time of exit or by mail in accordance with subsection (g) of this Section.


g)         Upon the completion of each inspection, survey and evaluation, the appropriate Department personnel who conducted the inspection, survey or evaluation shall submit a copy of their report to the licensee or their representative upon exiting the facility or upon considering results of an inspection conducted pursuant to Title XVIII or XIX of the Social Security Act as licensure findings.  A copy of the information gathered during a complaint investigation will not be provided upon exiting the facility.  Comments or documentation provided by the licensee which may refute findings in the report, which explain extenuating circumstances that the facility could not reasonably have prevented, or which indicate methods and timetables for correction of deficiencies described in the report shall be provided to the Department within ten days of receipt of the copy of the report.  (Section 3-212(c) of the Act)


h)         Consultation consists of providing advice or suggestions to the staff of a facility at their request relative to specific matters of the scope of regulation, methods of compliance with the Act or this Part, or general matters of patient care.


(Source:  Amended at 19 Ill. Reg. 11600, effective July 29, 1995)