CaraDay Demo Facility — Survey Risk Summary

The headline numbers

• Census: 50 beds total, 31 active residents, 9 discharged
• Survey-risk recommendations in queue: 50 total
  • 🔴 7 critical
  • 🟠 39 high
  • 🟡 4 medium
• (Separately, there are 87 HIPPS-optimization recommendations — those are revenue-integrity issues, not survey risk.)

The recurring pattern

Across the critical and high-risk residents, the same three documentation/clinical issues keep clustering on the same charts:

1. Unwitnessed falls with incomplete post-fall documentation (no huddle reference, missing reassessment, or — in several cases — silenced/deactivated bed alarms). This is F-tag F689 (accidents) territory.
2. Stage 2 pressure injuries (most often coccyx/sacral or heel) — frequently not yet reflected in MDS skin coding. F-tag F686.
3. Documented depressive symptoms (in MD, MSW, and/or nursing notes — sometimes with an SSRI started) but no PHQ-9 / D0150 score captured in the MDS. F-tag F697 and a direct PDPM Nursing/depression end-split issue.

When all three appear on one chart, the resident lands in critical.

The 7 critical residents (highest priority)

| Resident | Status | Why critical | |---|---|---| | Carlos Fuentes (84c60bfc…) | Active | 4/11 unwitnessed fall + Stage 2 coccyx + depression w/o PHQ-9 | | Margaret Holloway (843d9cb9…) | Active | BERG 8/56, fall 3/27, Stage 2 coccyx, depression w/o PHQ-9 | | Carlos Mendoza (1e2903fe…) | Active | 4/10 fall w/ desat, new Stage 2, depression w/o PHQ-9 | | James Okafor (62c1480f…) | Deceased | Fall w/ orthostasis, Stage 2, depression w/o PHQ-9 — auditable record | | James Okafor (7b48d16c…) | On leave | 3/14 fall, Stage 2 (3/11), depression w/o PHQ-9 | | Linda Szymanski (bbd3d895…) | Discharged | 2/8 fall, progressing Stage 2 coccyx, depression w/o PHQ-9 | | Delores Washington (5f0733fd…) | Discharged | 1/31 fall w/ abrasion, depression flagged but no PHQ-9 |

The two deceased/discharged criticals (Okafor, Szymanski, Washington) still matter — those records are auditable in any survey window covering their stay.

High-risk residents (25 returned, partial list)

The high-risk cohort is heavily weighted toward CVA-sequelae residents (I69.30) — Beaumont, Berkowitz, Briscoe, Hartman, Holcomb, Hollingsworth, Holloway, Holsworth, Huang, Kowalski, S. Okafor, Papineau, Chen — most with the same fall + skin + depression pattern.

What I'd do next

The single highest-leverage move: run a PHQ-9 / D0150 sweep. The "depression documented but no PHQ-9" gap appears on virtually every critical and high-risk chart. Closing it simultaneously reduces F697 exposure and potentially shifts the Nursing component end-split (PDPM benefit).

Recommended next step: Pick one critical resident — I'd start with Carlos Fuentes (active, recent fall, all three gaps present) — and run analyze_hipps_optimization on him so you can see the exact documentation actions proposed against his record. Want me to do that now?