Continuation of the Review of OBRA Regulations: The National Community Practice Standards

§483.30 is always associated with nursing services and often used along with another sections of OBRA in the course of litigation.  This regulations specifically is used to assert that there were insufficient nursing resources that lead to an adverse outcomes.  These types of outcomes can be:

• failure to properly complete a clinical assessment after a unwitnessed fall,
• failure to properly assess or monitor changes in a resident's condition,
• inadequate staffing or staff supervision.
• failure to advocate for the resident in demanding and assuring prompt access to needed medical and hospital care.

§483.35  - This OBRA section addresses food service in a nursing facility and would be used in allegations concerning:

• failure to provide snacks or nutritional supplements when associated with weight loss,
• failure to provide substitute foods of similar nutritional value for residents who have refused the initial food choice,
• failure to provide foods of the correct consistency (usually associated with a clinical recommendation that was not followed and an allegation that a resident chocked to death on pieces of solid food),
• failure to provide adequate food proportions.

§483.40 - This OBRA section has to do with physician services. The following allegations appear most frequently:

• Physician orders must be followed,
• Physician must medically assess the resident according to established timetable,
• The facility must arrange for the provision of physician services on a 24 hour a day basis.

§483.65 - The facility must establish and maintain a infection control program that creates a safe, sanitary, and comfortable environment.  Examples of this section would include:

• Development of MRSA, an antibiotic bacteria
• Development of a infected pressure ulcer infections caused through substandard application of universal precautions

§483.70 - A facility must be designed and maintained to protect the health and safety of the residents.  Allegations under this physical environment section could include:
a failure to maintain or or properly use a piece of equipment. Examples could include:

•  a resident lift machine (Hoyer lift) that fails because the safety lock is disengaged or eroded over time. 
• The hot water heater is set too high and a resident suffers skin burns.