Sections of an Acceptable Plan of Correction

An acceptable PoC is required for all deficiencies/violations to be in compliance.

When more than one deficiency/violation is cited, the PoC for each deficiency must be acceptable for the overall PoC to be deemed acceptable.

It is not necessary for a facility to re-write the corrective action for different deficiencies/violations if the corrective action is identical. For example, the plan of correction for W255 may state, "Refer to W159." This is acceptable if the facility plans on using the same corrective actions for a deficiency written at W255 and W159.

All deficiencies cited on the CMS Form 2567 and all violations cited on HHSC Form 3724 must be individually addressed in the PoC.