I am submitting this comment as the founder of the Connie Taliaferro Initiative for Long-Term Care Reform and as the daughter and advocate of a former Virginia nursing-facility resident.

I support the Virginia Department of Health’s effort to establish clearer and more consistent guidance for reviewing administrative sanctions against nursing facilities. The proposed guidance appropriately identifies serious and repeated noncompliance, actual or potential resident harm, abuse or neglect, failure to correct deficiencies, compliance history, and systemic operational failures as factors OLC should consider.

However, I am concerned that the guidance creates review triggers without establishing circumstances in which a sanction is required. The document repeatedly states that sanctions “may” be considered and explains that meeting a citation threshold does not necessarily mean a sanction will be imposed. Consequently, a facility could meet one or more serious sanctions-review triggers without receiving any sanction or the public receiving an explanation of why OLC declined to act.

Certain findings should require an appropriate minimum sanction. These should include:

• Actual resident harm;

• Substantiated abuse or neglect;

• Immediate jeopardy or another serious threat to resident health or safety;

• Severe compromise of residents’ quality of care or quality of life;

• Failure to correct a serious deficiency by the required correction date;

• Repeated failure to achieve or maintain compliance; and

• Systemic or persistent noncompliance that exposes residents to continuing risk.

The specific sanction may remain proportional to the severity, scope, duration, resident impact, and facility response. However, when one of these serious findings is substantiated, enforcement should not be completely discretionary. A review without a meaningful consequence does not provide sufficient accountability or deterrence.

The guidance should also state clearly that a serious first-time violation may result in immediate sanctions. OLC should not have to wait for a facility to receive repeated citations when a single violation causes actual harm, involves abuse or neglect, creates immediate jeopardy, or demonstrates that residents cannot be protected safely. Repetition may justify escalating a sanction, but it should not be required before the Commissioner acts to protect residents.

OLC should issue a written, publicly available sanctions-review determination whenever a sanctions trigger is met. That determination should identify:

• The trigger or triggers reviewed;

• The relevant findings and compliance history;

• The actual or potential effect on residents;

• Whether a sanction was imposed;

• The type and duration of any sanction;

• The reasons supporting the selected sanction; or

• If no sanction was imposed, the specific reasons OLC declined to act.

Public explanations should be required regardless of whether OLC ultimately imposes a sanction. Residents, families, advocates, prospective residents, and taxpayers deserve to know how serious regulatory findings were evaluated and why a particular enforcement decision was made.

The guidance should also establish a timeframe for completing sanctions reviews. Serious resident-safety findings require prompt decisions. An enforcement process that remains pending without a defined deadline may allow unsafe conditions or ineffective management practices to continue.

Citation counts can help identify patterns, but resident protection should remain the controlling consideration. One serious violation may justify immediate action, while repeated lower-level violations may demonstrate an escalating or systemic failure. OLC should examine the complete compliance history across inspections, complaint investigations, revisits, related regulatory areas, and prior corrective actions.

I respectfully request that VDH revise the proposed guidance to require sanctions for defined serious findings, expressly authorize immediate sanctions for serious first-time violations, establish sanctions-review deadlines, and require public written explanations for all sanctions-review decisions.

Michelle Taliaferro
Founder
Connie Taliaferro Initiative for Long-Term Care Reform
connietaliaferroinitiative@outlook.com