CMS Nursing Home F-Tag Deficiency Library

Resident Rights / Exercise of Rights

Rights Exercised by Representative

Right to be Informed/Make Treatment Decisions

Right to Participate in Care Planning

Resident Self-Administration of Drugs

Reasonable Accommodations of Needs/Preferences

Choose/Be Notified of Room/Roommate Change

Self-Determination

Resident/Family Group and Response

Grievances

Request/Refuse/Discontinue Treatment; Formulate Advance Directives

Notify of Changes (Injury/Decline/Room, Etc.)

Personal Privacy/Confidentiality of Records

Grievance Procedures

Free from Abuse and Neglect

Develop/Implement Abuse/Neglect Policies

Respond Appropriately to Allegations of Abuse

Not Use Verbal, Mental, Sexual or Physical Abuse

Report Reasonable Suspicion of a Crime

Comprehensive Assessments & Timing

Quarterly Assessment At Minimum

Accuracy of Assessments

PASARR Screening for MD and ID

Baseline Care Plan

Develop/Implement Comprehensive Care Plan

Care Plan Timing and Revision

Services Provided Meet Professional Standards

Quality of Care

Treatment/Care for Dependent ADLs

Treatment/Svcs to Prevent/Heal Pressure Ulcers

Foot Care

Increase/Prevent Decrease in ROM/Mobility

Free of Accident Hazards/Supervision/Devices

Bowel/Bladder Incontinence, Catheter, UTI

Nutrition/Hydration Status Maintenance

Tube Feeding Management/Restore Eating Skills

IV Catheter-Care/Consistent Aseptic Tech

Respiratory/Tracheostomy Care & Suctioning

Pain Management

Dialysis

Trauma-Informed Care

Pharmacy Svc/Procedures/Pharmacist/Records

Drug Regimen is Free from Unnecessary Drugs

Psychotropic Drugs: Use/Monitoring/Tapering

Free of Medication Error Rates of 5% or More

Residents Are Free of Significant Med Errors

Label/Store Drugs and Biologicals

Provided Nutrition Care/Services Meet Needs

Menus Meet Resident Needs/Preferences

Food Quality/Temp/Tasty/Attractive/Varied

Sufficient Staffing of Qualified Dietary Personnel

QAPI/QAA Improvement Activities

QAPI/QAA Data Collection/Monitoring

QAPI/QAA Program Activities

Sufficient Nursing Staff

Competent Nursing Staff

MD/Medical Director Services

Nurse Aide Registry Verification; Retraining

Nurse Aide Perform Review – 12 Hrs/Yr In-service

Sufficient/Competent Staff-Behavioral Health Needs

Infection Prevention & Control Program

Antibiotic Stewardship Program

Safe/Functional/Sanitary/Comfortable Environment

Maintain Comfortable/Safe Temperature Levels

Maintain/Clean/Comfortable Environment

Governing Body

Facility-Wide Assessments

Facility Assessment

Medical Records

Medical Record Content