Harmony Healthcare Blog

Top 10 F-Tags Deficiency Trends in Nursing Facility Health Inspections

Posted by Kris Mastrangelo on Tue, May 15, 2018


Edited by Kris Mastrangelo

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


Hand with marker writing the word Trends

Health Inspections are the topic of every nursing facility across the country.  According to Nursing Home Compare, the current national average of deficiencies is 5.8 F-Tags Per Facility. 

There are 204 possible deficiencies a nursing home is subject to during a Federal Survey derived from the below 20 categories. 

  • Resident Rights
  • Admission, Transfer, and Discharge Rights
  • Freedom from Abuse, Neglect, and Exploitation
  • Quality of Life
  • Resident Assessment
  • Comprehensive Resident-Centered Care Plans
  • Quality of Care
  • Behavioral Health Services
  • Pharmacy Services
  • Infection Control
  • Nursing Services
  • Food and Nutrition Services
  • Physician Services
  • Specialized Rehabilitative Services
  • Dental Services
  • Physical Environment
  • Administration
  • Laboratory, Radiology Services, and Other Diagnostic Services
  • Quality Assurance and Performance Improvement
  • Training Requirements

Applying the 20/80 Pareto Principle (20% efforts yield 80% results) to prioritizing tasks in tackling survey preparation is useful.  In particular, to know the most frequently cited deficiencies. 

“Pareto’s Principle or the 80/20 Rule is a useful construct when analyzing our efforts and outcomes. It is priceless when applied to task or goal lists, and it provides a useful analytical framework for many problem situations.” [i]

Below are the Top 10 F-Tags per the January 2018 CASPER.  This data reflects the last standard health survey of active SNF/NF.  Please note, it excludes complaint, federal monitoring, and special focus surveys. 

Top 10 F-Tags 

 

Category

Old
F-Tag

New
F-Tag

No. of
Tags

%

1

Infection Control

F441

F880

5,918

6.73%

2

Food & Nutrition

F371

F812/F813

5,811

6.61%

3

Quality of Care

F323

F689/F700

4,169

4.74%

4

Quality of Care

F309

F675/F684/ F697/F698/F744

3,612

4.11%

5

Pharmacy Services

F431

F755/F761

3,520

4.00%

6

Quality of Care

F329

F757/F758

3,121

3.55%

7

Resident Assessment

F279

F639/F656

3,021

3.44%

8

Administration

F514

F842

2,361

2.69%

9

Resident Assessment

F278

F641/F642

2,227

2.53%

10

Quality of Life

F241

F550

2,201

2.50%

 

Total

35,961

40.90%

 

Download the F-Tag Crosswalk

Specifically, it is prudent to take a look at the following areas: 

  1. F441:  Infection Prevention & Control:  The Infection Prevention and Control Program (IPCP) program must be facility-wide and include all departments and contracted services.  If a specific care area concern is identified, it should be evaluated under the specific care area, such as for pressure ulcers, respiratory care, catheter care, and medication pass observations which include central lines, peripheral IVs, and oral/IM/respiratory medications. 
  2. F371:  Food & Nutrition (Food Procurement, Store/Prepare/Serve – Sanitary):  Store, cook, and serve food in a safe and clean way. 
  3. F323:  Quality of Care (Free of Accident Hazards/Supervision/Devices):   Ensure that all nursing home areas are free from accident hazards and provide adequate supervision to prevent avoidable accidents.
  4. F309:  Quality of Care:  Provide necessary care and services to maintain or improve the highest well-being of each resident. 
  5. F431:  Pharmacy Services (Pharmacy Services/Procedures/Pharmacist/ Records)Maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards. 
  6. F329:  Quality of Care (Drug Regimen is Free from Unnecessary Drugs)Ensure that each resident's entire drug/medication regimen is free from unnecessary drugs and is managed and monitored to achieve highest level of well-being. 
  7. F279:  Resident Assessment (Develop/Implement Comprehensive Care Plan):  Ensure MDS and Care Plans accurately reflect care needs and services provided.  Ensure accurate and timely MDS completion and submission. 
  8. F514:  Administration (Resident Records – Identifiable Information):  Maintain accurate, complete and organized clinical records on each resident which follow professional standards. 
  9. F278:  Resident Assessment (Accuracy of Assessments)Ensure each resident receives an accurate assessment by a qualified health professional. 
  10. F241:  Quality of Life (Resident Rights/Exercise of Rights)Provide care in a manner that is person
  • centered,
  • respectful,
  • dignified, and
  • anticipates the needs of the resident 

Harmony Healthcare International (HHI) is here to help. We understand how much work is involved for you and your staff to run an efficient, compliant, and fiscally sound facility.  

Harmony Healthcare International (HHI) can: 

  • Identify areas of risk and opportunity
  • Education on rules and regulations
  • Implement Systems (QAPI)
  • Monitor progress and performance 

The most frequently cited scope and severity is the D category at 55.7% (as of 1.31.18).  This will be discussed with the next blog post.

PDPM

Harmony Healthcare International (HHI) performs monthly compliance audits. If you need help with this area, please contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 

  1. F. JOHN REH April 12, 2018
  2. 42 CFR § 483 subpart B; CMS “State Operations Manual,” Appendix PP

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