| 2026-04-30 | F0812, F0880 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. / Provide and implement an infection prevention and control program. | F |
| 2026-04-30 | F0628, F0657, F0804, F0949 | Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. / Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. / Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. / Provide behavior health training consistent with the requirements and as determined by a facility assessment. | D |
| 2026-02-19 | F0600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | J |
| 2026-02-19 | F0841, F0868 | Designate a physician to serve as medical director responsible for implementation of resident care policies and coordination of medical care in the facility. / Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | F |
| 2025-04-11 | F0684, F0686, F0690, F0880 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. / Provide appropriate pressure ulcer care and prevent new ulcers from developing. / Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. / Provide and implement an infection prevention and control program. | D |
| 2025-03-04 | F0656, F0812, F0837, F0838, F0865, F0867, F0880, F0882, F0944 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. / Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. / Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility. / Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. / Have a plan that describes the process for conducting QAPI and QAA activities. / Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. / Provide and implement an infection prevention and control program. / Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. / Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program. | F |
| 2025-03-04 | F0842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | E |
| 2025-03-04 | F0578, F0636, F0641, F0642, F0644, F0657, F0684, F0692, F0698, F0742, F0758, F0761, F0808 | Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. / Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. / Ensure each resident receives an accurate assessment. / Ensure a qualified health professional conducts resident assessments. / Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. / Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. / Provide appropriate treatment and care according to orders, resident’s preferences and goals. / Provide enough food/fluids to maintain a resident's health. / Provide safe, appropriate dialysis care/services for a resident who requires such services. / Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. / Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. / Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. / Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. | D |
| 2025-01-15 | F0880 | Provide and implement an infection prevention and control program. | L |
| 2024-12-12 | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | G |
| 2024-12-12 | F0728 | Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse aides who have worked less than 4 months are enrolled in appropriate training. | E |
| 2024-12-12 | F0609, F0686, F0849, F0880 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. / Provide appropriate pressure ulcer care and prevent new ulcers from developing. / Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. / Provide and implement an infection prevention and control program. | D |
| 2024-08-29 | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | J |
| 2024-05-01 | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | J |
| 2024-05-01 | F0623 | Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | D |
| 2023-12-21 | F0812, F0867, F0944 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. / Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. / Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program. | F |
| 2023-12-21 | F0695, F0725, F0842 | Provide safe and appropriate respiratory care for a resident when needed. / Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. / Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | E |
| 2023-12-21 | F0609, F0641, F0684, F0693, F0758, F0849, F0880, F0883, F0940 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. / Ensure each resident receives an accurate assessment. / Provide appropriate treatment and care according to orders, resident’s preferences and goals. / Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. / Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. / Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. / Provide and implement an infection prevention and control program. / Develop and implement policies and procedures for flu and pneumonia vaccinations. / Develop, implement, and/or maintain an effective training program for all new and existing staff members. | D |