How do observations such as these occur during a survey?  Unfortunately, many of them occur because responsible staff are not routinely monitoring that the developed plan of care is consistently being carried out or, if it is being carried out, documentation does not validate that care and services were provided. It is not uncommon for a survey to highlight the need for a facility to review its systems related to a cited F-tag. Remember it is our responsibility to provide the necessary care and services for a resident to maintain or improve their ability to carry out activities of daily living. If they do diminish, a surveyor should be able to review the medical record, interview staff and identify that any loss was unavoidable and not reflective of an inadequate system or poor compliance with carrying out the plan of care.

F tag 684

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As you can see from these citations, it is very easy for a surveyor to visually observe a resident and then follow up with documentation review and interviews with both the resident and staff and identify a negative outcome, such as the example of the resident losing the ability to ambulate.  What an unacceptable outcome for that resident.

This week’s Ftag of the Week on the CMSCG Blog is F676 Activities of Daily Living (ADLs)/ Maintain Abilities, which is part of the Quality of Life regulatory group. F676 spells out the facility’s responsibility for the provision of care and services to ensure that a resident’s activities of daily living do not diminish unless there is evidence that the resident’s clinical condition changed so that the diminishment was unavoidable.

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CMS Compliance Group, Inc. is a regulatory compliance consulting firm with extensive experience servicing the post-acute/ long term care industry. With the idea of continuous quality improvement in mind, CMSCG’s interdisciplinary team ensures that all departments can achieve and maintain compliance while improving quality of care.

In such cases, it is more practical and often recommended to replace the entire hub assembly rather than attempting to replace only the bearing.

F684

A bad wheel bearing sound is usually a loud hum coming from that wheel sort of like loud road noise from bad tires.

F686

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Appendix PP of the State Operations Manual (SOM) directs the reader to F677 ADL Care Provided for Dependent Residents for Interpretive Guidance. We will look at F677 ADL Care in a future CMSCG Blog post, but for now, here are some of the ways that F676 has been cited on survey:

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