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Compliance

Staying survey-ready – Avoiding F-Tag 689 in your long-term care community

Do you want to know how you can avoid this deficiency in your long-term care or SNF community? Compliance expert Rebecca DeRousse explains how you can save yourself the hassle, financial loss, and negative impact on your marketability by avoiding this tag.

The second most commonly cited F-Tags state surveyors’ issue is the F689 deficiency otherwise known as “Free of Accident Hazards/Supervisions/Devices”.

Do you want to know how you can avoid this deficiency in your long-term care or SNF community? Compliance expert Rebecca DeRousse explains how you can save yourself the hassle, financial loss, and negative impact on your marketability by avoiding this tag.

F0689 - Free of Accident Hazards/Supervisions/Devices

This tag has a lot of components to it including:

  • Falls
  • Resident smoking
  • Resident-to-resident altercations
  • Wandering/elopement 
  • Substance use disorder
  • Physical plant hazards
  • Assistive devices/equipment hazards
The CMS F-tag states that "The facility must ensure that the resident environment remains as free of accident hazards as is possible, [and that] each resident receives adequate supervision and assistance devices to prevent accidents."

Below, you’ll find practical ways you can help avoid citations for your facility for many of these key components.

Falls

Nuraing home residents are twice as likely to fall than than older adults living in the community
Experienced nursing home administrator and compliance expert, Rebecca DeRousse states, "We know that falls are not always avoidable, particularly in the population we deal with. There are a lot of factors that can result in falls. Falls will happen but it's important to try to avoid them by addressing identified hazards or risks, and then the resident's risk factors, including their need for supervision, care, and assistive devices."

How to avoid falls in the nursing home

  • Environmental rounding - gather an interdisciplinary team and perform a routine walk-through or round of your building with the intention of looking for hazards. With several eyes from different departments such as nursing, maintenance, housekeeping, and others you'll be amazed at what risks you quickly identify. 
  • Fall huddle - A fall huddle should occur immediately after a fall. Once the resident is safe and comfortable again, you should routinely gather the team involved with the resident to identify possible causes or factors contributing to the fall and discuss preventative measures for the future.
  • Individualized care planning - regularly evaluate the care plans of residents to see what interventions are in place and ascertain their effectiveness for that person. Keeping those care plans updated as needed will help your team identify possible opportunities for improved prevention and assistive devices.

One such intervention that has been proven to reduce bed falls by 77% among high fall-risk residents is the Empresa FloorBed. Lowering to just 3.9" from the floor with width-extension options and even-plane high safety mats, it’s reducing bed falls and related injuries in skilled nursing facilities and LTC communities just like yours. 

  • QAPI committee activities - Ensure that your QAPI group are frequently carrying out a trend analysis of falls in your facility. They should be looking at times of day, days of the week, different units, shifts, equipment involved and other measurable factors relating to falls. This should help them to identify areas which could potentially be improved upon. 
  • Staff education - Ensuring your staff are regularly educated on best practices for fall prevention and root cause analysis too can help ensure an optimum fall prevention strategy is being carried out. Accora offers a range of free educational resources such as webinars, videos, articles, and downloadable content for the use of long-term care professionals. Check out our resources section to see our latest offerings.

Resident smoking

The safest way to ensure your senior care community avoids this deficiency is to designate your campus as a smoke or tobacco-free site. If this is not possible then here are some parameters to implement which could help you avoid citation. 

  • Assess residents who smoke for assistance and supervision needs
  • Limit accessibility of matches and lighters
  • Designate a smoking area and set smoking times if possible
  • Prohibit smoking by residents when oxygen is in use or near flammable substances
  • Educate staff and visitors about your policies

Resident-to-resident altercations

Rebecca's top tips for avoiding this deficiency are: 

  • Identify residents with a history of disruptive or intrusive interactions
  • Identify triggers for an altercation
  • Evaluate staffing levels for adequate supervision and ensure consistent staff where possible
  • Provide ongoing staff training on supervision, behavioral management, and de-escalating conflict
  • Look to prevent catalytic factors which could lead to anger and disruption such as boredom, hunger, or loud environments. 

Wandering and elopement

According to Rebecca DeRousse, "We have always felt like"elopement" was someone leaving the campus and walking down the road but actually the definition is the resident leaves the premises or safe area without the facility's knowledge and supervision." It doesn't just refer to leaving the grounds, but also to accessing non-resident areas, or outside areas like courtyards or parking lots which are still on the campus, but no one knows that they are there. 

Avoiding the wandering and elopement tag

  • Establish clearly defined facility policies
  • Specify interventions in your comprehensive plan of care for residents at risk
  • Respond immediately to wander or door alarms
  • Ensure your disaster and emergency preparedness plan includes a plan to locate a missing resident
  • Execute quarterly elopement drills on each shift

Safety for residents with substance use disorder

It is certainly worth noting that a deficiency will not be cited in this area if the facility follows the proper procedures even if there is a negative outcome such as an overdose in cases involving residents with substance use disorder. 

Ways to avoid this deficiency include: 

  • Identifying and assessing residents' risk for leaving without notification
  • Developing interventions to address the risk of overdose in their care plan
  • Look for signs and symptoms of substance use
  • Monitor at-risk residents after any leaves of absence and after they've had visitors
  • Keep Narcan on hand
  • Keep your staff trained on all emergency procedures and ensure you have CPR-trained staff

Assistive devices and equipment hazards

We talk a lot about how assistive devices and equipment are here to prevent hazards, but they can also cause or contribute to them. If they are improperly used or improperly maintained, then they can pose a serious risk. Some areas to focus on to help you avoid being tagged with this deficiency are: 

  • Ensuring all staff, residents, and family members are adequately educated about the proper use of relevant devices
  • Consider the personal fit of a device for the individual
  • Ensure you have a policy that is enforced about the number of caregivers required to use the mechanical lift
  • Implement a no-restraint policy and evaluate your current beds for entrapment risks

Entrapment and bed rails are ongoing anxieties for long-term care professionals. There is a fine line between safety-conscious interventions and restraints, and we always need to make sure we are on the right side of it. Remember to always evaluate devices on a resident-by-resident basis because what may be suitable for one may be entirely inappropriate for another. We also have to remember to consistently document interventions we have implemented and why, then continuously evaluate whether they are still the right choice for that resident.

Final thoughts

If you found this article helpful and want to know more about guarding against frequently cited F-Tags from CMS, then you might like our recently recorded, on-demand webinar by compliance expert Rebecca DeRousse, Top 10 cited F-Tags and how to avoid them. This webinar is free to access and covers ten of the most commonly cited federal tags for long-term care and skilled nursing facilities.

If you want to ensure you don’t miss future educational content for LTC professionals from Accora, then please sign up for our newsletter.

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FAQs

What is an F-Tag? 

F-tags, ftags, and CMS tags all refer to the same thing. They are the citations you can be tagged with upon a state surveyor discovering deficiencies in your residential care facility. Short for Federal Tags, they are essentially labels that indicate a senior care community is not meeting the CMS requirements. This might not directly indicate a deficiency in terms of quality of care though. There are times when failing to properly report on the standards of care will result in costly fines and impact your marketability too. 

Why are F-Tags important? 

Being cited with a deficiency by the state can affect health care providers in several ways, mainly financially. F-Tag citations can carry heavy fines and they will also affect your nursing home's marketability if the tag becomes a matter of public record. After all, who wants to put their mom into a home which has been tagged as deficient in some way? 

Being tagged after nursing home surveys can also affect morale. In these post-covid days of staffing shortages, financial difficulties, and rapidly changing legislation, it can be a metaphorical kick in the teeth for your front-line caregiving team to be told that all their hard work just hasn't been good enough to satisfy the surveyors. The inevitable plan of correction and follow-up surveys will add more strain and stress onto all members of the staff and can prove disruptive for the residents. 

Compliance
Fall Prevention
Long Term Care
Accora Team
FloorBed technology to help skilled nursing, rehabilitation and long term-care facilities prevent falls and fall-related injuries.
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Rebecca DeRousse
MBA, MHA, CNHA - owner of DeRousse Healthcare Consulting, LLC.
Rebecca DeRousse
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