Let’s avoid F tags: Focus on the Basics, Be Human, Care Like You Mean It and good things will happen.

In this fast paced world of nursing home care, it’s easy to get lost in the maze of regulations, policies, and procedures. But at its core, excellent care doesn’t come from checking boxes—it comes from treating residents with dignity, respect, and timely attention. Whether you're a nurse, CNA, member of the interdisciplinary team or administrator, the fundamental practices of caregiving make all the difference, not just in avoiding citations but in ensuring that your residents live comfortably and safely.

Here are great examples of how focusing on the basics can prevent citations. Let’s review some real citation examples, highlight how it could have been avoided, and propose strategies for success.

1. Timely Response to Call Bells (F-tag 684)

Citation Example: A nursing home was cited for failing to respond to a resident’s call bell for assistance to use the restroom, resulting in a fall.

How It Could Have Been Avoided: Implement a system that prioritizes call bell responses, (call lights should be everyone’s responsibility) not just specific staff members. Assign specific staff members to monitor call light response time and provide feedback to the team.

Fix Strategy: Create a clear protocol for responding to call bells within 5 minutes, using technology or regular audits to track response times. Train staff on the importance of prompt responses and provide recognition for adherence to the policy.

2. Following Physician Orders (F-tag 684)

Citation Example: Staff failed to administer a resident’s prescribed medication on time due to medication not available. This resulted in hospitalization due to several doses of missed medications.

How It Could Have Been Avoided: Ensure accurate transcription of physician orders and maintain communication between nursing staff, physician and the pharmacy.

Fix Strategy: Use electronic medical records (EMR) alerts for medication times and institute double-checks for critical medications. Implement medication administration training, focusing on timing and adherence.

3. Assisting with ADLs (Activities of Daily Living) (F-tag 677)

Citation Example: A resident was left unattended during a shower, resulting in a fall.

How It Could Have Been Avoided: Provide staff training on assisting residents with ADLs, including maintaining physical presence during risky activities.

Fix Strategy: Establish policies where residents requiring help with ADLs, such as showering, are never left alone. Create a buddy system for staff to ensure safety in high-risk situations.

4. Infection Control (F-tag 880)

Citation Example: A facility was cited for an outbreak of preventable infections due to improper hand hygiene by staff.

How It Could Have Been Avoided: Routine hand hygiene and the proper use of personal protective equipment (PPE) are critical.

Fix Strategy: Implement random hand hygiene audits, provide ongoing infection control education, and ensure hand sanitizer stations are available and used by all staff.

5. Pressure Ulcer Prevention (F-tag 686)

Citation Example: A resident developed a stage 3 pressure ulcer due to inadequate repositioning.

How It Could Have Been Avoided: Frequent repositioning of residents and proper use of pressure-relieving devices.

Fix Strategy: Create individualized care plans for at-risk residents and include frequent skin assessments and repositioning schedules. Utilize pressure-reducing mattresses and cushions where necessary.

6. Maintaining Proper Nutrition and Hydration (F-tag 692)

Citation Example: A resident was hospitalized for dehydration, and the facility was cited for inadequate monitoring of fluid intake.

How It Could Have Been Avoided: Closely monitor residents’ food and fluid intake and help those who need help eating or drinking.

Fix Strategy: Implement daily hydration rounds and train staff on identifying the signs of dehydration. Keep easily accessible water stations throughout the facility.

7. Dignity and Respect for Residents (F-tag 550)

Citation Example: A staff member was overheard using a condescending tone when addressing a resident, resulting in a dignity citation.

How It Could Have Been Avoided: Train staff on respectful communication and treating residents as individuals.

Fix Strategy: Implement regular in-services on person-centered care and ensure staff understands the importance of language, tone, and attitude.

8. Medication Errors (F-tag 759)

Citation Example: A resident received the wrong dose of a medication, leading to serious side effects.

How It Could Have Been Avoided: Double-checking medications before administration and having a clear medication reconciliation process.

Fix Strategy: Use barcode scanning for medication administration and require two nurses to verify high-risk medications. Offer periodic medication administration accuracy drills.

9. Safe Transfers (F-tag 684)

Citation Example: A resident fell during a transfer because staff did not follow the care plan to use a lift.

How It Could Have Been Avoided: Ensure that care plans are followed meticulously, particularly with residents requiring mechanical assistance.

Fix Strategy: Conduct regular training on safe transfer techniques, with periodic checks to ensure that care plans are being followed accurately.

10. Proper Documentation (F-tag 514)

Citation Example: Inadequate documentation of a resident’s condition led to a delay in treatment.

How It Could Have Been Avoided: Accurate, up-to-date documentation should be part of daily care routines.

Fix Strategy: Reinforce the importance of timely and complete documentation during every shift. Utilize audits to catch missing or incomplete entries.

11. Fire and Safety Drills (F-tag 689)

Citation Example: A facility was cited for not conducting required fire safety drills, placing residents at risk.

How It Could Have Been Avoided: Schedule regular fire drills and safety checks as required by regulations.

Fix Strategy: Develop a comprehensive safety drill calendar and provide staff training on fire safety and evacuation procedures.

12. Pain Management (F-tag 697)

Citation Example: A resident’s pain was not adequately addressed, and the facility was cited for poor pain management practices.

How It Could Have Been Avoided: Implement regular pain assessments and ensure staff promptly address pain complaints.

Fix Strategy: Use standardized pain assessment tools and ensure nurses are trained in non-pharmacological pain relief options as well as appropriate medication use.

13. Resident Choice (F-tag 561)

Citation Example: A facility was cited for failing to honor a resident’s preference regarding their mealtime.

How It Could Have Been Avoided: Prioritize resident choice in daily routines and include preferences in care plans.

Fix Strategy: Conduct regular resident satisfaction surveys and involve residents in care planning to ensure their preferences are respected.

14. Emergency Preparedness (F-tag 838)

Citation Example: A nursing home was cited for being unprepared during a weather emergency, putting residents at risk.

How It Could Have Been Avoided: Ensure there is an up-to-date emergency preparedness plan and conduct regular drills.

Fix Strategy: Update the emergency preparedness plan annually and perform tabletop drills that simulate emergency situations.

15. Resident Elopement Prevention (F-tag 689)

Citation Example: A resident with dementia wandered out of the facility unsupervised, leading to an elopement citation.

How It Could Have Been Avoided: Adequate supervision of residents with a history of wandering is essential.

Fix Strategy: Install door alarms, conduct elopement drills, and ensure that high-risk residents are placed in secure, monitored areas.

Call to Action

Nursing homes are places where lives are at stake every day. By focusing on the fundamentals—like timely call bell response, respectful care, and accurate documentation—you can not only avoid citations but create an environment where residents thrive. This responsibility lies with everyone on the team, from nursing aides to administrators. Don't wait for a citation to remind you of what truly matters—be proactive, be human, and care like you mean it.

Responsible Persons: The Director of Nursing (DON) and Administrator should ensure all protocols are being followed, perform regular audits, and promote a culture of accountability and compassionate care across the facility. Additionally, CNAs, nurses, and interdisciplinary teams must be vigilant in upholding these best practices daily.

Make resident care the priority, and the rest will follow. Need help getting your team on track, conduct us for your mock surveys and trainings.

Aysha Kuhlor MSN, RN, PAC-NE

Chief Clinical Advisor

Phone 808-688-7459

Email [email protected]

Web www.theinspac.com

Courses https://courses.theinspac.com- explore our courses and certifications

Linktree: https://linktr.ee/theinspac to book an appointment

Contact: [email protected]

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