Most Common Nursing Home Deficiencies as of 2025

Plagued with constant changes, nursing homes struggle to keep up with the current demands of the industry and expectations of CMS. Below are the most common deficiencies nursing homes have received within the past three years (as of June 2025).

F656, Care plans

At number 5, with 14,586 deficiencies over three years, sits “Develop[ing] and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.” Often seen as a nuisance or “just another task” care plans should be a vital part of any resident’s care and quality standards. The primary purpose of a care plan is to provide continuity of care across shifts, units, facilities, and during a transfer to the hospital or home. The key here is continuity of care, which should be kept in mind when building care plans. They are not to cover for liability of a resident’s actions, or to be purely a medical record. Care plans should include any information about the resident that makes the resident a person. For example, family members’ names, relationships, and even typical routines. The goal CMS is looking for is individualized care plans. Care plans are just the layman's name we give it. The true name given by nursing home regulation 483.21 is titled “Comprehensive person-centered care planning.” Simply breaking down each word helps us avoid common mistakes leading to deficiencies.

Commonly used to “double-tag”, F656 is often paired with F757 Unnecessary medications or F698 Dialysis. For example, a facility may receive F757 and F656 if the facility failed to include the dialysis schedule, location, transportation details, etc, in the resident’s care plan. F656 can be widely used and “double-tagged”.

F684, Quality of Life

At number 4, coming in at a close 15,847 deficiencies over three years, is Quality of Care and Life.

From the regulations “483.24 Quality of life is a fundamental principle that applies to all care and services provided to facility residents. Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, consistent with the resident's comprehensive assessment and plan of care.”

Another significant deficiency encompasses life enrichment, ADLs, and ensuring the resident is evaluated by audiology following a change in their hearing.

F812, Food Procurement

While it sounds like an easy one to avoid, in three years, F812 racked up 19,498 deficiencies. If it’s anything from a gallon of open milk undated or a box of flour sitting directly on the floor, it will fall under F812. F812 is also one of “those tags” that surveyors can push, given the guidance is “Store, prepare, distribute, and serve food in accordance with professional standards for food service safety.” Meaning that there is no direct regulation stating food cannot be kept in a bathroom or on a floor, it is generally covered in most food service safety courses that it would not be acceptable. Furthermore, to decide on the food kept on the floor is worthy of a deficiency, a surveyor would first look at the facility’s food storage policy, next would interview the food service director and other staff on the expectation on food storage, and lastly would consult professional standards for food safety. Likely choosing a company like ServSafe.

What all this means is that, if a facility would like to IDR (Informal Dispute Resolution) a deficiency, they could more easily for F812 and claim that what the surveyor noted was not a professional standard for food safety. The best defense against a vague regulation is a bulletproof policy or standard operating procedure. This will ensure there is a set standard and expectation that everyone is aware of.

F689, Free of Accidents and Hazards, Supervision, and Devices

Falls are the greatest risk for the geriatric crowd; given this, it may not be a shock to see number 2 taken up by 20,716 deficiencies over three years. According to the University of Rochester Medical Center,

“Elderly patients are three times as likely to die following a ground-level fall compared to their under-70 counterparts.”

F689 covers previous accidents or falls, potential accidents, and could even include accidents occurring while the surveyors are within the facility. 42 CFR 483.25(d) states “The facility must ensure that— The resident environment remains as free of accident hazards as is possible; and each resident receives adequate supervision and assistance devices to prevent accidents.” Another regulation that is broad enough to require further critical thinking.

Typically well-covered in clinical policies, accidents simply must be monitored with proper and comprehensive, thoughtful interventions. The general rule followed in nursing homes is that for each accident, one intervention must be put in place. Always challenge this concept. Why must we put in an intervention following the accident? Why is there only one intervention per fall or any accident? It is important to question what has become normal within nursing homes. Especially as nursing homes were “COVID-ized” and falls became common practice rather than something to cohesively protect our residents from. Accidents should not be an option; they should be avoided at all costs. Like a car accident, you only hit another car if you can’t control it.

CMS defines accidents into two categories. Avoidable and unavoidable accidents. The key difference is whether the accident could have been reasonably prevented by the facility. An avoidable accident may include the facility failing to evaluate the environment for risks and/or eliminate them. Also considered an avoidable accident is an accident occurring following an intervention being put in place, and the intervention failing. It is the expectation of CMS that the facility will monitor the effectiveness of the new intervention, and therefore, an accident occurring with a new intervention in place could be considered avoidable. An avoidable accident means that the facility evaluated the environment and eliminated any potential hazards to the best of its ability.

Side note on accidents: Commonly misunderstood is that “residents have the right to fall.” While residents do have many rights, this statement is blatantly not accurate. Residents have the right to be safe. Residents have the right to refuse to utilize interventions following accidents and falls. Even if the resident refused their walker 99 times in one day, the staff must continue to offer their walker. Especially if it’s within their care plan, which could lead us back to F656 as well.

F880, Infection Control

Coming out of our COVID-era, nursing homes are still struggling with infection control, bringing the number one deficiency of infection control up to 22,831 occurrences over three years.

It can be anything from a mask below your nose, gloves in the hallway, or a trash can with residue on it. It all falls under infection control. And now with CMS's new guidance on MDROs and enhanced barrier precautions, the education and implementation of infection control is more important than ever (when it comes to surveys).

F880 also includes the implementation and usage of an effective infection control program to effectively monitor and prevent the spread of diseases. The regulations specifically state it must include its own policies and procedures, and even goes as specific as linens. “§483.80(e) Linens. Personnel must handle, store, process, and transport linens so as to prevent the spread of infection.”

The regulations going into F880 are truly immersive and should be thoroughly read and reviewed by every Administrator, Director of Nursing, and Infection Preventionist.

While F880 is likely the broadest of all the deficiencies, staying on top of the standards is achievable by providing your staff with the right tools to succeed. Here at New England Heart Rate, we teach some element of infection control in almost all of our courses. We are one of the few CPR companies to offer American Red Cross Bloodborne Pathogens training as well.

Truly, no last-minute audit or action can save you from all five of these mighty deficiencies; however, proper education and clear expectations before the survey can. Not only that, but it will improve resident outcomes, satisfaction, and care, and that is the real goal.

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Please note this article is for awareness only; for the most accurate information, follow the CMS QSO letters or refer to 42 CFR Part 483 Subpart B for the most recent nursing home regulations.