10 CMS Compliance Tips Every Skilled Nursing Facility Should Follow

Maintaining CMS compliance isn't just about passing the annual survey — it's about building systems and habits that keep your residents safe and your facility in good standing year-round. Here are ten practical strategies that administrators and directors of nursing can implement to reduce deficiency citations and improve survey readiness.

1. Conduct Regular Mock Surveys

Don't wait for the state survey team to find problems. Schedule quarterly internal mock surveys using the same protocols and checklists that CMS surveyors use. Walk the floors, review charts, interview staff, and document findings. This proactive approach identifies issues before they become citations.

2. Keep Your QAPI Program Active

The Quality Assurance and Performance Improvement (QAPI) program is a CMS requirement, but many facilities treat it as a checkbox rather than a tool. An effective QAPI program uses data to identify trends, root causes, and improvement opportunities. Review incident reports, falls data, infection rates, and complaint patterns monthly.

3. Train Staff on Abuse Reporting Timelines

One of the most commonly cited deficiencies (F 609, F 610) involves failure to report allegations of abuse, neglect, or injuries of unknown source within the required timeframes. Every staff member should know that allegations involving abuse or serious bodily injury must be reported to the State Survey Agency within 2 hours, and all other allegations within 24 hours.

4. Audit Care Plans Regularly

Care plans should be living documents that reflect each resident's current condition and needs. Audit a sample of care plans monthly to ensure they are individualized, updated after significant changes, and include measurable goals. Baseline care plans must be developed within 48 hours of admission and a written summary provided to the resident or representative.

5. Document Everything

In the eyes of CMS surveyors, if it isn't documented, it didn't happen. Ensure staff document care delivery, resident interactions, family communications, incident investigations, and corrective actions thoroughly and promptly. Incomplete documentation is one of the top reasons facilities receive deficiency citations.

6. Maintain Proper Nurse Staffing Posting

Federal regulations (F 732) require facilities to post daily nurse staffing information — including the number and actual hours worked by RNs, LPNs, and CNAs per shift, along with the resident census — in a prominent place accessible to residents and visitors. This posting must be updated at the beginning of each shift. Many facilities are cited simply for posting this information in a location that isn't visible to the public.

7. Check Call Bells Daily

Resident call system deficiencies (F 919) are easily preventable. Implement a daily call bell check as part of the CNA routine — test every bedside and bathroom call bell and document the results. Repair or replace non-functioning call bells immediately and log the maintenance action.

8. Review Medication Administration Practices

Unnecessary medications (F 756, F 757, F 758) and medication errors are frequent survey findings. Ensure the consulting pharmacist reviews each resident's drug regimen monthly, that psychotropic medications have documented clinical indications and gradual dose reduction attempts, and that PRN medication use is monitored and documented.

9. Keep Your Physical Environment Safe

Walk your facility with fresh eyes regularly. Check that handrails are secure, floors are dry and free of tripping hazards, temperatures are comfortable, lighting is adequate, and emergency exits are unobstructed. Environmental deficiencies are among the easiest to prevent and the easiest for surveyors to spot.

10. Have a Plan of Correction Process Ready

Even the best-run facilities receive citations. Having a streamlined POC process means you can respond quickly and confidently. Know who on your team is responsible for drafting each section, establish a review workflow before submission, and keep templates that address common F-Tags. Tools like EasyPOC can generate the initial draft in seconds, giving your team a strong starting point.

Paul Richards, RN, MSHI

Founder, EasyPOC

Paul Richards is a registered nurse and Chief of Informatics & Quality at The Allure Group, where he oversees healthcare informatics and quality improvement across a network of six skilled nursing facilities in New York City. He holds a Master of Science in Health Informatics and built EasyPOC to solve the compliance documentation challenges he witnessed firsthand every day.