Activities of Daily Living (ADLs)
Cited for F677? Here's what surveyors were looking for, how serious it tends to be, and how to structure a Plan of Correction that holds up.
Citation figures from the CMS Provider Data Catalog. Rank reflects the most recent CASPER data.
What the regulation says
What F677 actually means
F677 protects the residents who can't do for themselves. If a resident is dependent for ADLs, the facility has to provide the grooming, hygiene, oral care, and nutrition support they can't manage alone. It's cited when a dependent resident is found unkempt, poor oral care, long dirty nails, unshaven, in soiled clothing, because that's direct evidence the necessary services weren't provided. The more dependent the resident, the more the facility owns the outcome.
What surveyors check
Observation of dependent residents, cross-checked to the care plan and MDS-coded dependency. Oral hygiene, nail and hair care, shaving, clean and appropriate clothing, and whether the resident's ADL needs identified in the assessment are actually met. They distinguish a resident's decline that is unavoidable from one caused by the facility not providing needed care.
What most often triggers it
- Poor oral hygiene in a resident dependent for mouth care
- Long, dirty fingernails or unkempt hair on a dependent resident
- Resident found in soiled or inappropriate clothing
- ADL interventions in the care plan not carried out
- Avoidable decline in ADL function without a documented reason
How serious is it? Scope & severity
F677 lands D–F most often, a grooming or hygiene gap with potential for more than minimal harm. It rises to G when the failure causes avoidable harm or decline, for example an oral-care lapse contributing to a dental or nutritional problem.
The CMS scope & severity grid runs from an isolated no-harm gap (A) up through widespread Immediate Jeopardy (L). The level a surveyor assigns drives how urgent and far-reaching your Plan of Correction must be.
Example citation
How to write the Plan of Correction
(1) Provide the needed ADL care to the cited resident and update the plan. (2) Identify scope: observe other dependent residents for the same gaps. (3) Systemic change: re-educate staff and clarify assignment accountability for ADL care, with documentation expectations. (4) Monitoring: audit dependent residents' grooming and hygiene, and ADL documentation, on a defined schedule through QAPI.
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What is F677?+−
The CMS tag for ADL care of dependent residents, under 42 CFR §483.24(a)(2), requiring necessary grooming, hygiene, oral care, and nutrition support.
What most commonly triggers it?+−
A dependent resident observed unkempt: poor oral care, long nails, soiled clothing.
How serious is it?+−
Usually a no-harm "D–F," rising to "G" if the gap causes avoidable decline.
How do you respond?+−
Provide the care, audit other dependent residents, clarify assignment accountability, and monitor.
Related tags
This page is a compliance reference and does not constitute legal or clinical advice.