CMS F-Tag · 42 CFR §483.25(i), Respiratory & Tracheostomy Care · Quality of Care

Respiratory & Tracheostomy Care

Cited for F695? Here's what surveyors were looking for, how serious it tends to be, and how to structure a Plan of Correction that holds up.

Paul Richards, RN, MSHI·Founder, EasyPOC·✓ Clinically reviewed·Updated Jul 6, 2026

Most-cited nationally

Citation figures from the CMS Provider Data Catalog. Rank reflects the most recent CASPER data.

What the regulation says

42 CFR §483.25(i), Respiratory care, including tracheostomy care and tracheal suctioning

§483.25(i) Respiratory care, including tracheostomy care and tracheal suctioning. The facility must ensure that a resident who needs respiratory care, including tracheostomy care and tracheal suctioning, is provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, the residents' goals and preferences, and §483.65 of this subpart.

Verbatim from the CMS State Operations Manual, Appendix PP.

What F695 actually means

F695 is a clinical-competency tag. It's cited when respiratory or tracheostomy care doesn't meet professional standards, improper suctioning technique, trach site care lapses, oxygen not delivered per order, or emergency equipment missing from the bedside. More than most tags, F695 comes down to a direct question: are the staff performing this high-acuity procedure actually competent to do it? That's why it maps so tightly to documented competency validation.

What surveyors check

They observe the care and verify competency. Suctioning technique and whether sterile or clean technique is used appropriately, trach site and inner cannula care, humidification and oxygen delivery against orders, whether emergency equipment (spare trach, obturator, suction) is at the bedside, and the care plan for the resident's respiratory needs. They'll also check that staff performing the care have documented competency.

What most often triggers it

Suctioning performed without proper technique or without needed supplies
Tracheostomy site or inner cannula care not done per standards
Emergency airway equipment not present at the bedside
Oxygen not administered per physician order (flow, delivery device)
Staff performing trach care without documented competency

How serious is it? Scope & severity

Given the clinical acuity, F695 often lands at G and above, actual harm is easy to establish when airway care fails. It can reach J/K/L (Immediate Jeopardy) when a respiratory or airway lapse creates a likelihood of serious harm or death, and at D–F for a practice or equipment gap caught before harm.

Severity ↓ / Scope →

Isolated

Pattern

Widespread

Immediate Jeopardy

Actual harm

No harm, higher potential

No harm, minimal potential

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

F695 · Illustrative composite

Based on observation and interview, the facility failed to provide tracheostomy care consistent with professional standards for Resident #2, who has a tracheostomy. Emergency equipment, including a spare tracheostomy tube and obturator, was not present at the bedside, and the nurse observed performing suctioning did not use sterile technique. Staff interview confirmed no documented tracheostomy competency for two of three nurses assigned to the resident.

Illustrative example, not a real facility.

How to write the Plan of Correction

(1) Correct the cited resident's care and ensure bedside emergency equipment and proper technique immediately. (2) Identify scope: review all residents with respiratory or trach needs and the staff assigned. (3) Systemic change: validate competency by return demonstration for every staff member performing respiratory/trach care, and standardize bedside emergency setup. (4) Monitoring: audit respiratory residents and competency records on a defined schedule through QAPI. (This is a natural EasyPOC Clinical Procedure Mode fit, the procedure plus its competency checklist.)

Cited for F695? Draft your Plan of Correction now.

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Common questions

What is F695?+

The CMS tag for respiratory care including tracheostomy care and tracheal suctioning, under 42 CFR §483.25(i).

What most commonly triggers it?+

Improper suctioning or trach technique, missing bedside emergency equipment, and staff without documented competency.

How serious is it?+

Frequently cited at the harm level (G) and can reach Immediate Jeopardy given airway risk.

How do you respond?+

Correct the care, validate staff competency by return demonstration, standardize bedside setup, and monitor.

This page is a compliance reference and does not constitute legal or clinical advice.