This F-Tag requires nursing facilities to ensure that all services outlined in a resident's comprehensive care plan are delivered by individuals with the appropriate skills, experience, knowledge, and licensure or certification. Facility operators must verify staff competency for each assigned task, as unqualified personnel performing care plan services constitutes a deficiency. Severity ranges from potential harm (Level 2) to immediate jeopardy (Level 4) depending on the risk posed to residents.
View official sourceF659 (Rev. 211; Issued: 02-03-23; Effective: 10-21-22; Implementation: 10-24-22) §483.21(b)(3) Comprehensive Care Plans The services provided or arranged by the facility, as outlined by the comprehensive care plan, must— (ii) Be provided by qualified persons in accordance with each resident's written plan of care. GUIDANCE The facility must ensure that services provided or arranged in accordance with the resident’s plan of care are delivered by individuals who have the skills, experience and knowledge to do a particular task or activity. This includes proper licensure or certification, if required. INVESTIGATIVE PROCEDURES AND PROBES NOTE: Provision of services by qualified individuals would be cited here, but implementation of the care plan would be cited in F656. • Are the services identified in the comprehensive care plan being provided by qualified persons? • Do staff assigned to the resident have the skills, experience and knowledge to provide care and services that meet the resident’s needs? DEFICIENCY CATEGORIZATION An example of Level 4, immediate jeopardy to resident health or safety includes, but is not limited to: • The facility had no qualified staff on duty knowledgeable or competent in how to care for a resident with a tracheostomy, posing a risk for serious injury, harm, impairment or death for the resident. An example of Level 3, actual harm that is not immediate jeopardy includes, but is not limited to: • The facility utilized a staff member who was not qualified to draw a resident’s blood, according to the resident’s care plan, resulting in the resident sustaining extensive bruising, swelling, pain and decreased ability to use the arm after the blood draw An example of Level 2, no actual harm with potential for than more than minimal harm that is not immediate jeopardy includes, but is not limited to: • The facility failed to ensure staff were qualified to perform blood pressure (BP) readings. During survey, staff were observed taking and reporting resident BPs that were abnormal. After further investigation, it was determined that staff were using the incorrect size BP cuff, yielding inaccurate BP readings, resulting in the potential for more than minimal harm. Non-compliance with this regulation places the resident at risk for more than minimal harm. Therefore, Severity Level 1 does not apply for this regulatory requirement.