This regulation requires that a nursing facility's activities program be directed by a qualified professional — either a licensed/registered therapeutic recreation specialist, a certified activities professional, a qualified occupational therapist or OTA, or someone with qualifying experience or state-approved training. The activities director is responsible for developing, implementing, supervising, and evaluating the activities program, including individualized care planning contributions. Non-compliance is cited regardless of whether resident harm occurred.
View official sourceF680 (Rev. 173, Issued: 11-22-17, Effective: 11-28-17, Implementation: 11-28-17) §483.24(c)(2) The activities program must be directed by a qualified professional who is a qualified therapeutic recreation specialist or an activities professional who— (i) Is licensed or registered, if applicable, by the State in which practicing; and (ii) Is: (A) Eligible for certification as a therapeutic recreation specialist or as an activities professional by a recognized accrediting body on or after October 1, 1990; or (B) Has 2 years of experience in a social or recreational program within the last 5 years, one of which was full-time in a therapeutic activities program; or (C) Is a qualified occupational therapist or occupational therapy assistant; or (D) Has completed a training course approved by the State. INTENT §483.24(c)(2) The intent of this regulation is to ensure that the activities program is directed by a qualified professional. DEFINITIONS §483.24(c)(2) “Recognized accrediting body” refers to those organizations that certify, register, or license therapeutic recreation specialists, activity professionals, or occupational therapists. Activities Director Responsibilities An activity director is responsible for directing the development, implementation, supervision and ongoing evaluation of the activities program. This includes the completion and/or directing/delegating the completion of the activities component of the comprehensive assessment; and contributing to and/or directing/delegating the contribution to the comprehensive care plan goals and approaches that are individualized to match the skills, abilities, and interests/preferences of each resident. Directing the activity program includes scheduling of activities, both individual and groups, implementing and/or delegating the implementation of the programs, monitoring the response and/or reviewing/evaluating the response to the programs to determine if the activities meet the assessed needs of the resident, and making revisions as necessary. NOTE: Review the qualifications of the activities director if there are concerns with the facility’s compliance with the activities requirement at §483.24(c)(1), F679, or if there are concerns with the direction of the activity programs. A person is a qualified professional under this regulatory tag if they meet the qualifications (if applicable) of §483.24(c)(2)(i), and one (or more) of the qualifications of §483.24(c)(2)(ii). KEY ELEMENTS OF NONCOMPLIANCE §483.24(c)(2) To cite deficient practice at F680, the surveyor's investigation will generally show that the facility failed to ensure the activities program is directed by a qualified professional, who: • Is licensed or registered, (if applicable); and o Is eligible for certification as a therapeutic recreation specialist, or as an activities professional by a recognized accrediting body on or after October 1, 1990; or o Has 2 years of experience in a social or recreational program with the last 5 years, one of which was full-time in a therapeutic activities program; or o Is a qualified occupational therapist or occupational therapy assistant; or o Has completed a training course approved by the state. NOTE: F680 is a tag that is absolute, which means the facility must have a qualified activities professional to direct the provision of activities to the residents. Thus, it is cited if the facility is non-compliant with the regulation, whether or not there have been any negative outcomes to residents. In determining the Scope and Severity, surveyors must consider the extent to which non-compliance at F679 is attributed to the lack of an activity director or the lack of qualifications of the activity director.