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Ftag of the Week – F684 Quality of Care (Part 1)

This week’s “Ftag of the Week” on the CMSCG Blog is F684 Quality of Care, which is part of the Quality of Care regulatory group. This requirement is almost all new regulatory language, so we will be addressing it in two parts. Next week we will be reviewing End of Life and Hospice Care as it relates to F684. The central focus of many regulations, including F684, is the facility’s responsibility to identify and provide needed care and services that acknowledge each resident’s preferences and goals for care which obviously need to be resident-centered. The Intent of this regulation clearly states that the care and services provided need to meet professional standards of practice as well as meet each resident’s physical, mental and psychosocial needs.

Surveyors are directed to use the Guidance at F684 to review concerns which have caused or have the potential to cause a negative outcome for the resident in the areas of physical, mental and psychosocial health or well-being that is not specifically addressed under another tag.

What is being assessed under this tag that is not addressed under a specific Ftag in addition to hospice and end of life concerns – specifically noted is a non pressure-related skin ulcer/wound. You need to have a comprehensive plan of care in place for arterial ulcers, a diabetic neuropathic ulcer as well as a venous or stasis ulcer. This means the facility has a responsibility to accurately determine what type of skin ulcer/wound a resident actually has. It is not acceptable to simply label it a “skin impairment.”

Non-compliance can be cited for not providing needed care and services and the resident has an actual or potential decline in his/her physical, mental and or psychosocial wellbeing, for failing to recognize and/or assess risk factors for specific conditions or problems, as well as not informing and educating the resident of the risks/benefits of not following the plan of care. What are you going to do with the diabetic resident who is non-compliant with allowing the staff to provide the ordered treatment to their diabetic foot ulcer? Or, worse yet, the staff simply did not provide treatment to a stasis ulcer as ordered.

We all know that surveyors cite many issues under the Quality of Care Ftag that can be cited under a specific tag. The regulatory language specifically states that “surveyors should evaluate compliance with these regulations and cite deficiencies at F684 only when other regulations do not address the deficient practice.”

Check back next week for Part 2 of our post on F684 Quality of Care.

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