In Parts 1 and 2 of our CMSCG Ftag Series for F689 Accidents/Supervision, we looked at the foundational pieces of F689 — the regulatory expectations, the systems‑based approach that the Centers for Medicare & Medicaid Services (CMS) requires, and the responsibilities around supervision and device use. But one of the clearest themes in the Interpretive Guidance is that accidents rarely stem from one major failure. It’s the small, everyday hazards that staff walk past — the things that “don’t seem like a big deal” — that often signal that a system isn’t reliably identifying and correcting risks. Little things that contribute to F689 accident hazards are potentially present everywhere in a nursing facility. Are your staff actively monitoring for potential hazards when they are doing rounds – or even just completing their assigned duties?
Missed the earlier posts F689 Accident Hazards/ Supervision?
As we move into Part 3, we’re focusing on those “little things.” These low‑level environmental and equipment‑related hazards may not cause immediate harm, but when they show up repeatedly, they add up quickly — and surveyors view them as evidence of a broader breakdown under F689.
The “Little” Things That Lead to F689 Accident Hazards
During the normal flow of daily tasks, it’s easy for small hazards to slip by unnoticed — but they add up quickly. Are your staff actively monitoring for potential hazards when they’re doing rounds — or even just completing their assigned duties? Do staff take a final look before leaving a resident’s room to make sure the call bell is accessible and the environment is safe? We know staff are rushed, but inattention to these small details can have serious consequences.
When a surveyor enters the unit – or we’re doing a mock survey – there are so many issues that can be quickly observed. What do you think will be the outcome when some of the issues listed below are identified:
- Unattended housekeeping carts with chemicals or sharp items accessible (better yet – the EVS closet unlocked with lots of liquids that could be harmful if ingested)
- Cluttered hallways (wheelchairs, linen bags, equipment blocking handrails or access down the hallway, etc.)
- Wheelchairs with missing or broken parts (foot rests, armrests, brakes that don’t hold, rips in the wheelchair armrests)
- Call bells out of reach (most likely under the bed or draped over the overbed light)
- Bed height not adjusted for resident safety (Nurse assistants need to lower the bed after providing care)
- Overbed tables or trays positioned unsafely (staff hooked the overbed table under the leg of the bedside stand and the resident wants to get up and has to try to “untangle” the table and falls)
- Loose cords or tubing on the floor (tripping hazard + infection control issue could lead to not 1 but 2 deficiencies)
- Spills or wet floors not addressed immediately and appropriate safety signage not in place (what do you think the outcome will be when multiple staff walk past an obvious spill without intervening to mitigate the situation?)
- Furniture in disrepair (wobbly chairs, unsecured dressers which could tip, a drawer without a stop mechanism so it pulls out of the frame)
- Resident rooms which are excessively cluttered (items accumulating on floors, chairs, etc. – we’re not even mentioning residents with hoarding behaviors)
- Electric powered equipment placed too close to bedding/ curtains (fans, oxygen concentrators against the wall or privacy curtain)
- Daisy-chaining of cords/ power strips on the floor
- Residents observed wearing unsafe footwear (regular socks, residents ambulating in slippers that don’t fit or have no back)
- Exits blocked by equipment, trash cans, laundry bins, etc.
- Hot beverages left within reach of resident with cognitive impairment or other concerns which could result in a spill (Picture this: the overbed table is crowded with the resident’s personal items and there is literally no room for the meal tray . . . so it gets “balanced” near the edge of the table, the table gets jarred and the hot coffee spills on the resident. It happens.)
- No staff around – Not seeing any staff on the unit, in dining rooms or common areas where residents are congregated for “monitoring” – one of the biggest red flags there is!
These types of accident hazards may seem minor when viewed in isolation, but collectively, they reflect how well your facility is preventing F689 accident hazards. Take a look around your building — is your accident‑prevention system functioning the way you expect it to? Do the small details reflect a team that’s consistently identifying and addressing risks, or are there signs that things are slipping through the cracks? Are they actually looking for potential risks during rounds? In the next part of this series, we’ll move beyond these everyday issues and look at the higher‑risk situations that can lead to much more serious outcomes when systems break down.
If these “little things” are showing up in your building, it may be time for a deeper look. CMSCG’s survey readiness consultants can help you identify gaps, strengthen your accident‑prevention systems, and reduce your risk under F689. Contact us to schedule a mock survey or focused review.
