F677: ADL Care for Dependent Residents

What is F-Tag F677 - ADL Care for Dependent Residents?‍

This tag intends to review the ADL care needed for dependent residents such as eating, toileting, bathing, dressing, grooming, ambulating, and transferring. Each ADL has components that could lead to non-compliance if the care is not received according to standards, care plan, and resident choice and preference. The regulation itself is short, but the requirements are not followed per CMS definitions.

§483.24(a)(2) of the State Operations Manual Appendix PP – Guidance to Surveyors for Long Term Care Facilities, revised 2.3.23, defines this requirement as “A resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene."

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How do you avoid an F-Tag F677 citation?

Systemic reviews of the following 4 areas will ensure your facility complies with F677 requirements.  

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Area 1: GROOMING

Oral Care – who is brushing residents’ teeth?  

• Do you have supplies necessary to brush teeth, store dentures, and provide separate spaces for toothbrush/toothpaste if sharing a bathroom?
• Who looks at residents’ smiles to ensure teeth are being brushed and proper oral care is given? Does the Social Worker communicate if there is an issue with teeth when she completes the interview?  Is this task assigned to a certain discipline?  If not, should it be?  
• What time of the day is this task completed?  In the morning before breakfast?  Do evening CNA’s brush teeth before bed?  Do shower CNA’s brush teeth during their shower or bath?  Make sure someone owns these tasks.

Nail Care – who trims fingernails and toenails?

• Do bath aides trim nails at bath/shower time?
• Who trims the nails of diabetics?  Licensed nurses only?  A contracted podiatrist monthly?
• Who ensures shoes fit properly and are not causing issues with nail growth or ingrown nails?  What is the expectation of how this information is communicated?
• Polaris Group’s sister company Preferred Podiatry Group can assist if you are looking for onsite podiatric care needs.

Facial Hair – who is responsible for trimming/shaving?

• Does each male resident have their own electric razor?
• Do you have razors available for trimming women’s facial hair?
• If a resident wants to grow a beard or mustache, is that identified on their care plan?

Bathing – how often are residents offered/given a bath or shower?

• If a resident requests to not have two showers a week, is the reason documented on their care plan?
• If a resident requests more than two showers weekly, is this request honored?

Dressing – is the resident wearing clothing selected by themselves or by a staff member?

• Does the clothing fit properly?
• Does the clothing have missing buttons or tears visible to visitors?
• Does the clothing have name identification visible to visitors?
• Is clothing free of stains and/or dried food?  
• Does the zipper work?
• Is the resident wearing proper fitting shoes or only gripper socks?  Is this choice indicated in their care plan?

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Area 2: NUTRITION

Who is assigned to assist with meal service/intake?

• Are all residents eating meals in the dining room?  Should they be?
• Are residents encouraged and assisted with drinking liquids at mealtimes and between meals?
• Who passes fresh ice water?  How often is it passed in 24 hours?  Is it placed where the resident can easily access it?
• Are plate guards, weighted utensils, and specialized diets provided based on each resident's needs and abilities?

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Area 3: ASSISTANCE WITH BATHROOM

How do all staff know what the resident’s current ability is to use the bathroom?

• Does the resident use the toilet, use a bedpan, use a commode, or a urinal?  How is this information communicated?
• Can a resident clean themselves or require assistance?  
• Can a resident change their own brief or pad?
• Can a resident manage their own ostomy or catheter?  Does their care plan identify this?

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Area 4: ASSISTANCE WITH TRANSFERS

What is the current ability of the resident to move between surfaces?  Bed, chair, wheelchair, standing position?

• Is their current ability clearly described in current care plans?
• How often does therapy evaluate the resident’s current level of mobility?
• Do you have a restorative aide program that ensures transfer ability does not decline?
• Does your facility support a Walk to Dine program where residents ambulate, when possible, to meals and are seated in upright chairs rather than eating meals in their wheelchairs?

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Appropriate treatment and services include all care provided to residents by staff, contractors, or volunteers of the facility to maximize the resident’s functional abilities. This includes pain relief and control, especially when it is causing a decline or a decrease in the quality of life of the resident.  If your facility has a history of citations related to FTag 677 or if you want to implement programs that mitigate issues with FTag 677, contact us today and see how Polaris Group Consultants can help.

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