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This revises the following F-tags, particularly to assist surveyors to use PBJ data to identify low staffing concerns for deeper investigation:

F725 (Sufficient Nursing Staff): Instructs surveyors to access the PBJ Staffing Data Report, which contains information about overall direct-care staffing levels, including nurse staffing, from the Certification and Survey Provider Enhanced Reports (CASPER) reporting system and use it to identify sufficient nursing staff concerns. If concerns are identified, surveyors will investigate using the Sufficient and Competent Staffing Critical Element Pathway and updated probes included in F725.

F727 (RN 8 Hours/7 Days/Week, Full-Time Director of Nursing (DON)): Instructs surveyors to use the PBJ Staffing Data Report to determine whether facilities have an RN onsite each day. If concerns are identified, surveyors will investigate using the Sufficient and Competent Staffing Critical Element Pathway and updated probes included in F727. Note: Due to the way the report is structured, CMS training documents carry over previous guidance that facilities that report the absence of an RN for four or more days in a quarter will be cited at F727. However, this is not included in the draft Appendix PP guidance, and CMS notes that it expects that surveyors will consider issuing a citation “when a minimum of one day is identified to not meet the nurse staffing requirement for both a Registered Nurse and licensed nursing staff.”

F729 (Nurse Aide Registry Verification, Retraining): Updates the survey procedure to instruct surveyors to review at least five nurse aide personnel files, if concerns are identified with nurse aide services at F725 and F726 (Competent Nurse Staff), including any specific staff members with whom concerns were identified.

F732 (Posted Nurse Staffing Information): Adds new survey procedures and probes, requiring surveyors to use observations and record reviews to ensure compliance, as well as adding a new key element of noncompliance: failure to make daily staffing available to the public upon request.