Falls are the most frequently cited deficiency in nursing homes, and a fall with injury is a leading source of resident harm and litigation. The facility must ensure each resident receives adequate supervision and assistance devices to prevent accidents (F689). The documentation must show the fall risk was assessed, an individualized plan was in place, and — after a fall — that a skilled post-fall assessment, notification, and root-cause review occurred and new interventions were added.
Falls also drive a daily skilled need: a resident with a recent fall, a gait or cognitive decline, or anticoagulation requires skilled surveillance and plan adjustment that a layperson cannot provide.
