F657 — Care Plan Revisions
Failure to review and revise the resident's comprehensive care plan after each assessment — including quarterly, annual, significant change, and any time the resident's condition warrants update.
Reg cite · 42 CFR 483.21(b)(2)(iii)
157 surveys in corpus
29 states
What surveyors look for
- Care plan timestamps showing revisions within 7 days of any assessment change
- IDT meeting minutes referencing the revision
- Resident/responsible-party invitation to participate in revisions
- Updated interventions that flow from the revised assessment data
Common gotchas
- Care plan electronically locked after admission with no revision history
- Quarterly review checkbox marked but no actual interventions modified
- Acute changes (fall with injury, behavior escalation) not triggering same-day care plan note
Real survey examples
From CMS-published 2567s in our corpus. Resident identifiers redacted.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed,
and revised by a team of health professionals.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** .
Based on record review, observation, and interview the facility failed to revise care plans to reflect the
current level of care and services for two residents (#1 and #18) based on a sample of 22 residents. This
failed practice placed residents at risk for not receiving the necessary and/or a…
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
tremor and impaired muscular coordination), diabetes, and congestive heart failure (a chronic condition that
results when the heart muscle is unable to pump blood efficiently).
Review of Resident's care plan, last revised on [date], revealed a focused problem of: At risk for
constipation, ileus or impaction related to the use of morphine. Further review revealed this focus problem
was started on [date].
Review of Resident's current electronic Medication Administration Record (eMAR) revealed Resident had no activ…
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed,
and revised by a team of health professionals.
.
Based on interview and record review, the facility failed to update and revise the care plan for two residents
(#s 1 and 19), out of 13 sampled residents. Specifically, the facility failed to update and revise the care
plans to reflect: 1) anticoagulant medication use for Resident; and 2) chronic right shoulder pain for
Resident. Failure to assess and revise care…
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Review of Resident's medication history revealed he/she was still taking Apixaban on [date] and was
not held any time prior to this date since admission. Further review revealed the only time Resident's
anticoagulant medication was held was on [date] (for both doses that day) and [date] (for only one dose
in the morning and resumed that evening) for bleeding associated with a tooth extraction that occurred on
[date].
During an interview on [date] at 10:36 AM, the MDS Coordinator stated that Resident's anticoagu…
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Review of the Physical Therapy Progress Note, dated [date] at 4:40 PM, revealed: Patient attempted to
transfer from bed to wheelchair required mod assist [moderate assistance] due to reports of pain in RLE
and R [right] shoulder .
Review of the Nursing Note, dated [date] at 1:59 AM, revealed: [Resident] only complaint was pain: a
HA and pain both legs (right leg to foot was the majority of the pain) and also in the right shoulder. [He/she]
was given Oxycodone with night meds[medications] for 9/10 pain, and Vick…
Accepted POC examples
Real accepted-POC examples for this F-tag are not yet in the open corpus. The POC drafter above generates a structurally correct draft from CMS S&C Letter 13-21's four-question schema — edit it to fit your facility's specifics before submission.
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