08/14/2025

Survey Tip of the Week: Sufficient Space and Equipment

The Long-Term Care Survey Process (LTCSP) requires surveyors to assess whether the facility provides sufficient space and equipment in dining, health services, recreation, and program areas to meet residents’ needs, as identified in their assessments and care plans. Citations have occurred when recliner chairs did not move and function properly, linen was not readily available on all shifts, and transfer lifts were not repaired timely.  

In the State Operations Manual Appendix PP, CMS provides examples of noncompliance: Dining and program areas that do not allow for the safe use of mobility devices, therapy areas that lack adequate equipment, or spaces that are not accessible to residents due to clutter or crowding. Surveyors will also assess whether these areas support the activities and services outlined in the resident’s comprehensive care plan.

Under §483.90(d)(1), facilities must ensure:

• · Dining, recreation, health services, and program areas are large enough to comfortably accommodate persons who usually occupy the space, including space for wheelchairs, walkers, and other mobility aids.
• · Residents are not restricted in their ability to access and use these spaces.
• · There is adequate storage and setup space for items such as activity supplies, therapy equipment, assistive technology, or adaptive devices.
• · The environment allows for full participation in care planned activities and services, including hand-eye coordination programs, therapy sessions, and adaptive equipment use.

Facilities should also routinely monitor compliance using the surveyor guidance outlined in the State Operations Manual Appendix PP. Additionally, the survey pathways can be found in the Survey Resources zip file on the CMS Nursing Home webpage and under the downloads section on this CMS webpage. LeadingAge Ohio has provided survey tips to help navigate the changes in the revised QSO-25-14- NH memo. The previously provided survey tips can be accessed on the LeadingAge Ohio webpage under the Communications tab, then The Source tab. CMS has updated the survey resources on the CMS Nursing Home webpage in accordance with the revised QSO-25-14- NH memo. LeadingAge has developed webinars and resources on the requirements of participation which are located on the LeadingAge learning hub. LeadingAge continues to add QuickCasts on the regulatory groups. Updated resources have also been added on the Nursing Home RoP Tools and Resources webpage.

For more information about the requirements of participation and citations occurring in Ohio, please join us on the monthly STAT: Survey Tips and Tactics call. Register now for the September 10 call at 11:00AM. LeadingAge Ohio is sharing tips to assist members during the survey process. Send questions you would like addressed in future Tips of the Week to Stephanie DeWees at sdewees@leadingageohio.org.