US · guidance
CMS SOM App. FC, Tag M0285
§485.917(c)(2) Performance improvement activities must track adverse client events,
analyze their causes, and implement preventive actions and mechanism that include
feedback and learning throughout the CMHC.
Interpretive Guidelines §485.917(c)(2)
In general, an adverse event would be an untoward, undesirable, and usually
unanticipated event that causes death or serious injury, or the risk thereof to a client. The
CMHC maintains documentation of identification, tracking and analysis of all adverse
events. The CMHC must implement preventive actions to avoid a recurrence of an
adverse event and document the employee(s) responsible for implementation, tracking of
the implementation and analyze the impact of the preventive action. Staff training would
need to occur after each event to teach and call attention to prevention efforts and all
appropriate performance improvement activities (prevention activities) would be
incorporated into annual training programs.
History
Rev. 196, Issued: 01-10-20, Effective: 01-10-20, Implementation: 01-10-20
Provenance
- Source
- cms.gov
- Retrieved
- 2026-07-22
- Edition
- som-2026-07-22
- Content hash
0b9adf94d740504b03c571d36882ef410a78457dcccbd0d8f8a2fea54dc9da53
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