US · guidance
CMS SOM App. J, Tag W183
§483.430(c)(2) There must be responsible direct care staff on duty and awake on a 24-hour
basis, when clients are present, to take prompt, appropriate action in case of injury, illness,
fire or other emergency, in each defined residential living unit housing- -
(i) Clients for whom a physician has ordered a medical care plan;
(ii) Clients who are aggressive, assaultive or security risks;
(iii) More than 16 clients; or
(iv) Fewer than 16 clients within a multi-unit building.
Guidance §483.430(c)(2)
Indicators of staff not being awake in relation to the occurrence of incidents, accidents, and
injuries may include, but are not limited to:
• incidents of unplanned client absences;
• untimely reaction to a medical emergency;
• injuries from client to client aggression; or
• a pattern of injuries of unknown origin.
If even one client meets 483.430(c)(2)(i-ii) then staff must be awake on a 24-hour basis.
A client has a medical care plan when an acute or chronic occurrence requires clinical
assessment and monitoring on a scheduled basis.
History
Rev. 135, Issued: 02-27-15, Effective: 04-27-15, Implementation: 04-27-15
Provenance
- Source
- cms.gov
- Retrieved
- 2026-07-22
- Edition
- som-2026-07-22
- Content hash
662d93aa6a7efeae6a6a68094f8c75f1dd5e21223aa091c25945e79bc5324aa2
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