CMS SOM App. U, Tag R190

The RNHCI must be staffed with qualified experienced personnel who are present

in sufficient numbers to meet the needs of the patients.

Interpretive Guidelines: §403.740

The RNHCI must be staffed with sufficient, qualified personnel. To be an efficient and

well-run institution, all staff, including those not directly involved in patient care, must

work to improve the overall quality of the facility.

Staff are available and know how to respond to individual patients’ needs and

emergencies at all times. The RNHCI has sufficient staff to provide needed care and

services.

The test of adequacy of staffing is how well the facility has organized itself to detect and

react appropriately to potential emergencies, such as fire, injuries, etc. The RNHCI is

responsible for organizing and evaluating its activities, assignments and available staff in

such a way that maximizes the benefit to the patient.

Survey Procedures:

• Is there observational or other evidence to suggest that patients’ needs are not

being met (e.g., demonstrate need for toileting, changing) while staff do laundry,

housekeeping, cooking, or other tasks?

• Interview staff and ask them questions related to their schedules and patient load.

Determine the number of patients versus the number of staff. Can non-medical

care be provided effectively?