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The 10 Most Common CMS Deficiencies in US Nursing Homes: What They Cost and How to Prevent Them

Summary

  • We analyzed the official CMS provider data catalog from January 2024 to July 2026 to determine the most frequent, harmful and expensive CMS deficiencies in US nursing homes.
  • Most frequent: Infection control (F880), accidents and supervision (F689) and food handling (F812).
  • Most harmful: Accidents and supervision (F689), abuse and neglect (F600) and treatment per orders (F684).
  • Most expensive: Accidents and supervision (F689), abuse and neglect (F600) and treatment per orders (F684).
  • With voize, nurses can document care right when it happens, thereby increasing documentation quality, which is at the core of many common deficiencies.

What are the 10 most frequent CMS deficiencies in US nursing homes?

Based on data from January 2024 to July 2026, the ten most frequent CMS deficiencies in US nursing homes are:

  1. Infection control (F880): Cited 17,011 times = 6% of all citations.
  2. Accidents and supervision (F689): Cited 15,594 times = 5.5% of all citations.
  3. Food handling (F812): Cited 12,824 times = 4.5% of all citations.
  4. Treatment per orders (F684): Cited 11,889 times = 4.2% of all citations.
  5. Care plan (F656): Cited 9,811 times = 3.4% of all citations.
  6. Drug labeling and storage (F761): Cited 9,127 times = 3.2% of all citations.
  7. Abuse and neglect (F600): Cited 7,012 times = 2.5% of all citations.
  8. Abuse reporting (F609): Cited 6,735 times = 2.4% of all citations.
  9. ADL assistance (F677): Cited 6,655 times = 2.3% of all citations.
  10. Pharmacy services (F755): Cited 6,494 times = 2.3% of all citations.

Most frequent CMS deficiencies

285,300 citations, January 2024 to July 2026.

  1. Provide and implement an infection prevention and control program.

  2. Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

  3. Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

  4. Provide appropriate treatment and care according to orders, resident’s preferences and goals.

  5. Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

  6. Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

  7. Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

  8. Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

  9. Provide care and assistance to perform activities of daily living for any resident who is unable.

  10. Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Show the data as a table
Most frequent CMS deficiencies by period: number of citations
Rank2024 to 2026202420252026 (Jan to Jul)
1Infection control (F880): 17,011Infection control (F880): 6,847Infection control (F880): 6,676Infection control (F880): 3,488
2Accidents and supervision (F689): 15,594Accidents and supervision (F689): 6,542Accidents and supervision (F689): 5,982Accidents and supervision (F689): 3,070
3Food handling (F812): 12,824Food handling (F812): 5,489Food handling (F812): 4,829Food handling (F812): 2,506
4Treatment per orders (F684): 11,889Treatment per orders (F684): 4,851Treatment per orders (F684): 4,636Treatment per orders (F684): 2,402
5Care plan (F656): 9,811Care plan (F656): 4,148Care plan (F656): 3,720Care plan (F656): 1,943
6Drug labeling and storage (F761): 9,127Drug labeling and storage (F761): 3,730Drug labeling and storage (F761): 3,484Drug labeling and storage (F761): 1,913
7Abuse and neglect (F600): 7,012ADL assistance (F677): 2,944Abuse and neglect (F600): 2,830Medical records (F842): 1,389
8Abuse reporting (F609): 6,735Abuse and neglect (F600): 2,866Abuse reporting (F609): 2,646Pharmacy services (F755): 1,359
9ADL assistance (F677): 6,655Abuse reporting (F609): 2,770Pharmacy services (F755): 2,535Abuse reporting (F609): 1,319
10Pharmacy services (F755): 6,494Respiratory care (F695): 2,683ADL assistance (F677): 2,446Abuse and neglect (F600): 1,316

Percentages are shares of all health citations in the period. Select a deficiency for the official CMS description. Source: CMS Provider Data Catalog, Health Citations (August 2026 release).

What are the 10 most harmful CMS deficiencies in US nursing homes?

We counted only citations with scope and severity G to L, meaning a resident was actually harmed or in immediate jeopardy. Immediate jeopardy is J to L. Based on data from January 2024 to July 2026, the ten most harmful CMS deficiencies in US nursing homes are:

  1. Accidents and supervision (F689): 5,483 harm-level citations = 35% of its citations.
  2. Abuse and neglect (F600): 2,656 harm-level citations = 38% of its citations.
  3. Treatment per orders (F684): 1,599 harm-level citations = 13% of its citations.
  4. Pressure ulcers (F686): 1,311 harm-level citations = 23% of its citations.
  5. Significant medication errors (F760): 623 harm-level citations = 17% of its citations.
  6. Pain management (F697): 472 harm-level citations = 22% of its citations.
  7. Nutrition and hydration (F692): 381 harm-level citations = 12% of its citations.
  8. Notification of changes (F580): 339 harm-level citations = 7.9% of its citations.
  9. Care plan (F656): 334 harm-level citations = 3.4% of its citations.
  10. CPR and life support (F678): 292 harm-level citations = 52% of its citations.

Most harmful CMS deficiencies

Harm-level citations, January 2024 to July 2026.

Immediate jeopardy (J to L)Actual harm (G to I)

  1. 2,181 immediate jeopardy, 3,302 actual harm, 15,594 citations in total.
    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

  2. 1,112 immediate jeopardy, 1,544 actual harm, 7,012 citations in total.
    Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

  3. 585 immediate jeopardy, 1,014 actual harm, 11,889 citations in total.
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

  4. 198 immediate jeopardy, 1,113 actual harm, 5,762 citations in total.
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.

  5. 260 immediate jeopardy, 363 actual harm, 3,592 citations in total.
    Ensure that residents are free from significant medication errors.

  6. 55 immediate jeopardy, 417 actual harm, 2,156 citations in total.
    Provide safe, appropriate pain management for a resident who requires such services.

  7. 38 immediate jeopardy, 343 actual harm, 3,275 citations in total.
    Provide enough food/fluids to maintain a resident's health.

  8. 199 immediate jeopardy, 140 actual harm, 4,292 citations in total.
    Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

  9. 155 immediate jeopardy, 179 actual harm, 9,811 citations in total.
    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

  10. 282 immediate jeopardy, 10 actual harm, 565 citations in total.
    Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.

Show the data as a table
Most harmful CMS deficiencies by period: harm-level citations (share of the tag's citations)
Rank2024 to 2026202420252026 (Jan to Jul)
1Accidents and supervision (F689): 5,483 (35%)Accidents and supervision (F689): 2,270 (35%)Accidents and supervision (F689): 2,237 (37%)Accidents and supervision (F689): 976 (32%)
2Abuse and neglect (F600): 2,656 (38%)Abuse and neglect (F600): 1,131 (39%)Abuse and neglect (F600): 1,077 (38%)Abuse and neglect (F600): 448 (34%)
3Treatment per orders (F684): 1,599 (13%)Treatment per orders (F684): 673 (14%)Treatment per orders (F684): 616 (13%)Treatment per orders (F684): 310 (13%)
4Pressure ulcers (F686): 1,311 (23%)Pressure ulcers (F686): 603 (24%)Pressure ulcers (F686): 467 (22%)Pressure ulcers (F686): 241 (22%)
5Significant medication errors (F760): 623 (17%)Significant medication errors (F760): 249 (18%)Significant medication errors (F760): 255 (18%)Significant medication errors (F760): 119 (16%)
6Pain management (F697): 472 (22%)Pain management (F697): 224 (25%)Pain management (F697): 168 (20%)Pain management (F697): 80 (19%)
7Nutrition and hydration (F692): 381 (12%)Nutrition and hydration (F692): 196 (14%)Care plan (F656): 141 (4%)CPR and life support (F678): 61 (54%)
8Notification of changes (F580): 339 (8%)Notification of changes (F580): 182 (10%)Nutrition and hydration (F692): 133 (11%)Nutrition and hydration (F692): 52 (9%)
9Care plan (F656): 334 (3%)Care plan (F656): 149 (4%)Notification of changes (F580): 107 (7%)Notification of changes (F580): 50 (6%)
10CPR and life support (F678): 292 (52%)CPR and life support (F678): 130 (51%)CPR and life support (F678): 101 (52%)Care plan (F656): 44 (2%)

Harm level means scope and severity G to L. Select a deficiency for details and the official CMS description. Source: CMS Provider Data Catalog, Health Citations (August 2026 release).

What are the 10 most expensive CMS deficiencies in US nursing homes?

The costs of the F-tags in this category are calculated based on the fines plus estimated lost Medicare revenue from payment denials. Based on data from January 2024 to July 2026, the ten most expensive CMS deficiencies in US nursing homes are:

  1. Accidents and supervision (F689): $133.6 million in total, $80.3 million from fines.
  2. Abuse and neglect (F600): $117.4 million in total, $87.2 million from fines.
  3. Treatment per orders (F684): $52.5 million in total, $38.3 million from fines.
  4. Pressure ulcers (F686): $46.1 million in total, $30 million from fines.
  5. Notification of changes (F580): $17.5 million in total, $12.9 million from fines.
  6. Pain management (F697): $11.5 million in total, $5 million from fines.
  7. Infection control (F880): $10.9 million in total, $8 million from fines.
  8. Significant medication errors (F760): $10.4 million in total, $8.4 million from fines.
  9. Food handling (F812): $10.1 million in total, $6.2 million from fines.
  10. CPR and life support (F678): $10 million in total, $6.9 million from fines.

Most expensive CMS deficiencies

Fines plus estimated payment denials, January 2024 to July 2026.

FinesPayment denials (estimated)

  1. $80.3M fines, $53.3M estimated payment denials, 15,594 citations, $8,568 per citation.
    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

  2. $87.2M fines, $30.1M estimated payment denials, 7,012 citations, $16,736 per citation.
    Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

  3. $38.3M fines, $14.2M estimated payment denials, 11,889 citations, $4,416 per citation.
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

  4. $30.0M fines, $16.1M estimated payment denials, 5,762 citations, $7,998 per citation.
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.

  5. $12.9M fines, $4.6M estimated payment denials, 4,292 citations, $4,072 per citation.
    Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

  6. $5.0M fines, $6.5M estimated payment denials, 2,156 citations, $5,318 per citation.
    Provide safe, appropriate pain management for a resident who requires such services.

  7. $8.0M fines, $2.9M estimated payment denials, 17,011 citations, $640 per citation.
    Provide and implement an infection prevention and control program.

  8. $8.4M fines, $2.0M estimated payment denials, 3,592 citations, $2,887 per citation.
    Ensure that residents are free from significant medication errors.

  9. $6.2M fines, $3.9M estimated payment denials, 12,824 citations, $790 per citation.
    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

  10. $6.9M fines, $3.2M estimated payment denials, 565 citations, $17,779 per citation.
    Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.

Show the data as a table
Most expensive CMS deficiencies by period: fines plus estimated payment denials (fines)
Rank2024 to 2026202420252026 (Jan to Jul)
1Accidents and supervision (F689): $133.6M ($80.3M fines)Accidents and supervision (F689): $64.2M ($35.8M fines)Accidents and supervision (F689): $48.7M ($32.4M fines)Accidents and supervision (F689): $20.7M ($12.1M fines)
2Abuse and neglect (F600): $117.4M ($87.2M fines)Abuse and neglect (F600): $58.0M ($41.7M fines)Abuse and neglect (F600): $47.6M ($35.4M fines)Abuse and neglect (F600): $11.7M ($10.2M fines)
3Treatment per orders (F684): $52.5M ($38.3M fines)Pressure ulcers (F686): $24.8M ($14.7M fines)Treatment per orders (F684): $20.5M ($15.3M fines)Treatment per orders (F684): $8.6M ($6.7M fines)
4Pressure ulcers (F686): $46.1M ($30.0M fines)Treatment per orders (F684): $23.4M ($16.3M fines)Pressure ulcers (F686): $16.4M ($11.7M fines)Pressure ulcers (F686): $4.9M ($3.6M fines)
5Notification of changes (F580): $17.5M ($12.9M fines)Notification of changes (F580): $12.2M ($8.1M fines)Infection control (F880): $4.3M ($3.3M fines)Significant medication errors (F760): $2.4M ($2.1M fines)
6Pain management (F697): $11.5M ($5.0M fines)Pain management (F697): $8.1M ($3.0M fines)Notification of changes (F580): $4.0M ($3.5M fines)Response to allegations (F610): $1.7M ($1.7M fines)
7Infection control (F880): $10.9M ($8.0M fines)CPR and life support (F678): $5.6M ($3.0M fines)Safe environment (F584): $3.9M ($2.2M fines)Respect and possessions (F557): $1.5M ($189K fines)
8Significant medication errors (F760): $10.4M ($8.4M fines)Food handling (F812): $5.5M ($3.4M fines)Dignity (F550): $3.9M ($1.6M fines)CPR and life support (F678): $1.5M ($1.3M fines)
9Food handling (F812): $10.1M ($6.2M fines)Infection control (F880): $5.5M ($3.7M fines)Nutrition and hydration (F692): $3.5M ($2.7M fines)Continence and catheter care (F690): $1.3M ($729K fines)
10CPR and life support (F678): $10.0M ($6.9M fines)Administration (F835): $4.9M ($2.9M fines)Food handling (F812): $3.4M ($2.0M fines)Notification of changes (F580): $1.3M ($1.3M fines)

Payment denials are priced as lost Medicare revenue using MedPAC payment rates, a conservative estimate. Each penalty is credited to the most severe deficiency in the inspection it followed. Source: CMS Provider Data Catalog, Health Citations and Penalties (August 2026 release).

How can common CMS deficiencies in US nursing homes be prevented?

Three methods work across almost all F-tags:

  1. Document care when it happens: Care that was given but charted late, vaguely or not at all is cited like care that never happened. Use voize to document care instantly.
  2. Fix the basics: Many citations turn into repeated problems because basic processes do not work, like documentation and staffing. Focus on getting them right before they turn into repeated citations.
  3. Run mock surveys: Surveyors use Critical Element Pathways as checklists during their audits. Running an internal audit shows you the gaps that a surveyor would find.

How did we analyze the CMS data?

We analyzed the official CMS provider data catalog from January 2024 to July 2026 to determine what the most frequent, the most harmful and the most expensive CMS deficiencies in US nursing homes are. We calculated and counted like this:

  • Frequency: One deficiency a surveyor recorded during an inspection, tied to one F-tag.
  • Harm: Citations with scope and severity G to L involve actual harm or immediate jeopardy to resident health or safety.
  • Costs: Fines plus estimated lost Medicare revenue from payment denials (when CMS stops paying for new admissions). CMS issues one penalty per inspection, not per deficiency, so we credited each penalty to the most severe deficiency found in that inspection. Payment denials were priced using MedPAC's Medicare payment rates.

Definitions of the most common F-tags

The following table shows short descriptions of the F-tags that we're referring to in this article based on the official CMS descriptions:

Tag Name CMS description
F550DignityHonor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
F557Respect and possessionsHonor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
F580Notification of changesImmediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
F584Safe environmentHonor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
F600Abuse and neglectProtect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
F609Abuse reportingTimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
F610Response to allegationsRespond appropriately to all alleged violations.
F656Care planDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
F677ADL assistanceProvide care and assistance to perform activities of daily living for any resident who is unable.
F678CPR and life supportProvide basic life support, including CPR, prior to the arrival of emergency medical personnel, subject to physician orders and the resident's advance directives.
F684Treatment per ordersProvide appropriate treatment and care according to orders, resident's preferences and goals.
F686Pressure ulcersProvide appropriate pressure ulcer care and prevent new ulcers from developing.
F689Accidents and supervisionEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
F690Continence and catheter careProvide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
F692Nutrition and hydrationProvide enough food/fluids to maintain a resident's health.
F695Respiratory careProvide safe and appropriate respiratory care for a resident when needed.
F697Pain managementProvide safe, appropriate pain management for a resident who requires such services.
F755Pharmacy servicesProvide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
F760Significant medication errorsEnsure that residents are free from significant medication errors.
F761Drug labeling and storageEnsure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
F812Food handlingProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F835AdministrationAdminister the facility in a manner that enables it to use its resources effectively and efficiently.
F842Medical recordsSafeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
F880Infection controlProvide and implement an infection prevention and control program.

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