5 Ways Skilled Nursing Facilities Can Prepare for Their 2027 CMS Recertification Survey

How can skilled nursing facilities prepare for a CMS recertification survey?

Skilled nursing facilities can prepare for a CMS recertification survey by checking that fall-prevention measures work across shifts, verifying that care-plan updates reach frontline staff, auditing hospital transfers and discharges, reconciling serious fall records with Minimum Data Set (MDS) reporting, and running a mock survey using current CMS guidance.

Every shift gives skilled nursing teams a chance to make care safer and more consistent. It might be an aide who notices a resident needs more help getting out of bed, or a nurse who makes sure a medication change follows a resident home. Preparing for your 2027 CMS recertification survey is a chance to build on those everyday acts of good care and make them easier to repeat across shifts, units, and care settings.

Start with three recent cases: a repeat fall, an unplanned hospital readmission, and a discharge home. Ask what went well, where staff needed better information or support, and what one change would make care safer for the next resident. Then use these five checks to turn what you find into a plan your team can put into practice.

The start of the year is a practical time to begin. Federal rules generally require a standard survey within 15 months of the last one, with a statewide average interval of 12 months or less. www.law.cornell.edu

1. Verify that fall-prevention measures work on every shift

What does F689 cover in a skilled nursing facility?

F689  addresses accident hazards, adequate supervision, and assistive devices. Look through recent falls for patterns by resident, unit, shift, and activity. Start with residents who fell more than once. For each case, ask what staff learned from the first fall, what changed in the care plan, and whether the next shift put that change into practice. Appendix PP

Try this in your mock survey. Pick a resident with repeat overnight falls. Ask the night team to show you where they find the resident’s current toileting or transfer instructions, what assistance the plan calls for, and who provides it. Compare what staff describe with the care plan and what you observe.

2. Check that changes in condition reach the people delivering care

Review F655 for baseline care plans, F656 and F657 for comprehensive care planning and revision, and F580 for required notifications. Sample a new admission, a resident returning from the hospital, and a resident with a recent change in mobility. Compare the assessment and nursing notes with the current care plan and the instructions direct-care staff use. Appendix PP

Follow one change from assessment to bedside. If a resident now needs more help transferring, check when the instruction changed, how staff learned about it, and whether the weekend team can find and follow it. When F580 notification criteria apply, verify whom staff notified, when, and what follow-up occurred.

3. Test care transitions and review unplanned hospital readmissions

Use F627 and F628 to review applicable transfer and discharge requirements. CMS reorganized its surveyor guidance in 2025, moving discharge-related requirements previously addressed under F660 and F661 into these tags. Check that your mock survey materials reflect the current guidance. Appendix PP

Trace the handoff in both directions. For a hospital-to-SNF admission, check whether the receiving nurse had the current medication list, mobility and supervision needs, and follow-up instructions. For a discharge home, check whether the resident, caregiver, and any receiving provider understood who would handle medications, equipment, and follow-up appointments, as applicable.

When does the 30-day SNF readmission window start?

For the FY 2027 SNF Value-Based Purchasing measure, the 30-day clock starts at the preceding hospital discharge. Eligible unplanned inpatient readmissions can count during the SNF stay or after the resident leaves the SNF if they occur within that window. Review recent cases with nursing, the medical director, and discharge planning to identify where earlier assessment, escalation, or a clearer handoff could have changed the course. www.cms.gov

4. Reconcile serious fall records and follow through in QAPI

Review F865 and F867 for your Quality Assurance and Performance Improvement (QAPI) program, including adverse-event monitoring and corrective action. In a one-year review, the HHS Office of Inspector General found that nursing homes omitted 43% of the falls involving both major injury and hospitalization it identified among Medicare-enrolled residents from required Minimum Data Set (MDS) reporting. Start with residents transferred after a fall. Compare incident reports, hospital findings, and MDS coding, especially when the injury was confirmed after transfer. www.cms.gov

Bring one recurring pattern to QAPI. If falls cluster during overnight toileting, assign an owner to test an intervention. Set a review date and check both whether staff carried out the intervention and whether falls continued on that shift.

5. Update your mock survey and quality dashboard for 2027

At your next leadership huddle, choose one gap from the three records you reviewed. Give someone ownership and a review date. Then ask a supervisor on a different shift to verify that the change reached the people delivering care.

Go deeper on fall prevention

If your survey prep uncovers repeat falls or gaps in supervision, Zemplee’s F689, Again. guide shows how to review recurring fall patterns and turn what you learn into changes to supervision and follow-up.  

Download the F689 guide (PDF)

Sources and references

• 42 CFR § 488.308 — Survey frequency
• CMS State Operations Manual, Appendix PP — Guidance for Long-Term Care Facilities
• CMS Revised Long-Term Care Surveyor Guidance and Critical Element Pathways
• CMS Revised Nursing Home Risk-Based Survey Implementation Memo
• CMS SNF Value-Based Purchasing Measures and Measure Expansion Timeline
• CMS SNF 30-Day All-Cause Readmission Measure Specifications
• HHS Office of Inspector General Report on Falls With Major Injury and Hospitalization