CMS F-tag

F646: Assessment & care planning

Notify the appropriate authorities when residents with MD or ID services has a significant change in condition. Cited 233 times at 226 nursing homes in the last three inspection cycles.

#135 of 242 tags0% caused harm34 statesLatest survey Dec 18, 2025

How F646 shows up in inspections

#135 of 242 tagsRarely cited

Rarely cited
Occasionally cited
Often cited
Very often cited
Among the most cited

How serious it usually is

Immediate jeopardyJ–L0%0
Actual harmG–I0%0
No actual harmD · E98.7%230
Minimal harmB1.3%3

0% of F646 citations involved actual harm or immediate jeopardy. Nationally, about 5% of all citations do.

By the numbers

233Citations
226Facilities cited2% of rated nursing homes

Citations by survey year

20182
201915
20202
20219
202230
202349
202458
202568

Partial years reflect the rolling three-cycle window, not a change in enforcement.

Where F646 is cited most

Survey agencies differ in what they emphasize, so compare a facility with its own state. Shares are the portion of each state’s rated nursing homes with at least one F646 citation.

States by share of facilities cited

Ohio7% of homes67 citations · 62 of 911 facilities
California3% of homes30 citations · 30 of 1,154 facilities
Massachusetts4% of homes13 citations · 12 of 338 facilities
Washington6% of homes12 citations · 11 of 192 facilities
Mississippi6% of homes11 citations · 11 of 200 facilities
North Carolina3% of homes11 citations · 11 of 417 facilities
Texas1% of homes11 citations · 11 of 1,167 facilities
Missouri1% of homes5 citations · 5 of 479 facilities
Oklahoma2% of homes5 citations · 5 of 282 facilities
Pennsylvania1% of homes5 citations · 5 of 653 facilities

Top 10 of 34 states. Every state page lists its most-cited tags.

Facilities cited most often

Allen View Healthcare CenterSpringfield, OH · Report card2 F646No harm
Belpre Landing Nursing and RehabilitationBelpre, OH · Report card2 F646No harm
Embassy of LoganLogan, OH · Report card2 F646No harm
Life Care Center of Skagit ValleySedro Woolley, WA · Report card2 F646No harm
Mt Airy Gardens Rehabilitation and Nursing CenterCincinnati, OH · Report card2 F646No harm
Oak Knoll Rehabilitation and Healthcare CenterFramingham, MA · Report card2 F646No harm
S.E.M. Haven Health Care CenterMilford, OH · Report card2 F646No harm
Acadia St Landry Nursing & Rehabilitation CenterChurch Point, LA · Report card1 F646No harm
Agawam South Rehab and NursingAgawam, MA · Report card1 F646No harm
Agawam West Rehab and NursingAgawam, MA · Report card1 F646No harm
Ansted CenterAnsted, WV · Report card1 F646No harm
Aperion Care Marion LLCMarion, IN · Report card1 F646No harm
Apple Rehab Laurel WoodsEast Haven, CT · Report card1 F646No harm
Arcadia Care MortonMorton, IL · Report card1 F646No harm
Arcadia Care Peoria HeightsPeoria Heights, IL · Report card1 F646No harm

What to ask a facility about a F646 citation

What exactly did the surveyor find, and on what date? The report card shows the date and the severity letter.
What was the plan of correction, and was it accepted by the state on the first submission?
Has the same tag been cited in more than one cycle? Repeat citations matter more than a single one.
If the letter was G or higher: what happened to the resident, and what changed in staffing or process?

Source: CMS Provider Data Catalog, Nursing Home Health Citations, current three inspection cycles, most recent survey Dec 18, 2025. Counts are citations unless labeled facilities.

What is F646 in a nursing home inspection?

F646 is the CMS F-tag for the requirement "Notify the appropriate authorities when residents with MD or ID services has a significant change in condition." (Assessment & care planning). Surveyors cite it when a facility is found out of compliance with that regulation during a standard survey or complaint investigation.

How common is F646?

F646 was cited 233 times at 226 facilities (2% of rated nursing homes) in the last three inspection cycles, ranking #135 of 242 tags. 0 of those citations involved actual harm or immediate jeopardy.

Does a F646 citation mean the facility is unsafe?

Not on its own. Read the scope and severity letter: D through F means no actual harm was found, G through I means a resident was harmed, and J through L means immediate jeopardy. Ask the facility what was cited, what was corrected, and when.

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