CMS State Operations Manual Appendix PP – Guidance to Surveyors for Long Term Care Facilities Course

Credits: 10
Course Expiration: May 15, 2022
Professional Approvals: CDR
Availability:Currently Available
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Required Reading!

This is the perfect course for anyone who works with nursing homes! 

This course is only available as a “CPE Additional Certificate”. There is no hard copy book – the link to the CMS SOM Appendix PP document is included in the course document.

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This course is based on the Centers for Medicare and Medicaid Services (CMS) State Operation Manual Appendix PP – Guidance to Surveyors for Long Term Care Facilities 11-22-17 revision, which is the document used for conducting nursing home surveys in accordance with survey protocols and Federal requirements to determine whether a citation of non-compliance is appropriate. The requirements for participation were recently revised to reflect the substantial advances that have been made over the past several years in the theory and practice of service delivery and safety.

The survey protocols and interpretive guidelines serve to clarify and/or explain the intent of the regulations. All surveyors are required to use them in assessing compliance with Federal requirements. Deficiencies are cited on violations of the regulations, which are to be based on observations of the nursing home’s performance or practices. This course provides RDNs that work with CMS-regulated skilled nursing facilities with a working knowledge of the regulations that govern those facilities. It also provides an understanding of what surveyors evaluate during the survey process and what deficiencies can result.

The course includes questions related to the following sections of the Centers for Medicare and Medicaid Services (CMS) State Operations Manual (SOM) Appendix PP:

  • Skin Integrity F686 (483.25 b)
  • Assisted Nutrition and Hydration F 692 and 693 (483.25 g)
  • Physician delegation of tasks to Dietitian/Therapist F715 (483.30)(e)(2)(3)
  • Food and nutrition services F 800-811 (483.60)
  • Food Safety Requirements F812 (483.60(i))
"This course provides the learner a tool with which to study the detailed information contained in F-tags and determine if current in-house procedures "measure up" to the intent of the regulation."
- Jane Bennett, MS, RDN, CD, Owner, RD Services, Bloomfield, IN
CMS State Operations Manual Appendix PP Course (1)
"Excellent for application of knowledge and skills of nutrition to the overall survey process."
- Brenda Richardson, MA, RDN, LD, CD, FAND, Owner/President, Salem, IN
CMS State Operations Manual Appendix PP Course (2)

After completing this continuing professional education course, the learner should be able to:

  1. Implement policies and procedures that meet regulatory requirements and current standards of practice related to nutrition care and food service delivery to promote optimal health and well-being of all individuals in a facility’s care.
  2. Apply risk factors for pressure ulcer/injury development to a patient’s plan of nutrition care.
  3. Create an environment that permits a resident the right to make informed decisions about their care.
  4. Analyze survey citation examples and determine the level of severity based on harm or potential for harm to the resident.
  5. Assess staffing in the food and nutrition services department to assure the CMS guidelines for both educational requirements and adequate staffing levels are achieved.
  6. Identify unsafe food handling practices that could result in deficient practice and appropriate corrective action.

This course is intended for: RDNs and NDTRs

CDR Activity Number: 148562   Self Study Activity Type: 720 Printed
CPE Level: 2

Suggested CDR Learning Needs Codes:

  • 3005 Assessment and diagnosis
  • 5040 LTC, intermediate, assisted living,
  • 5000 Medical Nutrition Therapy
  • 9020 Evaluation and application of research

Suggested CDR Performance Indicators:

  • 4.1.2 Interprets and integrates evidence-based research and literature in decision-making.
  • 8.1.5 Applies medical nutrition therapy in disease prevention and management.
  • 8.3.6 Keeps abreast of current nutrition and dietetics knowledge and trends.
  • 10.2.9 In collaboration with the client and interdisciplinary team (including NDTRs), selects and implements current and evidence-based nutrition interventions and patient education.

Note: Numerous other CDR Learning Need Codes and Performance Indicators may apply.


This self-study course includes required reading, a downloadable course document and an online exam with multiple choice, case study based questions. This course exam includes 49 questions. Upon passing the test, the learner can download and print the certificate.

Required Reading for this Course: State Operations Manual (SOM) Appendix PP – for Phase 2, F tag revisions, and related issues is a Department of Health and Human Services (DHHS) and Centers for Medicare and Medicaid Services (CMS) publication.

The text/book associated with this course is required solely for the course taker to learn the underlying principles which they will apply in taking a case-study based exam. Neither the authors nor the publishers of the text/book have contributed to or endorsed this course.


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