The Physical Environment Index
Every Medicare-certified nursing home is surveyed twice: the Life Safety Code visit, and the health survey. Part of the health survey is the building as the health surveyors see it — essential equipment in safe operating condition, the resident call system, bed frames and rails, ventilation, handrails, pest control, smoking policy, hazards — recorded as F-tags in a separate CMS file. This is a plain reference to that part of the record, and only that part.
These are counted on their own.A facility’s Life Safety total, its position within its state, its survey window and its clean-record badge are the fire-safety record only. The health survey runs on its own cadence and its findings are shown alongside, never added in. How this is compiled
The tags, most-cited first
The 13physical-environment tags of the health survey. Descriptions are CMS’s own.
| Tag | What the surveyor checks | Facilities | Cited twice or more |
|---|---|---|---|
| F-0880 | Provide and implement an infection prevention and control program. | 11,947 | 7,337 |
| F-0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | 10,066 | 5,728 |
| F-0584 | Honor 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. | 5,789 | 2,113 |
| F-0921 | Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | 2,550 | 617 |
| F-0908 | Keep all essential equipment working safely. | 1,663 | 234 |
| F-0919 | Make sure that a working call system is available in each resident's bathroom and bathing area. | 1,572 | 199 |
| F-0925 | Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | 1,475 | 255 |
| F-0909 | Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame. | 459 | 31 |
| F-0926 | Have policies on smoking. | 257 | 15 |
| F-0924 | Put firmly secured handrails on each side of hallways. | 197 | 4 |
| F-0923 | Have enough outside ventilation via a window or mechanical ventilation, or both. | 130 | 6 |
| F-0922 | Have enough backup water supply for essential areas of the nursing home. | 42 | 0 |
| F-0906 | Provide enough power supply for lighting all entrances and exits; equipment for fire detection and alarm systems, and extinguishers. | 11 | 0 |
What the maintenance department owns
Most of the health survey is about care. These are the tags where the finding is a piece of equipment, a system, or the state of the building — the ones that land on the maintenance director’s desk. In CMS’s own words, what each checks:
- F-0908 Keep all essential equipment working safely. · 1,663 facilities cited
- F-0919 Make sure that a working call system is available in each resident's bathroom and bathing area. · 1,572 facilities cited
- F-0909 Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame. · 459 facilities cited
- F-0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. · 1,475 facilities cited
- F-0921 Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. · 2,550 facilities cited
- F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. · 10,066 facilities cited
By state
The share of a state’s certified facilities with at least one physical-environment citation on file. As with the Life Safety tags, the spread says as much about how state agencies survey as about the homes.
| State | Certified facilities | With an F-tag | Share |
|---|---|---|---|
| DC | 17 | 17 | 100% |
| HI | 43 | 43 | 100% |
| IL | 666 | 663 | 100% |
| CA | 1,165 | 1,155 | 99% |
| ME | 78 | 77 | 99% |
| MO | 487 | 480 | 99% |
| RI | 72 | 71 | 99% |
| CT | 191 | 188 | 98% |
| MD | 221 | 217 | 98% |
| NV | 66 | 65 | 98% |
| OR | 128 | 126 | 98% |
| WA | 193 | 189 | 98% |
| KS | 296 | 287 | 97% |
| MI | 422 | 410 | 97% |
| ND | 72 | 70 | 97% |
| NM | 68 | 66 | 97% |
| TX | 1,177 | 1,140 | 97% |
| AR | 221 | 212 | 96% |
| CO | 210 | 202 | 96% |
| NE | 180 | 172 | 96% |
| WV | 123 | 118 | 96% |
| AK | 20 | 19 | 95% |
| LA | 265 | 252 | 95% |
| OH | 922 | 875 | 95% |
| OK | 283 | 269 | 95% |
| ID | 80 | 75 | 94% |
| MN | 338 | 318 | 94% |
| MS | 202 | 190 | 94% |
| UT | 97 | 91 | 94% |
| VT | 33 | 31 | 94% |
| WI | 323 | 303 | 94% |
| NJ | 348 | 325 | 93% |
| MT | 61 | 56 | 92% |
| NY | 593 | 547 | 92% |
| SD | 96 | 88 | 92% |
| TN | 303 | 279 | 92% |
| GA | 356 | 325 | 91% |
| VA | 289 | 263 | 91% |
| IN | 507 | 456 | 90% |
| MA | 341 | 308 | 90% |
| DE | 44 | 39 | 89% |
| WY | 36 | 32 | 89% |
| AL | 224 | 197 | 88% |
| FL | 694 | 609 | 88% |
| IA | 387 | 339 | 88% |
| AZ | 140 | 122 | 87% |
| KY | 267 | 232 | 87% |
| NH | 73 | 63 | 86% |
| PA | 656 | 566 | 86% |
| SC | 187 | 159 | 85% |
| NC | 419 | 334 | 80% |
F-tags are surveyed under State Operations Manual Appendix PP and published by CMS in the Health Deficiencies file, processed 2026-08-01. Only the thirteen physical-environment tags are compiled here; the rest of the health survey is not. Each facility’s page lists its physical-environment citations beside its Life Safety record. No regulation text is reproduced; requirements are referenced by section only.