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 13 physical-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. | 12,011 | 7,422 |
| F-0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | 10,065 | 5,695 |
| 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. | 5,803 | 2,124 |
| F-0921 | Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | 2,570 | 626 |
| F-0908 | Keep all essential equipment working safely. | 1,660 | 239 |
| F-0919 | Make sure that a working call system is available in each resident's bathroom and bathing area. | 1,564 | 210 |
| F-0925 | Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | 1,492 | 264 |
| 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 | 30 |
| F-0926 | Have policies on smoking. | 273 | 13 |
| F-0924 | Put firmly secured handrails on each side of hallways. | 190 | 4 |
| F-0923 | Have enough outside ventilation via a window or mechanical ventilation, or both. | 133 | 7 |
| F-0922 | Have enough backup water supply for essential areas of the nursing home. | 41 | 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. · 1,660 facilities cited
- F-0919 Make sure that a working call system is available in each resident's bathroom and bathing area. · 1,564 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. · 1,492 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. · 2,570 facilities cited
- F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. · 10,065 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 | 16 | 16 | 100% |
| HI | 43 | 43 | 100% |
| IL | 664 | 661 | 100% |
| CA | 1,165 | 1,154 | 99% |
| CT | 191 | 189 | 99% |
| ME | 78 | 77 | 99% |
| MO | 486 | 480 | 99% |
| RI | 72 | 71 | 99% |
| NV | 66 | 65 | 98% |
| WA | 193 | 190 | 98% |
| KS | 296 | 287 | 97% |
| MD | 221 | 215 | 97% |
| MI | 422 | 411 | 97% |
| ND | 72 | 70 | 97% |
| NM | 68 | 66 | 97% |
| OR | 128 | 124 | 97% |
| TX | 1,177 | 1,147 | 97% |
| VT | 33 | 32 | 97% |
| CO | 210 | 202 | 96% |
| NE | 180 | 172 | 96% |
| OK | 283 | 272 | 96% |
| WV | 123 | 118 | 96% |
| AK | 20 | 19 | 95% |
| AR | 222 | 212 | 95% |
| MN | 337 | 319 | 95% |
| OH | 924 | 879 | 95% |
| ID | 80 | 75 | 94% |
| LA | 265 | 250 | 94% |
| MS | 202 | 190 | 94% |
| NJ | 348 | 328 | 94% |
| UT | 97 | 91 | 94% |
| WI | 323 | 305 | 94% |
| NY | 592 | 549 | 93% |
| SD | 96 | 89 | 93% |
| TN | 303 | 281 | 93% |
| GA | 356 | 326 | 92% |
| MT | 61 | 56 | 92% |
| VA | 289 | 264 | 91% |
| IN | 507 | 454 | 90% |
| DE | 44 | 39 | 89% |
| MA | 341 | 305 | 89% |
| WY | 36 | 32 | 89% |
| AL | 224 | 198 | 88% |
| AZ | 140 | 123 | 88% |
| NH | 73 | 64 | 88% |
| FL | 694 | 607 | 87% |
| IA | 387 | 337 | 87% |
| KY | 266 | 228 | 86% |
| PA | 656 | 562 | 86% |
| SC | 187 | 153 | 82% |
| NC | 419 | 332 | 79% |
F-tags are surveyed under State Operations Manual Appendix PP and published by CMS in the Health Deficiencies file, processed 2026-10-01. 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.