The federal Centers for Medicare & Medicaid Services (CMS) provides a range of resources for nursing home surveyors (inspectors) to assist in the evaluation of whether a nursing home’s care and services comport with federal minimum standards. These resources are also useful to nursing homes, residents, and others concerned about the quality of nursing home care. Following are a range of resources, including Appendix PP, which provides interpretive guidelines for long-term care facilities. Critical Element Pathways – indicated with an * – are used for investigating potential areas of concern.

For an overview of the requirements for state oversight of nursing homes, see LTCCC’s Guide to Nursing Home Oversight and Enforcement.

Last update June 2025.

Appendix PP – Guidance for Surveyors
Appendix Q
Appendix Z
Chapter 7 – State Operations Manual
Immediate Jeopardy Template
Long Term Care Survey Process (LTCSP) Procedure Guide
Psychosocial Outcome Severity Guide
Scope and Severity Grid
Abuse*
Accidents*
Activities*
Activities of Daily Living*
Arbitration*
Behavioral-Emotional*
Beneficiary Notice*
Bladder and Bowel Incontinence*
Comm-Sensory*
Death*
Dementia Care*
Dental*
Dialysis*
Dining*
Discharge*
Environment*
Extended Survey*
General*
Hospice and End of Life*
Hospitalization*
Hydration*
Infection Prevention Control and Immunization*
Kitchen*
Medication Administration*
Medication Storage*
Neglect*
Nutrition*
Pain Management*
PASARR*
Personal Funds*
Physical Restraints*
Positioning, Mobility, ROM*
Pressure Ulcer*
QAPI and QAA*
Rehab and Restorative*
Resident Assessment*
Resident Council*
Respiratory Care*
Sufficient and Competent Staff*
Tube Feeding*
Unnecessary Medications*
Urinary Catheter or UTI*