11/05/2026

Survey Tip of the Week: Choking Prevention

CMS has recently identified choking prevention as a significant area of concern in nursing homes. Survey citations under F689, Accidents, have included residents receiving food inconsistent with their prescribed diets, residents accessing food from other residents' trays, and residents requiring supervision while eating being left unattended. This includes residents who require supervision but are left to eat alone in their rooms. 

Under F689, §483.25(d), facilities must ensure that each resident receives adequate supervision to prevent avoidable accidents. The State Operations Manual (SOM) Appendix PP directs facilities to identify and evaluate accident risks, implement individualized interventions to reduce those risks, and monitor their effectiveness. Residents with dysphagia, cognitive impairments, impulsive eating behaviors, or a history of choking may require additional precautions, including modified diets, assistance with eating, or supervision during meals and snacks. 

Choking prevention extends beyond ensuring the correct diet is delivered. Facilities must consider whether residents can access food that is unsafe for them, whether staff understand and implement required supervision, and whether appropriate precautions are maintained when residents choose to eat in their rooms. Surveyors may observe residents during meals, interview staff regarding individualized precautions, and review assessments, physician orders, and care plans to determine whether identified choking risks are being appropriately addressed. 

Facilities should review residents identified as being at risk for choking and verify that diet orders, care plans, and supervision requirements are accurate, communicated to staff, and consistently implemented. Consider conducting observations during meals and snacks, including in resident rooms, to identify potential gaps in supervision, food access, and adherence to prescribed diets. Refer to the Accidents Critical Element Pathway and SOM Appendix PP, F689, for additional guidance surveyor observation, interview, and record review investigations.