CMS · Survey deficiency reference

A-0701 Standard: Buildings

Identifier and Official Title

A-0701 is the tag for 42 CFR §482.41(a). The heading as printed in Appendix A Rev. 238 reads, verbatim:

A-0701 (Rev. 238; Issued: 03-20-26; Effective: 09-05-25; Implantation: 09-05-25) §482.41(a) Standard: Buildings

Verified against the full text of Rev. 238 on September 11, 2026, and independently confirmed by the operator’s search of the same PDF on September 10, 2026. If your citation names a tag that does not exist in Appendix A, see A-0758 does not appear in Appendix A.

What It Enforces (Verbatim)

As printed under the tag and identical to 42 CFR §482.41(a) in eCFR:

(a) Standard: Buildings. The condition of the physical plant and the overall hospital environment must be developed and maintained in such a manner that the safety and well-being of patients are assured.

That single sentence is the entire regulatory basis for most pest citations in U.S. hospitals. There is no pest-specific standard beneath it and no pest-specific interpretive guidance anywhere in Appendix A: “pest,” “vermin,” “rodent,” “insect,” and “infestation” occur 0 times in the 613-page Rev. 238 and 0 times in 42 CFR Part 482 (measured). Pest activity in a patient-care area, a storage room, or a support space is cited here as a failure to maintain the environment so that patient safety and well-being are assured.

Interpretive Guidelines (Verbatim, the General Passages)

Interpretive Guidelines §482.41(a)

The hospital must ensure that the condition of the physical plant and overall hospital environment is developed and maintained in a manner to ensure the safety and well-being of patients. This includes ensuring that routine and preventive maintenance and testing activities are performed as necessary, in accordance with Federal and State laws, regulations, and guidelines and manufacturer’s recommendations, by establishing maintenance schedules and conducting ongoing maintenance inspections to identify areas or equipment in need of repair. The routine and preventive maintenance and testing activities should be incorporated into the hospital’s QAPI plan.

The hospital must be constructed and maintained to ensure risks are minimized for patients as well as for employees and visitors. Hospitals are expected to demonstrate how they are addressing important safety features in accordance with nationally recognized standards.

The guidance then lists safety features to be addressed “when applicable, including but not limited to”: accessibility, age-related safety considerations, security, ligature risk, and weather-related exterior issues. None mentions pests; the list is expressly non-exhaustive.

Survey Procedures (Verbatim, the General Bullets)

Survey Procedures §482.41(a)

• Verify that the condition of the hospital is maintained in a manner to assure the safety and well-being of patients (e.g., condition of ceilings, walls, and floors, presence of patient hazards, etc.).

• Review the hospital’s routine and preventive maintenance schedules to determine that ongoing maintenance inspections are performed and that necessary repairs are completed.

• Review a copy of the most recent environmental risk assessment to determine if the hospital has identified any accessibility, age-related, security, suicide and/or weather related risks or concerns. If environmental safety concerns have been identified in this assessment, what plans have been implemented by the hospital to ensure patient/staff safety?

Two further bullets concern power strips and ligature-risk referrals. The first bullet, “presence of patient hazards,” is where a pest observation is recorded; the second and third are why the surveyor then asks for the maintenance schedule and the environmental risk assessment.

What the Surveyor Is Looking For

Direct observation during the facility tour: live pests, droppings, gnaw marks, harborage, deteriorated screens, gaps under doors, unsealed penetrations. The surveyor then asks whether the hospital knew and what it did. The questions that follow an observation track the Survey Procedures:

• Is there a written pest management plan, and does it cover this area?
• Is pest activity in the maintenance schedule and the environmental risk assessment the surveyor is told to review?
• When was this area last inspected, by whom, and what did the record say?
• What is the action threshold for this pest in this area, and was it applied?
• Who in the hospital was told, and what happened next?

A hospital that can answer all of these from records already in hand usually receives a standard-level finding with a straightforward correction. A hospital that cannot is at risk of the finding being widened to A-0700.

Documentation That Satisfies It

• The written pest management plan, with the cited area named in it and an action threshold stated for it
• The environmental risk assessment with pest activity as an assessed risk, because the Survey Procedures direct the surveyor to that document
• Service records for the area showing inspection findings, non-chemical interventions (exclusion, sanitation, mechanical controls), and any chemical application, with dates
• Work orders for the structural repairs that closed the entry points the surveyor saw
• The trend report that shows the area’s history and that it was reviewed, with QAPI reporting as the guidance expects
• Evidence that infection prevention and environmental services were notified and involved

Where Facilities Most Commonly Fail

• The observed area is not in the written plan at all (mechanical rooms, loading docks, and staff break areas are the usual omissions)
• The service record shows a monthly chemical application and nothing else, which tells the surveyor the program is calendar-driven rather than threshold-driven
• Exclusion defects (door sweeps, screens, penetrations) are treated as the pest vendor’s problem when they are the facilities department’s work order
• The environmental risk assessment does not mention pests, so the surveyor’s third procedure comes up empty
• No one can produce the trend data, so the hospital cannot show it knew

Plan of Correction: What It Must Address

Appendix A’s own survey protocol (Rev. 238, exit-conference instructions) tells surveyors to:

Inform the facility that a written plan of correction must be submitted to the survey agency within 10 calendar days following receipt of the written statement of deficiencies.

and to explain the required characteristics of a plan of correction, which the protocol lists verbatim as:

Corrective action to be taken for each individual affected by the deficient practice, including any system changes that must be made;

• The position of the person who will monitor the corrective action and the frequency of monitoring;

• Dates each corrective action will be completed;

• The administrator or appropriate individual must sign and date the Form CMS-2567 before returning it to the survey agency; and

• The submitted plan of correction must meet the approval of the State agency, or in some cases the CMS Regional Office for it to be acceptable.

The protocol’s post-survey section adds that 42 CFR 488.28(a) allows certification with deficiencies “only if the facility has submitted an acceptable plan of Correction [POC] for achieving compliance within a reasonable period of time acceptable to the Secretary,” and that “After a POC is submitted, the surveying entity makes the determination of the appropriateness of the POC.”

Applied to a pest finding at A-0701, the plan has to show: remediation of the observed activity and the harborage that produced it, with the service records; inspection of comparable areas, not only the room the surveyor entered; the system change (the written plan, thresholds, exclusion work orders, vendor scope, the risk assessment updated, QAPI reporting); the position that monitors it and how often; and a completion date for each action. The structure is not a template, and the surveying entity decides whether the plan is acceptable.

Confidence Notes

HIGH confidence. The tag heading, regulation text, Interpretive Guidelines, and Survey Procedures are transcribed from Appendix A Rev. 238 (Issued 03-20-26), read in full from the reference’s archived copy of the CMS PDF on September 11, 2026, and agree with the operator’s independent search of the same PDF on September 10, 2026. The regulation text was matched against the eCFR XML of 42 CFR Part 482. The description of surveyor practice is the reference’s characterization, not CMS text.