When an organization has a fall risk reduction program but it does not include all populations served, how is this scored?

Any examples are for illustrative purposes only.

The organization's fall reduction program is expected to include all patient/resident care settings and populations. We don't prescribe what the program must include but there must be something to address the risk of harm from falls for all of the organization's settings and populations. That includes the possibility that a specific unit or population had been assessed and determined to have a minimal risk of patient/resident harm from falls and that nothing further needs to be done for that setting or population. However, if a particular setting or population was simply ignored in the organization's program, then it would not meet the requirement.