D
April 10, 2026
Tag F0656
Complaint investigation
Corrected Apr 2026
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
No actual harm, potential for more than minimal harm
D
February 24, 2026
Tag F0657
Complaint investigation
Corrected Apr 2026
Resident Assessment and Care Planning Deficiencies
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
No actual harm, potential for more than minimal harm
D
February 24, 2026
Tag F0638
Complaint investigation
Corrected Apr 2026
Resident Assessment and Care Planning Deficiencies
Assure that each resident’s assessment is updated at least once every 3 months.
No actual harm, potential for more than minimal harm
J
February 24, 2026
Tag F0689
Complaint investigation
Corrected Mar 2026
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Immediate jeopardy to resident health or safety
D
August 28, 2025
Tag F0770
Corrected Oct 2025
Administration Deficiencies
Provide timely, quality laboratory services/tests to meet the needs of residents.
No actual harm, potential for more than minimal harm
E
August 28, 2025
Tag F0883
Corrected Oct 2025
Infection Control Deficiencies
Develop and implement policies and procedures for flu and pneumonia vaccinations.
No actual harm, potential for more than minimal harm
E
August 28, 2025
Tag F0842
Corrected Oct 2025
Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
No actual harm, potential for more than minimal harm
E
August 28, 2025
Tag F0628
Corrected Oct 2025
Resident Rights Deficiencies
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
No actual harm, potential for more than minimal harm
E
August 28, 2025
Tag F0605
Corrected Oct 2025
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
No actual harm, potential for more than minimal harm
F
August 28, 2025
Tag F0909
Corrected Oct 2025
Environmental Deficiencies
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.
No actual harm, potential for more than minimal harm
D
April 11, 2024
Tag F0812
Complaint investigation
Corrected Jun 2024
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
No actual harm, potential for more than minimal harm
D
April 11, 2024
Tag F0657
Corrected Jun 2024
Resident Assessment and Care Planning Deficiencies
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
No actual harm, potential for more than minimal harm
D
April 11, 2024
Tag F0641
Corrected Jun 2024
Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
No actual harm, potential for more than minimal harm
D
April 11, 2024
Tag F0604
Complaint investigation
Corrected Jun 2024
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
No actual harm, potential for more than minimal harm
D
April 11, 2024
Tag F0582
Corrected Jun 2024
Resident Rights Deficiencies
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
No actual harm, potential for more than minimal harm
D
February 24, 2023
Tag F0909
Corrected Apr 2023
Environmental Deficiencies
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.
No actual harm, potential for more than minimal harm
D
February 24, 2023
Tag F0761
Corrected Apr 2023
Pharmacy Service Deficiencies
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
No actual harm, potential for more than minimal harm
D
February 24, 2023
Tag F0657
Corrected May 2023
Resident Assessment and Care Planning Deficiencies
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
No actual harm, potential for more than minimal harm
D
February 24, 2023
Tag F0655
Corrected Apr 2023
Resident Assessment and Care Planning Deficiencies
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
No actual harm, potential for more than minimal harm
D
February 24, 2023
Tag F0636
Corrected Apr 2023
Resident Assessment and Care Planning Deficiencies
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
No actual harm, potential for more than minimal harm
D
February 24, 2023
Tag F0623
Corrected Apr 2023
Resident Rights Deficiencies
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
No actual harm, potential for more than minimal harm
D
February 24, 2023
Tag F0622
Corrected Apr 2023
Resident Rights Deficiencies
Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.
No actual harm, potential for more than minimal harm
D
February 24, 2023
Tag F0559
Corrected May 2023
Resident Rights Deficiencies
Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made.
No actual harm, potential for more than minimal harm
E
February 24, 2023
Tag F0888
Corrected Apr 2023
Infection Control Deficiencies
Ensure staff are vaccinated for COVID-19
No actual harm, potential for more than minimal harm
E
February 24, 2023
Tag F0880
Corrected Apr 2023
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
No actual harm, potential for more than minimal harm
E
February 24, 2023
Tag F0867
Corrected May 2023
Administration Deficiencies
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
No actual harm, potential for more than minimal harm
E
February 24, 2023
Tag F0759
Corrected Apr 2023
Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
No actual harm, potential for more than minimal harm
E
February 24, 2023
Tag F0758
Corrected May 2023
Pharmacy Service Deficiencies
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
No actual harm, potential for more than minimal harm
E
February 24, 2023
Tag F0757
Corrected May 2023
Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
No actual harm, potential for more than minimal harm
E
February 24, 2023
Tag F0756
Corrected Apr 2023
Pharmacy Service Deficiencies
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
No actual harm, potential for more than minimal harm
E
February 24, 2023
Tag F0727
Corrected Apr 2023
Nursing and Physician Services Deficiencies
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
No actual harm, potential for more than minimal harm
E
February 24, 2023
Tag F0700
Corrected Apr 2023
Quality of Life and Care Deficiencies
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
No actual harm, potential for more than minimal harm
E
February 24, 2023
Tag F0695
Corrected Apr 2023
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
No actual harm, potential for more than minimal harm
E
February 24, 2023
Tag F0692
Corrected May 2023
Quality of Life and Care Deficiencies
Provide enough food/fluids to maintain a resident's health.
No actual harm, potential for more than minimal harm
E
February 24, 2023
Tag F0684
Corrected May 2023
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
No actual harm, potential for more than minimal harm
E
February 24, 2023
Tag F0656
Corrected Apr 2023
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
No actual harm, potential for more than minimal harm
E
February 24, 2023
Tag F0641
Corrected Apr 2023
Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
No actual harm, potential for more than minimal harm
E
February 24, 2023
Tag F0578
Corrected Apr 2023
Resident Rights Deficiencies
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
No actual harm, potential for more than minimal harm
Citations are published by CMS from state survey agency findings. A citation describes what an inspector
observed on a specific date; homes are required to submit a correction plan, and many findings are resolved
long before you read them. Ask the administrator what happened and what changed.