Based on staff interview, clinical record review, and facility documentation review, the facility staff failed, for 1 resident (Resident #13) in the survey sample of 24 residents, to ensure that Resident #13 was free of a physical restraint. The facility staff failed to ensure that Resident #13 was free of being restrained by a bed sheet tied around a Geri-chair. The Findings included: Resident #13 was a [AGE] year old who was admitted to the facility on [DATE]. Resident #13's [DIAGNOSES REDACTED]. The Minimum Data Set, which was a Quarterly Assessment with an Assessment Reference Date of 9/2/17, coded Resident #13 as having a Brief Interview of Mental Status Score of 3, indicating severely impaired cognition. On 11/7/17 at 2:45 P.M. an unannounced tour was conducted of the facility. …
F221 citations in Virginia
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Keep each resident free from physical restraints, unless needed for medical treatment.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
No F221 citations were recorded in Virginia for 2025. That means none appear in the CMS file for that year — not that the requirement does not apply.
In the surveyor’s words
What Virginia surveyors wrote
F221 findings written in Virginia, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
Based on observation, staff interview, clinical record review, and facility document review, the facility staff failed to ensure an accurate assessment of a physical restraint for one of 15 residents. (Resident #5) The findings include: Resident #5 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The current minimum data set (MDS), an annual with an assessment reference date (ARD) of 8/21/13, showed the resident unable to partake in the brief interview for mental status (BIMS), so the staff have assessed the resident with having both short and long term memory loss and needing extensive assistance with decision making. On 9/17/13 at 2:00 p.m., Resident #5 was observed in her room, sitting in her wheelchair with a lap buddy on. …
What else Virginia surveyors cite →
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