The following deficiency was cited during a recertification survey that was initiated on 10/16/17. An immediate jeopardy was identified on 10/24/17 at 11:25 am, and a Plan of Removal was accepted on 10/24/17 at 5:17 pm. Based on observation and interview, the facility failed to prevent an infestation of the kitchen with insects specifically cockroaches. This deficient practice has the potential to cause foodborne illness for the 97 (excluding one resident that is receiving a tube feeding) Residents who eat meals served from the kitchen. This deficient practice resulted in an Immediate Jeopardy at a scope and severity of J identified on 10/24/17 at 11:25 am. The facility administrator was notified at this time. The facility provided an acceptable Plan of Removal on 10/24/17 at 5:10 pm. …
F469
Environmental Deficiencies
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
The harm level
How severely F469 is cited
0.0% of citations found actual harm or worse (level G and above).
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy | J— | K— | L— |
| Actual harm | G— | H— | I— |
| No harm, potential for more than minimal | D— | E2100.0% | F— |
| No harm, potential for minimal | A— | B— | C— |
In the surveyor’s words
What an F469 citation says
One finding from each severity level, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
Based on observation, interview and record review; it was determined the facility failed to maintain an effective pest control program to ensure the facility is free of pests for 2 of 4 halls (200 Hall and 500 Hall) reviewed for pest control program (Resident #1, Resident #2, Resident #8 and Resident #10). The facility failed to ensure Resident #1 was not attacked by ants in her room on the 200 Hall on 7/17/17. The facility failed to ensure Resident #1 was not attacked by ants on 7/18/17 in her room on the 200 Hall. …
Based on observation, interview, and record review, the facility failed to have a policy and procedure for the control of pests in the facility. This failure resulted in cockroaches being observed in one of 36 resident rooms (Resident A) which had the potential to have an infestation of cockroaches which can result in the spread of disease in a vulnerable population of 95 residents. Findings: An unannounced visit was made to the facility on [DATE], to investigate a complaint regarding the physical environment. During an interview with a Housekeeper (HSK 1), on September 22, 2017 at 11:10 AM, HSK 1 stated she had initially observed cockroaches in Resident A's room last August 2017. …
Based on observation, interview and document review, the facility failed to ensure adequate pest control was maintained for flying insects throughout the facility, which was mainly identified throughout the 1st floor and dining room. This deficient practice had the potential to affect all 95 residents (R31, R162, R130, R35) residing in the facility. Findings include: R31 was interviewed on 10/01/2017, at 9:53 a.m. stated the facility has problems with sewer flies, the water fountain doesn't work and it is rusted, and the unused bathroom tubs I think the sewer flies come from there. The flies are everywhere. R31 further indicated a lot residents are coughing and hacking. …
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