Based on interviews and the review of facility documentation, it was determined that the facility failed to ensure that proper notice was provided for a room change for 1 out of 22 residents reviewed (Resident R4). Findings include: Review of Resident R4's clinical record included the following diagnoses: end stage renal disease (a condition that occurs when the kidneys no longer work well enough to meet the body's needs); dysphagia (difficulty swallowing); hypertension (high blood pressure), and depression (a mood disorder that causes a persistent feeling of sadness and loss of interest). …
F559 citations in Pennsylvania
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.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Pennsylvania cites F559 more often than its own record predicts
1.78 times the share F559 takes of citations nationally.
Of every deficiency written in Pennsylvania in 2025, this is the portion that was F559.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Pennsylvania surveyors wrote
F559 findings written in Pennsylvania, 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.
The short window
Recent years
| Year | Share of Pennsylvania citations | vs expected |
|---|---|---|
| 2023 | 0.22% | 3.11× |
| 2024 | 0.18% | 1.79× |
| 2025 | 0.20% | 1.78× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Pennsylvania surveyors cite →
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