Based on observation and eighteen records reviewed (RR) on 03/24/2025 through 03/26/2025 from 9:00 AM to 3:00 PM, it was determined that the facility did not ensure providing in making decisions regarding medical care and treatment with the resident or representative in advance directives 2 out of 18 records reviewed. (R.R #106 and #108). Findings include: 1. During the evaluation of the records review on 03/25/2025, the following was found: a. R.R #215 is a [AGE] year-old male admitted [DATE] with Infected Sacral Ulcer. Noted in the record review on 03/26/2025 at 10:13 AM, the advance directive was observed without the signature of the resident or representative. b. R.R #217 is a [AGE] year-old male admitted on [DATE] with Amputation of the First Toe of the Right Foot. …
F578 citations in Puerto Rico
Advance directives · 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.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Puerto Rico cites F578 more often than its own record predicts
2.64 times the share F578 takes of citations nationally.
Of every deficiency written in Puerto Rico in 2025, this is the portion that was F578.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Puerto Rico surveyors wrote
F578 findings written in Puerto Rico, 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 Puerto Rico citations | vs expected |
|---|---|---|
| 2023 | 2.78% | 2.59× |
| 2024 | 1.76% | 1.79× |
| 2025 | 2.50% | 2.64× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Puerto Rico surveyors cite →
Deficiency Index is independent and is not affiliated with, endorsed by, or approved by CMS, Medicare, or any government agency. About this data · Report a correction