Based on observation, interview, and record review, the facility failed to ensure that all residents were free from physical restraints. Specifically, 1 resident was restrained during oral care. Resident Identifier: 1. Findings include: The surveyor reviewed the facility's grievance log. The grievance log revealed that on March 3, 2025, the facility received an incident report from the school that Resident 1 attended, regarding a possible abuse event that happened on February 28, 2025 with Respiratory Therapist (RT) 1 and Resident 1. The following summary was documented in the log: Resident 1 was visibly upset during oral care that RT 1 was performing. Resident 1 was attempting to cover their face during these cares. Registered Nurse (RN) 1 offered assistance, and RT 1 declined assistance. …
F604 citations in Utah
Restraints · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Utah cites F604 less often than its own record predicts
0.59 times the national share — cited less often here than elsewhere.
Of every deficiency written in Utah in 2025, this is the portion that was F604.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Utah surveyors wrote
F604 findings written in Utah, 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 Utah citations | vs expected |
|---|---|---|
| 2023 | 0.46% | 1.21× |
| 2025 | 0.22% | 0.59× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Utah surveyors cite →
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