F609 in Utah. Pick another state for the same tag.
Against expectation — 2025
Utah cites F609 more often than its own record predicts
Versus expected share1.91×
1.91 times the share F609 takes of citations nationally.
Share of Utah citations4.68%
Of every deficiency written in Utah in 2025, this is the portion that was F609.
Utah4.68%
National2.45%
Share of all citations that were F609.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Utah surveyors wrote
F609 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.
K · Immediate jeopardy, patternAugust 20, 2025
Based on interview, and record review, for 10 of 32 residents sampled, the facility did not ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source, were reported immediately, but not later than 2 hours after the allegation was made, to the State Survey Agency. Specifically, the State Survey Agency was not notified of sexual relations between cognitively impaired residents, multiple resident elopements, injuries of unknown origin with some resulting in fractures, and a resident not secured in transportation vehicle. Resident identifiers: 2, 7, 11, 27, 31, 33, 36, 42, 47 and 49. …
Based on interview and record review the facility did not ensure that all alleged violations involving injuries of unknown source were reported immediately, but no later than 2 hours after the allegation was made, if the events resulted in serious bodily injury to the administrator, State Survey Agency (SSA) and Adult Protective Services (APS). Specifically, for 1 out of 9 sampled residents, the SSA and APS were not notified when a resident's tracheostomy flange broke, resulting in a dislodged tracheostomy tube. The resident subsequently went into cardiac arrest and died. This will be cited at a harm level. Resident identifier: 9. …
D · No harm, potential for more than minimal, isolatedJuly 15, 2026
Based on interview and record review, the facility did not ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment were reported immediately to the State Survey Agency (SSA). Specifically, for 1 out of 16 sampled residents, a resident eloped from the facility and this elopement was not reported to the SSA. Resident identifier: 4.Findings included:Resident 4 was admitted to the facility on [DATE] with diagnoses which included generalized anxiety disorder, major depressive disorder, and vascular dementia.On 5/7/26 a wandering risk scale assessment was conducted on resident 4. …
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