Based on interview and record review it was determined the facility failed to ensure appropriate services and medical equipment were provided at time of discharge for 1 of 3 sampled residents (#11) reviewed for facility discharge. As a result, the unsafe discharge resulted with Resident 11 experiencing unnecessary hardship and pain. Findings include: Resident 11 was admitted to the facility on [DATE] with diagnoses including essential tremors, left hip hemiarthroplasty (partial hip joint replacement). Resident 11's 2/17/23 Admission MDS indicated she/he was cognitively intact. A Notice of Medicare Non-Coverage (NOMNC) which notified the resident of skilled services ending was issued on 2/15/23 and indicated skilled services would end on 2/17/23. …
F622 citations in Oregon
Transfer and discharge · Resident Rights Deficiencies
Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2024
Oregon cites F622 less often than its own record predicts
0.24 times the national share — cited less often here than elsewhere.
Of every deficiency written in Oregon in 2024, this is the portion that was F622.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Oregon surveyors wrote
F622 findings written in Oregon, 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.
Based on interview and record review it was determined the facility failed to document the basis for transfer and failed to include code and health status to the receiving provider for 1 of 3 sampled residents (#7) reviewed for hospitalization . This placed residents at risk for inaccurate health care. Findings include: Resident 7 was admitted to the facility in 8/2024, with diagnoses including traumatic brain injury and delirium. Resident 7's 10/3/24 Discharge MDS indicated the resident was discharged to an acute care hospital. Review of Resident 7's medical record revealed no documentation to indicate the basis for the transfer and if appropriate information was communicated to the receiving hospital. …
The short window
Recent years
| Year | Share of Oregon citations | vs expected |
|---|---|---|
| 2023 | 0.16% | 0.62× |
| 2024 | 0.08% | 0.24× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Oregon surveyors cite →
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