Based on interview and record review, the facility failed to arrange safe and orderly discharge to meet health and safety needs, and failed to offer adequate orientation and preparation for discharge for 1 of 3 residents reviewed for discharge of a total sample of 9 residents, (#1). On 3/02/22 at 5:43 PM, resident #1 was discharged from the facility to the Emergency Department of a hospital over 50 miles away via ridesharing service. There was no communication between both facilities regarding the reason for the transfer, and resident #1 arrived at the hospital without a medication list or wound care orders for his multiple, complex pressure ulcers. The hospital contacted the facility regarding the discharge being unsafe and inappropriate for hospital admission. …
F624 citations in Florida
Resident Rights Deficiencies
Prepare residents for a safe transfer or discharge from the nursing home.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Florida cites F624 more often than its own record predicts
2.01 times the share F624 takes of citations nationally.
Of every deficiency written in Florida in 2025, this is the portion that was F624.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Florida surveyors wrote
F624 findings written in Florida, 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 record review and interviews, the facility failed to ensure a safe an orderly discharge and appropriately document in the medical record the events and follow through of the discharge for one resident (#1) who was transferred to an inappropriate location following an emergent incident between Resident #1 and another resident of three residents reviewed for transfer and discharge rights. Findings included: Review of the Admission Record for Resident #1 showed the resident was initially admitted to the facility on [DATE] with admitting diagnoses to include: unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance and anxiety; major depressive disorder, recurrent, moderate; generalized anxiety disorder; other specified… …
Based on a review of closed resident records, facility policies and procedures, and interviews with the resident and staff, the facility failed to provide and document sufficient preparation and orientation to one (Resident #2) of three residents reviewed, to ensure a safe and orderly discharge from the facility. The findings include: A review of Resident #2's medical record revealed an admission date of 3/18/25 and a discharge date of 4/6/25. The resident's diagnoses included dysphagia (difficulty swallowing) following cerebral infarction (stroke), type 2 diabetes mellitus (DM), difficulty walking, lack of coordination, and hypertension (HTN). …
The short window
Recent years
| Year | Share of Florida citations | vs expected |
|---|---|---|
| 2023 | 0.08% | 0.72× |
| 2024 | 0.06% | 0.47× |
| 2025 | 0.10% | 2.01× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Florida surveyors cite →
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