Based on observation, record review, policy review, and staff interview, it was determined the facility failed to ensure resident's care plans were revised to reflect current needs and interventions. This was true for 3 of 27 Residents (#7, #65, and #156) whose care plans was reviewed. This placed residents at risk of adverse outcomes if care and services were not provided due to care plans not being revised as residents' needs changed. Findings include:The facility's Comprehensive Person-Centered Care Planning policy dated 4/2025, documented the facility IDT will develop and implement a comprehensive person-centered, culturally competent, and trauma-informed care plan for each resident within seven (7) days of completion of the Resident Minimum Data Set (MDS) and will include resident's… …
F657 citations in Idaho
Care plan timing and revision · Resident Assessment and Care Planning Deficiencies
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Idaho cites F657 more often than its own record predicts
1.96 times the share F657 takes of citations nationally.
Of every deficiency written in Idaho in 2025, this is the portion that was F657.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Idaho surveyors wrote
F657 findings written in Idaho, 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 Idaho citations | vs expected |
|---|---|---|
| 2023 | 5.71% | 2.67× |
| 2024 | 3.10% | 1.62× |
| 2025 | 3.65% | 1.96× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Idaho surveyors cite →
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