Based on interview and record review, the facility failed to ensure professional standards were followed for a choking resident by administering emergency first aid such as abdominal thrust, for 1 of 8 sampled residents (Resident #1). The deficient practice resulted in the resident being unable to expel the foreign object from their airway. Resident #1 (R1) R1 was originally admitted on [DATE] and readmitted on [DATE], with diagnoses including cerebral vascular accident (CVA), vascular dementia, aphasia (disorder that affects the ability to communicate), dysphagia (swallowing difficulties), and esophageal stricture (an abnormal narrowing of the esophageal lumen). R1's history and physical dated [DATE], documented R1 had history of CVA with aphasia and dysphagia. …
F658 citations in Nevada
Professional standards of care · Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Nevada cites F658 less often than its own record predicts
0.64 times the national share — cited less often here than elsewhere.
Of every deficiency written in Nevada in 2025, this is the portion that was F658.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Nevada surveyors wrote
F658 findings written in Nevada, 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 observation, interview, record review, and document review, the facility failed to ensure 1) a physician-ordered antibiotic was available for administration resulting in a delay of over five hours for 1 of 54 sampled residents (Resident 158), 2) scheduled medications were not given late for 1 of 45 sampled residents (Resident 97) and 3) medications for multiple residents were not prepared at the same time prior to administration for 2 unsampled residents. The deficient practice had the potential to negatively impact the effectiveness of treatment and placed residents at risk for medication error. …
The short window
Recent years
| Year | Share of Nevada citations | vs expected |
|---|---|---|
| 2023 | 0.74% | 0.46× |
| 2024 | 1.53% | 0.94× |
| 2025 | 1.15% | 0.64× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Nevada surveyors cite →
Deficiency Index is independent and is not affiliated with, endorsed by, or approved by CMS, Medicare, or any government agency. About this data · Report a correction