Based on observations, interview and record review, the facility failed to develop and implement an effective discharge planning process that focused on the resident's discharge goals, the preparation of residents to be active partners and effectively transition them to post-discharge care, and the reduction of factors leading to preventable readmissions for one (Resident #1) of three residents reviewed for discharge planning. The facility failed to implement an effective discharge plan for Resident #1, when FM S reported the resident's home was without electricity. An Immediate Jeopardy (IJ) situation was identified on 04/25/2025 at 5:57 PM. The ADM and DON was notified and provided an IJ template, and a POR (Plan of Removal) was requested. …
F660 · Discharge planning
Resident Assessment and Care Planning Deficiencies
Plan the resident's discharge to meet the resident's goals and needs.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Every F660 citation surveyors wrote nationally that year.
Distinct nursing homes with at least one F660 finding.
The harm level
How severely F660 is cited
3.9% of citations found actual harm or worse (level G and above).
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy | J132.0% | K20.3% | L— |
| Actual harm | G91.4% | H10.2% | I— |
| No harm, potential for more than minimal | D56788.7% | E436.7% | F20.3% |
| No harm, potential for minimal | A— | B10.2% | C10.2% |
In the surveyor’s words
What an F660 citation says
One finding from each severity level, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
Based on record review, and staff, resident and family member interviews, the facility failed to develop and implement effective discharge planning that ensured a resident would have the necessary durable medical equipment when she was discharged home to include a hospital bed, gel bed overlay with mattress, half side rails, a trapeze bar, and oxygen supplies for 1 of 4 residents reviewed for discharge (Resident #1). Resident #1 stated she was not provided with equipment for oxygen therapy and would get short of breath, and it would wake her up. Resident #1 reported she would cough, and it made her throw up at night. …
Based on interview, record review, and document review, the facility failed to ensure a resident who had functional impairments was appropriately discharged for 1 of 4 sampled residents (Resident 4). This failure could potentially lead to medical complications or adverse events which could result in hospitalization, prolonged illness, or even death. Findings include: Resident 4 (R4) R4 was admitted to the facility on [DATE] and discharged home on [DATE], with diagnoses including fracture of shaft of humerus of right arm, chronic obstructive pulmonary disease, cerebral infarction, and chronic atrial fibrillation. A Notice of Medicare Non-Coverage (NOMNOC) document was issued to R4 on 12/09/2024. …
Based on interview and record review, the facility failed to properly document a discharge to home for one of three discharged residents, (Resident #40). The facility census was 40. The facility did not provide a policy for discharge planning. 1. Review of Resident #40's quarterly Minimum Data Set (MDS), dated [DATE] showed: - Long and short term memory problems; - Physical behavior directed at others occurred one to three days; - Verbal behavior directed at others occurred one to three days; - Substantial to maximal assistance with eating and transfers; - Dependent on the assistance of staff for oral hygiene, toilet use, showers, dressing and personal hygiene; - Always incontinent of bowel and bladder; - Diagnoses included dementia, Parkinson's disease (a disorder of the central nervous… …
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