Based on record review, resident, facility staff, and shelter staff interview the facility failed to develop and implement an effective discharge planning process to ensure discharge needs and goals were identified with the resident and the interdisciplinary team (IDT) as active participants in the discharge plan in order to prepare the resident for an effective transition to post-discharge care for a resident who was a planned discharge. On 2/14/24 Resident #241 was discharged without the facility verifying his discharge location and if his care needs were able to be met. In addition, the resident was discharged without adaptive equipment required for ambulation (rolling walker). …
F660 citations in North Carolina
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.
Against expectation — 2025
North Carolina cites F660 more often than its own record predicts
1.23 times the share F660 takes of citations nationally.
Of every deficiency written in North Carolina in 2025, this is the portion that was F660.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What North Carolina surveyors wrote
F660 findings written in North Carolina, 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 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 record review and resident and staff interviews, the facility failed to have a discharge planning process in place that incorporated the resident in the development of a discharge care plan that addressed the resident's discharge goals and post-discharge needs for residents who wished to discharge to the community for 2 of 3 sampled residents (Residents #50 and #70). Findings included: 1. Resident #50 was admitted to the facility on [DATE] with diagnoses that included diabetes, chronic pain, chronic post-traumatic stress disorder, and anxiety disorder. The admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #50 had intact cognition. …
The short window
Recent years
| Year | Share of North Carolina citations | vs expected |
|---|---|---|
| 2023 | 0.34% | 1.44× |
| 2024 | 0.44% | 2.09× |
| 2025 | 0.10% | 1.23× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else North Carolina surveyors cite →
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