Based on record review and staff interview, the facility failed to ensure Cardio-Pulmonary Resuscitation (CPR) interventions were initiated and continued until the arrival of emergency medical personnel for a resident observed with absence of vital signs with a Full Code status, resulting in death for one (1) of two (2) residents reviewed for death in the facility. This had the potential to affect all residents in the facility with a Full Code status. This immediate jeopardy began on [DATE] at approximately 3:00 AM when Resident #194 was observed with absence of vital signs. LPN #125 and Nurse Aide #126 reportedly initiated CPR but discontinued it prior to the arrival of EMS. The facility Administrator was informed of the Immediate Jeopardy (IJ) tag on [DATE] at 2:55 PM. …
F678 citations in West Virginia
Quality of Life and Care Deficiencies
Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
West Virginia cites F678 less often than its own record predicts
1.00 times the national share — cited less often here than elsewhere.
Of every deficiency written in West Virginia in 2025, this is the portion that was F678.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What West Virginia surveyors wrote
F678 findings written in West Virginia, 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 interview, the facility failed to honor a resident's Physician's Orders for Scope of Treatment (POST) form indicating the resident did not want cardio-pulmonary resuscitation. This deficient practice had the potential to affect one (1) of one (1) residents reviewed for the closed record category of death. This was determined to be past non-compliance beginning on [DATE] and ending [DATE]. Resident Identifier: #61. Facility Census: 57. Findings Included:a) Resident #61 The facility's policy titled Emergency Procedures, with no implementation or revision dates given, stated cardio-pulmonary resuscitation (CPR) would not be provided for residents having a valid physician order to withhold CPR per the resident's or resident's representative's request. …
The short window
Recent years
| Year | Share of West Virginia citations | vs expected |
|---|---|---|
| 2024 | 0.30% | 1.42× |
| 2025 | 0.18% | 1.00× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else West Virginia 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