Based on interview, observation, and review of clinical record, surveillance video and other records as indicated, it was determined that for one (R1) out of three residents reviewed for respiratory care, the facility failed to ensure that nursing staff provided appropriate care and services to R1, a resident with a diagnosis of congestive heart failure who had an acute respiratory change of condition that started after dinner on 8/2/26. While facility staff reported to the assigned nurse multiple times that R1 was coughing, had increased mucus but could not cough it up, and had trouble breathing, the nurse failed to recognize and act upon R1's acute respiratory change of condition by auscultating R1's lungs during her assessment, or to attempt to suction his airway for mucus/oral… …
F684 citations in Delaware
Quality of care · Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Delaware cites F684 less often than its own record predicts
0.94 times the national share — cited less often here than elsewhere.
Of every deficiency written in Delaware in 2025, this is the portion that was F684.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Delaware surveyors wrote
F684 findings written in Delaware, 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.
3. A review of R11's clinical record revealed: 3/24/21 - R11 was admitted to the facility. 11/16/24 - R11 was admitted to hospice care. 3/12/25 - A review of the medications on the 2/26/25 hospice plan of care document in the electronic medical record (EMR) compared to the medications that the facility had profiled for R11 in the facility EMR revealed the following discrepancies: -Ativan 0.5 mg by mouth every four hours as needed for agitation that was ordered by hospice on 11/16/24 was on the hospice medication list but not on the current facility medication list. -Miralax 17 grams, 1 scoop daily by mouth for constipation, was ordered by the facility on 11/1/24 was on the facility medication profile, but not on the hospice list of medications. …
Based on record review and interview it was determined that for two (R3 and R182) out of eight residents reviewed for infection control the facility to follow physicians' orders related to antibiotics. Findings include:1. Review of R182's clinical record revealed: 5/4/26 3:00 PM - An after care summary from a walk-in care clinic documented that R182, You are being treated for cellulitis of the right foot due to injury. Oral antibiotic prescribed take as directed. The antibiotic was called in to a local pharmacy near the facility. 5/4/26 10:43 PM - A nurses note in R182's clinical record documented, Resident approached this writer and reported that she had gone to urgent care for her right foot, where she was told she had an infection. …
The short window
Recent years
| Year | Share of Delaware citations | vs expected |
|---|---|---|
| 2023 | 3.70% | 1.02× |
| 2024 | 3.15% | 0.79× |
| 2025 | 4.04% | 0.94× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Delaware surveyors cite →
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