F686 in Oregon. Pick another state for the same tag.
Against expectation — 2025
Oregon cites F686 more often than its own record predicts
Versus expected share1.12×
1.12 times the share F686 takes of citations nationally.
Share of Oregon citations2.20%
Of every deficiency written in Oregon in 2025, this is the portion that was F686.
Oregon2.20%
National1.97%
Share of all citations that were F686.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Oregon surveyors wrote
F686 findings written in Oregon, 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.
J · Immediate jeopardy, isolatedMay 31, 2024
Based on interview and record review it was determined the facility failed to comprehensively assess, monitor, treat and follow physician orders for pressure ulcer treatment for 1 of 7 sampled residents (#4) reviewed for pressure ulcers. This failure, determined to be an immediate jeopardy situation, resulted in Resident 4's Stage 2 (partial thickness skin loss) pressure ulcer observed upon admission which worsened to an infected, unstageable (full thickness tissue loss where the depth of the wound is obscured by non-viable or dead tissue) pressure ulcer. Resident 4 was admitted to the hospital where she/he required surgical debridement (the removal of damaged tissue from the wound). …
Based on interview and record review, it was determined the facility failed to provide necessary treatment to promote healing of pressure ulcers for 1 of 1 sampled resident (#92) reviewed for pressure ulcers. This failure resulted in worsening of Resident 92's pressure ulcers and subsequent hospitalization. Findings include: The facility's Pressure Injuries Overview and Wound Staging Skin Management policy dated 3/2020 included the following:Pressure Ulcer/Injury refers to localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device.Avoidable means that the resident developed a pressure ulcer/injury and that one or more of the following was not completed:- Definition or implementation of interventions that are not… …
D · No harm, potential for more than minimal, isolatedMay 11, 2026
Based on interview and record reviewed it was determined the facility failed to implement wound care interventions as ordered for 1 of 1 sampled resident (#40) reviewed for pressure ulcers. This placed residents at risk for worsening pressure ulcers. Findings include: Resident 40 was admitted to the facility in 3/2026 with diagnoses including leg amputation and pressure ulcers.A 3/27/26 physician order indicated staff were to perform wound care to the pressure ulcers on Resident 40's back every day shift.Progress Notes on 4/6/26 and 4/10/26 indicated wound care was not completed, and staff passed the treatment on to the next shift.On 4/22/26, a complaint was received which indicated Resident 40 was admitted to the facility on [DATE] with multiple unstageable pressure ulcers to her/his… …
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