F686 in Vermont. Pick another state for the same tag.
Against expectation — 2025
Vermont cites F686 less often than its own record predicts
Versus expected share0.81×
0.81 times the national share — cited less often here than elsewhere.
Share of Vermont citations1.60%
Of every deficiency written in Vermont in 2025, this is the portion that was F686.
Vermont1.60%
National1.96%
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 Vermont surveyors wrote
F686 findings written in Vermont, 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 8, 2025
Based on interviews and record review, the facility failed to ensure that 3 of 7 residents in the applicable sample (Resident #1, #2, and #3) received necessary treatment and services consistent with professional standards of practice to prevent or promote healing and prevent infection of a pressure injury. As a result, Resident #1 developed an unstageable pressure injury which became necrotic (death of tissue); requiring hospitalization, and resulted in death related to due to osteomyelitis and sepsis of the pressure injury. This citation is at the immediate jeopardy level due to the facility's failure to prevent and treat pressure injury resulting in infection and death of 1 resident. Findings include:
1. …
Based on observations, interviews, and record review, the facility failed to ensure that 1 of 3 residents in the applicable sample (Resident #9) received necessary treatment and services consistent with professional standards of practice to promote healing by not obtaining physician's orders for treatment, not following care plan interventions, and not performing accurate skin and wound assessments. This deficient practice caused Resident #9's wounds to deteriorate, and caused him/her to develop additional pressure ulcers. This is a repeat deficiency for this facility, with violations cited during the previous recertification survey, dated 1/10/25. …
D · No harm, potential for more than minimal, isolatedJuly 8, 2026
Based on observation, interview, and record review, the facility failed to ensure care plan interventions related to prevention of pressure ulcers were implemented for 2 of 6 sampled residents (Residents #62 and #32). Findings include:1. Per review of Resident #62's record, s/he has a Brief Interview of Mental Status (BIMS) of 0 (severe cognitive impairment) and diagnoses include chronic obstructive pulmonary disease (COPD), disorders of bone density and structure, spondylosis (degenerative changes in the spine), need for assistance with personal care, dementia without behaviors, depression and anxiety. The resident was admitted to the facility on [DATE] for rehabilitation services following a hip fracture. …
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