Based on review of a facility reported incident (FRI) investigation, record review, policy review, and staff interview, the facility failed to provide appropriate respiratory care for 1 of 1 closed resident record (Resident #1) who required respiratory support from a ventilator. Failure to provide care consistent with professional standards of practice and the physician's orders may have resulted in or contributed to Resident #1's death and placed all other ventilator-dependent residents at risk of injury or death. …
F695 citations in North Dakota
Respiratory care · Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
North Dakota cites F695 less often than its own record predicts
0.63 times the national share — cited less often here than elsewhere.
Of every deficiency written in North Dakota in 2025, this is the portion that was F695.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What North Dakota surveyors wrote
F695 findings written in North Dakota, 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 observation, record review, review of facility policy, and resident and staff interview, the facility failed to provide the necessary care and services for 1 of 1 sampled resident (Resident #11) receiving oxygen. Failure to administer oxygen according to the physician's order may result in complications and compromise the resident's respiratory status.Findings include:Review of the facility policy titled Oxygen Administration occurred on 07/09/26. This policy, dated March 2023, stated, . Oxygen is administered under orders of a physician . Equipment setting for the prescribed flow rates.Review of Resident #11's medical record occurred on all days of survey. …
The short window
Recent years
| Year | Share of North Dakota citations | vs expected |
|---|---|---|
| 2023 | 1.40% | 0.60× |
| 2024 | 0.99% | 0.45× |
| 2025 | 1.38% | 0.63× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else North Dakota surveyors cite →
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