40417 This deficient practice has two Deficient Practice Statements A. Based on observations, record reviews, interviews, and policy review, the facility failed to ensure that 2 of 2 residents (Residents (R) 14 and R32) reviewed for tracheostomy (trach) care in the sample of 23 residents had the necessary supplies at the bedside in the event of a life-threatening emergency, and failed to train staff on appropriate emergency tracheostomy care in the event that a resident's airway was compromised, which placed residents with a tracheostomy at increased likelihood of serious harm or death. On [DATE] at 9:05 PM, the Administrator and the Regional Director of Operations were informed of an Immediate Jeopardy (IJ) at F695-J: Respiratory/Tracheostomy Care and Suctioning. …
F695 citations in South Carolina
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
South Carolina cites F695 more often than its own record predicts
2.25 times the share F695 takes of citations nationally.
Of every deficiency written in South Carolina 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 South Carolina surveyors wrote
F695 findings written in South Carolina, 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 review of facility policy, observation, interview, and record review, the facility failed to ensure Resident (R)14's prescribed oxygen was administered at the ordered flow rate for 1 of 1 residents reviewed for respiratory care. Specifically, the facility failed to ensure R14 received oxygen at the physician-ordered flow rate of 2 LPM (liters per minute) and failed to accurately document the oxygen flow rate being administered.Findings Include:Review of the facility policy titled Oxygen Concentrator, last revised 05/11/18, revealed a procedure requiring staff record oxygen therapy on residents' Treatment Administration Record (TAR) or Electronic Medical Record (EMR), including the prescribed flow rate.During an observation on 08/18/26 at 11:25 AM, revealed R14 receiving oxygen via… …
The short window
Recent years
| Year | Share of South Carolina citations | vs expected |
|---|---|---|
| 2023 | 2.36% | 1.01× |
| 2024 | 4.35% | 1.98× |
| 2025 | 4.95% | 2.25× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else South Carolina surveyors cite →
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