Based on record review, staff, resident, Consultant Pharmacist, and Physician interview, the facility failed to provide effective pain management and manage symptoms of withdraw for 2 of 10 residents (Resident #51 and Resident #46) reviewed for pain management. Resident #51 was prescribed gabapentin 800 milligrams (mg) four times daily for nerve pain. The medication was not available to administer and resulted in a total of 21 doses of the prescribed medication not administered from 5/8/24 through 5/13/24. Resident #51 had complaints of constant pain at up to a 10 (on a scale of 0 to 10 with the 10 being the worst pain possible), numbness in her legs, and spasms. …
F697 citations in North Carolina
Pain management · Quality of Life and Care Deficiencies
Provide safe, appropriate pain management for a resident who requires such services.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
North Carolina cites F697 less often than its own record predicts
0.68 times the national share — cited less often here than elsewhere.
Of every deficiency written in North Carolina in 2025, this is the portion that was F697.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What North Carolina surveyors wrote
F697 findings written in North 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 record review and interviews with staff, Nurse Practitioner (NP) and Physician, the facility failed to ensure pain management was provided to Resident #61, who had severe cognitive impairment and was unable to verbalize the need for pain medication, following an unwitnessed fall on 7/14/25 that resulted in changes in the level of transfer assistance she needed for toileting and moving from chair to bed. Communication from the nursing staff to the Nurse Practitioner on 7/15/25 failed to include Resident #61 had an unwitnessed fall. The NP did not assess the lower extremities for pain and concluded that the source of the hip pain was nerve pain. …
Based on record review and interviews with the resident and staff, the facility failed to ensure ordered pain medication was administered when requested for a resident (Resident #86) who was admitted on [DATE] with an order for as needed narcotic pain medication. The narcotic pain medication was not available for administration until 8/23/26 requiring an additional order for as needed acetaminophen to be obtained and administered to control the resident's pain. This deficient practice occurred for 1 of 2 residents reviewed for pain management. The Findings included; Resident #86 was admitted to the facility on [DATE] at 2:54 PM. …
The short window
Recent years
| Year | Share of North Carolina citations | vs expected |
|---|---|---|
| 2023 | 0.63% | 0.85× |
| 2024 | 0.64% | 0.87× |
| 2025 | 0.53% | 0.68× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else North Carolina surveyors cite →
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