Based on records reviewed and interviews for one of three sampled residents (Resident #1) who had a history of blood clots and required treatment with an anticoagulant medication, the Facility failed to ensure nursing staff implemented and followed their Medication Orders Policy regarding Resident #1's orders related to the administration of [MEDICATION(S)] (anticoagulant). The Hospital Discharge Summary indicated Resident #1's dose of [MEDICATION(S)] should be tapered down after 30 days, then continued daily at a lower dose for an additional 30 days, before being discontinued. However nursing staff changed the orders without clarifying them with the Physician and the administration of Resident #1's [MEDICATION(S)] was stopped after 30 days. …
F755 citations in Massachusetts
Pharmacy services · Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Massachusetts cites F755 less often than its own record predicts
0.26 times the national share — cited less often here than elsewhere.
Of every deficiency written in Massachusetts in 2025, this is the portion that was F755.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Massachusetts surveyors wrote
F755 findings written in Massachusetts, 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, observation, and interview, the facility failed to ensure pharmaceutical services met the needs of each resident. Specifically, the facility failed to ensure an insulin emergency kit was replaced by the pharmacy after being opened on one out of two units. Findings include: Review of the facility policy titled 'Emergency Pharmacy Service And Emergency Kits', dated January 2024, indicated:-The nurse records the medication used from the emergency kit on the medication order/use form and calls the pharmacy for replacement of the kit/dose and/or flags the kit with a color-coded lock to indicate need for replacement of kit/dose as soon as possible after the medication has been administered. …
Based on observation, record review and interview, the facility failed to ensure that nursing staff implemented and established systems to accurately reconcile controlled medications using acceptable standards of practice on two Units (Edgewood and [NAME]) of three units observed. Specifically, the facility failed to: 1. Maintain documentation of prescription numbers with the date of receipt of controlled substance medications and transfers. 2. Maintain professional standards of practice for discharging and transferring controlled medications within the narcotic book. …
The short window
Recent years
| Year | Share of Massachusetts citations | vs expected |
|---|---|---|
| 2023 | 0.68% | 0.32× |
| 2024 | 0.52% | 0.24× |
| 2025 | 0.62% | 0.26× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Massachusetts surveyors cite →
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