Based on observation, interview and record review, the facility failed to ensure two of seven residents (#32, #29) remained free of unnecessary drugs. Failure to: 1) ensure opioid pain medications were used for the shortest duration necessary, 2) to provide comprehensive medication side effect monitoring, 3) to evaluate the presence of adverse consequences which indicated opioid pain medications may need to be reduced or discontinued, 4) to respond timely to the presence of potential medication-related adverse side effects (ASEs), 5) to consider the impact of side effects of [MEDICAL CONDITION] medications in a resident who also experienced similar side effects of opioid pain medications, 6) to perform accurate and comprehensive pain evaluations, 7) to ensure the consultant pharmacist… …
F757 citations in Washington
Unnecessary drugs · Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Washington cites F757 more often than its own record predicts
1.58 times the share F757 takes of citations nationally.
Of every deficiency written in Washington in 2025, this is the portion that was F757.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Washington surveyors wrote
F757 findings written in Washington, 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, interview, and record review, the facility failed to ensure anticoagulant (AC) medication (medication that stops blood from clotting) side effects were consistently monitored for 3 of 4 sampled residents (Residents 1, 5 and 6), reviewed for unnecessary medications. This failure caused Resident 1 re-hospitalization and treatment to reverse blood thinning and placed additional residents at risk of experiencing medication side-effects and a diminished quality of life. …
Based on interview and record review, the facility failed to ensure a high-risk medication, a tricyclic antidepressant (TCA - a class of antidepressant medication used to treat low mood), had a documented diagnosis attached to the same medication, was consented to by the resident, and had a side effect monitor in place for 1 of 3 residents (Resident 1). This failure placed residents at risk of not being informed of health risks associated with potential adverse side effects and medical complications.Findings included . …
The short window
Recent years
| Year | Share of Washington citations | vs expected |
|---|---|---|
| 2023 | 1.24% | 1.54× |
| 2024 | 1.00% | 1.44× |
| 2025 | 1.26% | 1.58× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Washington surveyors cite →
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