Based on record review, observation, and interview, the facility failed to ensure their medication error rate was below 5% for 2 sampled residents (#4 and #36) and 2 unsampled residents (#49 and #55), out of 5 residents observed for medication administration. The facility's overall medication error rate was 23.08%. This failed practice placed the residents at risk for adverse medication outcomes. Findings: Resident #4 Record review on 5/18-22/25 revealed Resident #4 was admitted to the facility with diagnoses that included dysphagia (difficulty swallowing), rheumatoid arthritis (autoimmune disorder that affects the joints), and depression. An observation on 5/19/25 from 10:20 AM to 11:24 AM, revealed Licensed Nurse (LN) #2 prepared and administered medications for Resident #4. …
F759 citations in Alaska
Medication error rate · Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Alaska cites F759 less often than its own record predicts
0.99 times the national share — cited less often here than elsewhere.
Of every deficiency written in Alaska in 2025, this is the portion that was F759.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Alaska surveyors wrote
F759 findings written in Alaska, 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.
The short window
Recent years
| Year | Share of Alaska citations | vs expected |
|---|---|---|
| 2023 | 1.46% | 1.20× |
| 2024 | 0.78% | 0.72× |
| 2025 | 1.06% | 0.99× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Alaska surveyors cite →
Deficiency Index is independent and is not affiliated with, endorsed by, or approved by CMS, Medicare, or any government agency. About this data · Report a correction