Based on interview and record review it was determined the facility failed to notify the ordering physician of the results of an x-ray of a fracture for 1 of 5 sampled residents (#1) reviewed for accidents. As a result of this deficient practice Resident 1 experienced a delay in treatment of [REDACTED]. Findings include: Resident 1 was admitted to the facility in 6/2016 with [DIAGNOSES REDACTED]. A signed physicians order dated 3/27/18 revealed STAT (immediately) x-ray left upper leg and hip. …
F777 citations in Oregon
Administration Deficiencies
Provide or obtain x-rays/tests when ordered and promptly tell the ordering practitioner of the results.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Oregon cites F777 more often than its own record predicts
4.21 times the share F777 takes of citations nationally.
Of every deficiency written in Oregon in 2025, this is the portion that was F777.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Oregon surveyors wrote
F777 findings written in Oregon, 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 interview and record review it was determined the facility failed to notify the ordering physician of the results of a critical lab value for 1 of 2 sampled residents (#53) reviewed for accidents. This placed residents at risk for delayed treatment. Findings include: Resident 53 admitted to the facility in 2024 with diagnoses including dementia. On 10/9/24 labs were obtained, and the results were completed and reported to the facility the same day. The results indicated Resident 53 had a critical hemoglobin level of 5.8 g/DL (grams per deciliter) (normal reference range was 12.5-14.9 g/DL). …
The short window
Recent years
| Year | Share of Oregon citations | vs expected |
|---|---|---|
| 2023 | 0.08% | 3.32× |
| 2025 | 0.10% | 4.21× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Oregon 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