Based on interview and record review, the facility failed to follow contract agreements between the facility and Transportation Company 1 (TC 1) and the facility and [CONDITION(S)] Center (DC - an outside treatment center, for residents who require [CONDITION(S)]- a procedure for removal of accumulated waste from the blood) to ensure the safety of one of three sampled residents (Resident 1). On 9/4/2021 at 12:20 p.m., TC 1's driver (Driver 1) picked up Resident 1, who was confused, at risk of elopement (a patient who leaves a health facility when doing so may present an imminent threat to the patient's health or safety because of legal status or because the patient has been deemed too ill or impaired to make a reasoned decision to leave), to transport him to DC. …
F840 citations in California
Administration Deficiencies
Employ or obtain outside professional resources to provide services in the nursing home when the facility does not employ a qualified professional to furnish a required service.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
California cites F840 less often than its own record predicts
0.37 times the national share — cited less often here than elsewhere.
Of every deficiency written in California in 2025, this is the portion that was F840.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What California surveyors wrote
F840 findings written in California, 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, the facility failed to follow the physician's order and ensure one of five sampled residents (Resident 1) was provided with a follow-up neurosurgery (the medical specialty focused on diagnosing and treating disorders of the nervous system) specialist appointment. This deficient practice had the potential to result in negative health outcomes.Findings: During a review of Resident 1's admission Record, the admission Record indicated that the facility admitted Resident 1 on 12/9/2025 with diagnoses that included low back pain, anxiety disorder (mental health conditions that involve excessive fear, worry, or nervousness that interfere with daily life), and history of transient ischemic attack (TIA - known as a mini-stroke, and happens when a blood clot… …
Based on interview and record review the facility failed to ensure an outside resource contract for [MEDICAL TREATMENT] was in place. This deficient practice had the potential to delay the [MEDICAL TREATMENT] service for three of four residents (Resident 53, 66 and 221) reviewed for [MEDICAL TREATMENT] care in a total sample of 18 residents. Findings: On 4/14/18, at 8:27 a.m. the written agreement was requested from the medical record staff for Resident 53, 66 and 221's [MEDICAL TREATMENT] center services. The medical record staff stated the Administrator had requested the agreement from the center and did not have a contract or agreement with the [MEDICAL TREATMENT] center for Resident 53, 66, 221. …
The short window
Recent years
| Year | Share of California citations | vs expected |
|---|---|---|
| 2023 | 0.01% | 0.39× |
| 2024 | 0.03% | 0.72× |
| 2025 | 0.02% | 0.37× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else California 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