Based on interview and record review, it was determined the facility failed to have an effective system in place to investigate the root cause of the resident's falls. The Medical Director was responsible for providing the staff direction related to the facility's policy and the current professional standard of practice and failed to ensure the coordination of medical care in the facility. As a result, five (5) of forty-seven (47) sampled residents experienced falls with major injuries. …
F841 citations in Kentucky
Nursing and Physician Services Deficiencies
Designate a physician to serve as medical director responsible for implementation of resident care policies and coordination of medical care in the facility.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2024
Kentucky cites F841 more often than its own record predicts
5.21 times the share F841 takes of citations nationally.
Of every deficiency written in Kentucky in 2024, this is the portion that was F841.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Kentucky surveyors wrote
F841 findings written in Kentucky, 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, record review and review of the facility's Medical Director's responsibilities, it was determined the Medical Director failed to resident care policies for behaviors were implemented and failed to coordinate the medical care within the facility for 1 of 22 sampled residents, (R)84. The facility admitted R84 to the facility on [DATE] and the level 1 Pre-Admission Screening and Resident Review (PASRR), indicated a level 2 was indicated. The level 2 PASRR indicated R84 MUST receive psychiatric (psych) services on a monthly basis. However, the facility's Medical Director was not aware of that information and therefore, failed to ensure the facility provided R84 with the recommended psych services. …
The short window
Recent years
| Year | Share of Kentucky citations | vs expected |
|---|---|---|
| 2023 | 0.62% | 35.81× |
| 2024 | 0.15% | 5.21× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Kentucky surveyors cite →
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