F865 in Virginia. Pick another state for the same tag.
Against expectation — 2025
Virginia cites F865 more often than its own record predicts
Versus expected share1.93×
1.93 times the share F865 takes of citations nationally.
Share of Virginia citations0.46%
Of every deficiency written in Virginia in 2025, this is the portion that was F865.
Virginia0.46%
National0.24%
Share of all citations that were F865.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Virginia surveyors wrote
F865 findings written in Virginia, 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.
G · Actual harm, isolatedFebruary 7, 2025
Based on staff interview, clinical record reviews, and facility documentation review, the facility staff failed to implement and maintain an effective quality assurance and performance improvement (QAPI) program, and failed to provide evidence necessary to demonstrate compliance with these requirements, which resulted in harm for two residents (Resident #2 and Resident #4) in a survey sample of five residents.
The findings included:
On 2/5/25 at 11:40 a.m., an observation was conducted of the on-unit kitchenette where the coffee is prepared. The cook (other employee #1- OE #1) was observed taking the temperature of food items, which included the soup at 174 degrees farenheight and hotdog chili that was 175 degrees farenheight. …
F · No harm, potential for more than minimal, widespreadApril 28, 2026
Based on observation, staff interview and facility documentation review, the facility staff failed to implement and maintain an effective Quality Assurance Performance Improvement (QAPI) Program/Plan for three of four quarters reviewed, affecting all residents in the facilityThe Findings included: During the survey, investigations revealed the facility had issues involving multiple systems. There was no documentation of the issues being discussed during QAPI meetings. These issues affected the quality of life of the residents in the facility.The facility failed to maintain an effective QAPI (Quality Assurance Performance Improvement) program. …
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