Based on observation, record review and interview, the facility failed to ensure monitoring and maintenance of bedrails for entrapment for 3 of 3 sampled residents for Resident #19, #82, #87. The findings included:Review of a policy, titled, Proper Use of Bed Rails, implemented date 09/23 with a revised date of 01/26 revealed that the policy stated it is the policy of this facility to utilize person-centered approach when determining the use of bed rails. Appropriate alternative approaches are attempted prior to installing or using bed rails. If bed rails are used, the facility ensures correct installation, use and maintenance of the rails.The definition of bed rails that is in their policy documents bed rails are adjustable metal or rigid plastic bars that attach to the bed. …
F909 citations in Florida
Environmental Deficiencies
Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2024
Florida cites F909 less often than its own record predicts
0.93 times the national share — cited less often here than elsewhere.
Of every deficiency written in Florida in 2024, this is the portion that was F909.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Florida surveyors wrote
F909 findings written in Florida, 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 Florida citations | vs expected |
|---|---|---|
| 2023 | 0.08% | 0.54× |
| 2024 | 0.11% | 0.93× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Florida surveyors cite →
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