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F0695
D

Failure to Provide Physician-Ordered Respiratory Care

Salem, Oregon Survey Completed on 06-06-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide respiratory care and services in accordance with physician orders for a resident with COPD and diabetes. The resident was admitted with a care plan indicating the need for oxygen via nasal cannula as needed, along with interventions to monitor for signs of respiratory compromise. Observations over several days showed the resident receiving oxygen through a nasal cannula on multiple occasions, both in bed and during routine care. Staff interviews confirmed that the resident regularly used oxygen while in bed. Despite the ongoing administration of oxygen, a review of the clinical record revealed there were no documented physician orders for oxygen administration, nor were there orders specifying how often the oxygen filter should be cleaned, checked, or how often the tubing should be changed. Staff confirmed the absence of current physician orders for oxygen. This lack of documentation and physician oversight constituted a failure to provide respiratory care and services as required.

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