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F0695
D

Failure to Follow Physician's Order for Continuous Oxygen Therapy

King Of Prussia, Pennsylvania Survey Completed on 07-18-2025

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 follow a physician's order for continuous oxygen therapy for a resident who required oxygen via nasal cannula. Clinical record review showed that the resident had a current order for continuous oxygen, but documentation indicated that oxygen was not in use during ambulation. The facility's policy required oxygen to be provided according to equipment-specific procedures, and staff were aware that the resident was to receive oxygen continuously. An interview with the Director of Physical Therapy confirmed that the deficiency occurred when the resident was ambulated without oxygen, contrary to the physician's order.

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