A cognitively intact resident with multiple chronic conditions and identified risk for oral/dental problems received an initial dental exam, cleaning, and full mouth x-ray, with a note indicating possible need for an oral surgeon referral. The resident reported being told she would be notified when the dentist returned but was never informed of a follow-up visit, and no oral surgery appointment was scheduled despite her need for multiple tooth extractions and ongoing tooth pain managed with Tylenol. When the dentist later returned to the facility, the resident was not placed on the list to be seen, and facility staff could not explain the omission, contrary to facility policies requiring assistance with needed dental services and appointments.
A resident with severe cognitive impairment, dementia, malnutrition, and missing teeth had poor oral hygiene, food debris in the mouth, reddened oral tissues, oral pain, and difficulty eating and communicating. Speech therapy changed the diet from mechanical soft to pureed because of oral issues, and Social Work noted no insurance or family support for dental services, showing the facility did not ensure timely dental care for the resident’s needs.
A resident with multiple chronic conditions and dementia reported missing dentures, which were later found broken in a toilet. The care plan directed staff to monitor for oral/dental problems and to coordinate dental care and transportation, and the guardian reportedly agreed to arrange for the resident to be seen by a dentist. However, over the following months there was no documentation of any dental visits or of attempts to contact the guardian regarding dental care, despite the requirement for a completed dental consent form. The SSD confirmed the lack of documentation of guardian contact and was unaware of any policy on the frequency of guardian contact to resolve such issues.
A resident with severe cognitive impairment and multiple comorbidities was left without dentures for an extended period after they were reported missing. Staff were unclear about when the dentures were lost, and the resident did not receive a timely dental referral or intervention as required by facility policy. The delay in dental care and lack of documentation regarding interim measures led to a deficiency in providing appropriate dental services.
A resident with diabetes and anxiety lost several upper teeth during her stay and was not provided with a dental care plan or assistance in scheduling a dental appointment, despite expressing a desire to see a dentist. Staff confirmed no dental appointments had been arranged and no documentation of dental care planning was present.
Two residents did not receive timely dental care, including follow-up for dentures after tooth removal and assistance with denture replacement after loss. One resident, cognitively intact, was not offered further dental appointments after an initial cancellation, while another with dementia had not been seen by a dentist or assisted with lost dentures, despite care plans requiring such interventions.
A resident with a broken tooth and subsequent infection did not receive a timely follow-up dental appointment for root extraction. After an initial unsuccessful extraction and a referral for oral surgery, the resident was treated with antibiotics but was not scheduled for the necessary procedure. The scheduler left a message with the only Medicaid-accepting surgical clinic, but no further action was documented, leaving the resident to manage symptoms independently.
Two residents with cognitive and physical impairments experienced significant delays in receiving dental follow-up after their dentures went missing. The facility did not promptly initiate dental consultations or investigations, and staff were often unaware of the denture loss. Documentation showed gaps in communication and follow-up, resulting in prolonged periods without dentures and dissatisfaction with modified diets.
A resident with multiple chronic conditions and a history of dental issues reported a lost tooth, prompting a physician order for antibiotics and a prompt dental appointment. The facility did not schedule the dental appointment as ordered, and the resident later required hospital care for dental pain before the appointment was finally arranged.
A resident with significant medical needs and a broken lower denture, who had consented to receive dental services, did not receive any dental care or evaluation during their stay. The facility's records showed no evidence of dental visits or attempts to arrange for denture replacement, and staff interviews confirmed a lack of awareness and action regarding the resident's dental needs.
Self-audit
Pick a level of detail and, optionally, what to focus on — then generate a survey-ready checklist distilled from the most recent citations.
Beta · AI-generated — for reference only, not professional advice. Verify against current CMS guidance before relying on it. Assisto accepts no responsibility for how this checklist is used.
Citations used to create this checklist
Trusted data from CMS and state health departments
Every citation, penalty and Plan of Correction is sourced from public CMS records (latest release June 24, 2026) and official state health department websites — never guesswork.
Get More From Your Search Results
Create an account to access advanced search filters, save your searches, and get unlimited access to detailed Plan of Corrections.
Create an Account