An LPN was observed cleaning a community-use glucometer with an alcohol pad instead of the bleach wipe or equivalent required by the facility policy. The LPN stated he always used alcohol pads, while the DNS stated staff were to use bleach wipes. The glucometer was used for CBG checks on several residents with diabetes, and their records did not indicate a BBP.
Furniture Not Kept in Good Repair: Armchairs in multiple resident rooms and chairs in the front sitting area were observed with torn or cracked upholstery exposing cloth material. The Maintenance Director stated the furniture was not in good repair and had not been notified of the damage, while the Administrator stated staff were to remove furniture with tears.
Failure to assist a resident with oral hygiene. A cognitively intact resident admitted with a fracture required ADL assistance, including oral hygiene, per MDS and care plan. The resident stated staff did not provide a toothbrush or offer help brushing teeth, and the toothbrush was later found still in its original wrapper by the sink. The assigned CNA confirmed oral care was not provided, and the DNS stated residents should be offered oral care twice daily.
Failure to provide activity accommodations for a resident with highly impaired hearing. A cognitively intact resident with a fracture preferred watching older TV shows but stated he/she could not hear the television when wanting to watch it. Staff observed the resident in bed with the TV off on multiple occasions, and staff reported that headsets were used for hard-of-hearing residents, but one was not offered to this resident.
Missing Order for CPAP Use and Maintenance: A resident with sleep apnea and stroke had a CPAP in the room, but there was no physician order or care plan documentation for its use or maintenance. Staff knew the resident had the CPAP, yet CNAs and an RN reported they did not routinely clean the mask or tubing, and the LPN Resident Care Manager confirmed no order existed for the CPAP or its care.
A resident with Parkinson's disease, cognitive communication deficit, and dementia had a scheduled Sinemet order with specific administration times, but the MAR showed the times were changed by the DNS to simplify the CMA workflow without a documented provider order or resident discussion. Staff later stated a physician order was required for the change, and the resident's family was upset with the altered med times.
Failure to protect a resident from physical abuse by another resident. Two cognitively intact residents were involved in a physical altercation in the smoking area, during which one resident struck the other in the head with a cane, causing a scalp laceration that required staples and hospital transfer. The facility investigation reviewed video footage and concluded the act was willful and intended to cause harm.
A resident admitted after knee replacement surgery reported significant knee pain on arrival, but the ordered oxycodone was not available and pain medication was not given until the next day. A friend, the resident, a CNA, the pharmacist, and RNs confirmed the resident remained in pain, only one tablet was available instead of the full ordered dose, the resident declined the partial dose, and the nurse did not document the refusal, notify the MD, or assess the pain at admission.
A resident admitted with a pelvic fx had an unwitnessed fall and low O2 sat, prompting the MD to order a stat chest x-ray. The record did not show the x-ray was obtained, and staff interviews indicated stat imaging should have been completed the same day or within 4 to 6 hours, with the MD notified if it could not be done.
A resident with traumatic brain injury, brain damage, adjustment disorder, and cognitive impairment repeatedly used profanity, homophobic slurs, and threats toward other residents in common areas, including the dining room. Multiple residents reported feeling uncomfortable, threatened, upset, and unsafe, and staff witnesses confirmed the abusive outbursts occurred in front of other residents.
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 August 26, 2026) and official state health department websites — never guesswork.
In your survey window? See what surveyors are citing.
The Survey-Prep Report maps your facility's risk from 12 months of CMS and state citation data — what's being cited around you and what to check first. $129 one-time.