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F604: Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment

F604 is one of the federal requirements every Medicare and Medicaid certified nursing home must meet. CMS describes it as: Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. It sits in CMS's freedom from abuse, neglect, and exploitation category.

1,552citations in the CMS files
1,372homes cited at least once
335in the 12 months to September 2026
6.3%rated actual harm or immediate jeopardy

CMS Health Deficiencies file, data as of September 1, 2026. The files hold each home's last three standard inspections and three years of complaint visits.

How seriously inspectors rate it

Every citation gets a letter for how much harm inspectors found and how many residents it touched (how to read the letters). 26.8% of F604 citations came from a complaint visit rather than a routine inspection.

  • Immediate jeopardy (J, K, L)49 (3.2%)
  • Actual harm (G, H, I)48 (3.1%)
  • Potential for more than minimal harm (D, E, F)1,455 (93.8%)
  • Potential for minimal harm (A, B, C)0 (0.0%)

By letter: D 1,262, E 190, F 3, G 48, J 34, K 14, L 1.

What inspectors wrote

Three recent F604 citations from different states, quoted from the inspectors' statements of deficiencies (CMS form 2567). Names are removed by CMS.

Inspectors wrote, August 7, 2026, scope and severity DBased on review of facility policy, clinical record review, and staff interviews, it was determined that the facility failed to identify a bolster (a long, thick cushion) as a possible restraint and failed to assess the functional status of the individual resident to determine if the use of a bolster is a restraint for two of four residents (Residents R2 and R87).

Providence Health & Rehab Center, Beaver Falls, PA

Inspectors wrote, July 29, 2026, scope and severity DBased on observation, interview and record review, the facility failed to ensure one of six sampled residents (Resident 6) who had behaviors of getting up unassisted, was not restrained in a Trendelenburg (a specific body position where the patient lies flat on their back with their feet elevated higher than their head) like position, while seated in a Geri-chair. This deficient practice resulted in Resident 6's inability to get out of the Geri-chair unassisted and frustration when he wanted to get up but could not do so himself. This deficient practice had the potential for Resident 6 to act out and move in ways that could cause him injury.

Cerritos Vista Healthcare Center, Bellflower, CA

Inspectors wrote, July 24, 2026, scope and severity DBased on interview and document review, the facility failed to ensure a resident remained free from physical restraints not required to treat a medical symptom when the facility incorporated the use of law enforcement handcuffs into resident's care plan for 1 of 1 resident (R45) reviewed for restraints.

The Gardens at Winsted LLC, Winsted, MN

Most recent F604 citations at the harm or jeopardy level

Newest first, the latest 40 in the current files. Each home's page shows the citation in full context, with its correction status.

InspectionHomeTownLetterVisit
July 8, 2026Arcadia Care WatsekaWatseka, IL JComplaint
June 23, 2026Davis Health Care CenterWilmington, NC GComplaint
June 11, 2026Bria of BellevilleBelleville, IL GComplaint
May 28, 2026Cranbury CenterMonroe Township, NJ JComplaint
May 21, 2026Huntsville Health & Rehabilitation, LLCHuntsville, AL JComplaint
May 14, 2026Lenawee Medical Care FacilityAdrian, MI GComplaint
April 23, 2026Huntersville Health & Rehabilitation CenterHuntersville, NC GComplaint
March 29, 2026Bria of Elmwood ParkElmwood Park, IL GStandard
March 12, 2026The JeffersonArlington, VA JComplaint
March 12, 2026Life Care Center of LongmontLongmont, CO GStandard
February 23, 2026Wecare at Rolling Meadows Rehab and Nursing CeWaynesburg, PA GComplaint
February 12, 2026The Elms Rehab and Healthcare Center of CranburyCranbury, NJ JComplaint
February 10, 2026Lebanon North Nursing & RehabLebanon, MO GComplaint
February 4, 2026Ararat Nursing FacilityMission Hills, CA JComplaint
December 3, 2025Autumn Care of Myrtle GroveWilmington, NC GComplaint
October 29, 2025West Hickory HavenMilford, MI GComplaint
October 23, 2025Shelbyville ManorShelbyville, IL GComplaint
September 26, 2025Spring Valley Post Acute LLCVictorville, CA GComplaint
September 19, 2025Peach Tree PlaceWeatherford, TX JComplaint
June 30, 2025Adviniacare Summit Commons, LLCProvidence, RI JComplaint
May 27, 2025Autumnwood Nursing & Rehab CenterRittman, OH GComplaint
May 23, 2025Regal Heights Healthcare & Rehab CenterHockessin, DE GComplaint
May 21, 2025Laurel Park Rehabilitation and Healthcare CenterElizabeth City, NC GComplaint
May 16, 2025Ellisville Rehabilitation and NursingEllisville, MO GComplaint
May 1, 2025Winfield Rehab & NursingCrockett, TX JComplaint
May 1, 2025The Pines Post Acute and Memory CareClintonville, WI JComplaint
April 16, 2025Royalton Manor, LLCSt. Joseph, MI GStandard
April 3, 2025New York State Veterans Home at MontroseMontrose, NY GComplaint
March 20, 2025Sumter East Health & Rehabilitation CenterSumter, SC GComplaint
March 10, 2025Whispering Pines LodgeLongview, TX JComplaint
March 5, 2025Northbrook Healthcare CenterWillits, CA GComplaint
March 3, 2025West View Nursing Home, IncWest Warwick, RI JComplaint
February 25, 2025Mason City Area Nursing HomeMason City, IL JComplaint
February 21, 2025Optalis Health and Rehabilitation of Three RiversThree Rivers, MI GComplaint
February 5, 2025The Greens at HendersonvilleHendersonville, NC JComplaint
January 21, 2025Jersey Shore Skilled Nursing and Rehabilitation CeJersey Shore, PA GComplaint
December 24, 2024Schulman and Schachne Institute for Nursing and ReBrooklyn, NY JComplaint
December 9, 2024Complete Care at the BoulevardChicago, IL JComplaint
November 26, 2024Pineville Rehabilitation and Living CenterPineville, NC GComplaint
November 15, 2024Ararat Convalescent HospitalLos Angeles, CA JComplaint

Most recent F604 citations

InspectionHomeTownLetter
August 7, 2026Providence Health & Rehab CenterBeaver Falls, PA D
July 30, 2026Olympia Convalescent HospitalLos Angeles, CA E
July 29, 2026Lakeview Health Care & Rehabilitation CenterBoonville, MO D
July 29, 2026Cerritos Vista Healthcare CenterBellflower, CA D
July 28, 2026Compere Nh IncJackson, MS D
July 24, 2026Eden Nursing & Rehabilitation CenterBrackenridge, PA D
July 24, 2026The Gardens at Winsted LLCWinsted, MN D
July 23, 2026Sanford Health & Rehabilitation CoSanford, NC D
July 22, 2026York Nursing and Rehabilitation CenterPhiladelphia, PA D
July 20, 2026Westmoreland PlaceChillicothe, OH D
July 17, 2026The Gardens Healthcare CenterNorthridge, CA E
July 16, 2026Stoney Point Healthcare CenterChatsworth, CA D
July 13, 2026Putnam RidgeBrewster, NY D
July 13, 2026Sprain Brook Manor RehabScarsdale, NY D
July 10, 2026Golden Rose Care CenterPasadena, CA D
July 9, 2026Holmes County Long Term Care Center - DurantDurant, MS D
July 8, 2026Arcadia Care WatsekaWatseka, IL J
July 2, 2026White Oak Manor - YorkYork, SC D
July 2, 2026Chatsworth Park Health Care CenterChatsworth, CA D
July 2, 2026Sherman Oaks Health & RehabSherman Oaks, CA E
July 1, 2026Water's EdgeHayward, WI D
July 1, 2026Laconia Rehabilitation CenterLaconia, NH D
June 30, 2026Hillcrest Health Care, LLCMankato, MN D
June 26, 2026Seneca PlaceVerona, PA D
June 26, 2026Autumn Hills Health Care CenterGlendale, CA D

F604 citations by state

Counts depend on how many homes a state has and how often its inspectors visit, so a larger number is not by itself a worse record.

StateCitations
California294
New York109
Massachusetts98
Illinois97
Ohio87
Texas77
Pennsylvania63
Missouri53
Michigan51
Washington47
Minnesota45
Mississippi34
Louisiana30
Colorado28
Florida27
Tennessee26
Wisconsin26
Indiana23
Maryland22
Oklahoma21
Oregon19
Montana17
North Carolina17
New Jersey17
Connecticut13
Georgia13
New Mexico13
West Virginia13
South Carolina12
Hawaii11
Iowa11
Nebraska11
Arizona10
Kansas10
South Dakota10
Idaho9
Kentucky8
New Hampshire8
Nevada8
Rhode Island8
Virginia8
Alabama6
Arkansas6
Utah6
District of Columbia5
Maine5
Delaware4
North Dakota4
Alaska3
Puerto Rico3
Vermont3
Wyoming3

By inspection year: 2018 6, 2019 44, 2020 17, 2021 38, 2022 84, 2023 266, 2024 446, 2025 412, 2026 239.

Common questions

What is F604 in a nursing home inspection?
F604 is the federal requirement to "ensure that each resident is free from the use of physical restraints, unless needed for medical treatment". CMS files it under freedom from abuse, neglect, and exploitation. A home cited under F604 did not meet that requirement at the inspection.
How often is F604 cited?
The CMS files as of September 1, 2026 list 1,552 F604 citations at 1,372 nursing homes, 335 of them in the 12 months to that date. 6.3% were rated as actual harm or immediate jeopardy.
Is a F604 citation serious?
It depends on the letter. Most F604 citations (93.8%) were rated as potential for more than minimal harm, D to F. 49 were immediate jeopardy, the most serious level.

The interpretive guidance inspectors use for each F-tag is CMS's State Operations Manual, Appendix PP. NursingHomeClear reports the citations as CMS records them and is not affiliated with CMS. All F-tags · Methodology

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