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F758: Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited

F758 is one of the federal requirements every Medicare and Medicaid certified nursing home must meet. CMS describes it as: Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. It sits in CMS's pharmacy service category.

4,901citations in the CMS files
4,104homes cited at least once
0in the 12 months to September 2026
0.5%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). 8.7% of F758 citations came from a complaint visit rather than a routine inspection.

  • Immediate jeopardy (J, K, L)5 (0.1%)
  • Actual harm (G, H, I)20 (0.4%)
  • Potential for more than minimal harm (D, E, F)4,873 (99.4%)
  • Potential for minimal harm (A, B, C)3 (0.1%)

By letter: B 3, D 3,868, E 998, F 7, G 19, H 1, J 3, K 1, L 1.

What inspectors wrote

Three recent F758 citations from different states, quoted from the inspectors' statements of deficiencies (CMS form 2567). Names are removed by CMS.

Inspectors wrote, May 13, 2025, scope and severity DBased on observation, interview, and record review, the facility failed to ensure 1 of 3 residents (Resident 4) were free of unnecessary psychotropic drugs (any drug that affects brain activities associated with mental processes and behavior). Failure for the facility to obtain informed consent for treatment with psychotropic drugs and to ensure Resident 4 was monitored for adverse side effects, placed residents at risk of not being fully informed of the risks and benefits of treatment with psychotropic drugs and to receive unnecessary psychotropic drugs.

Spokane Falls Care, Spokane, WA

Inspectors wrote, May 7, 2025, scope and severity DBased on record reviews, staff and Physician Assistant interviews, the facility failed to ensure an as needed (PRN) psychotropic medication, Lorazepam, prescribed for anxiety had a stop date 14 days or less for 1 or 5 residents (Resident #17) reviewed for unnecessary medications.

The Laurels of Greentree Ridge, Asheville, NC

Inspectors wrote, May 5, 2025, scope and severity DBased on observation, record review and interview, the facility failed to attempt a gradual dose reduction of an antipsychotic medication for 1 of 5 residents reviewed for unnecessary medications. (Resident 20)

Woodland Manor, Elkhart, IN

Most recent F758 citations at the harm or jeopardy level

Newest first, all 25 in the current files. Each home's page shows the citation in full context, with its correction status.

InspectionHomeTownLetterVisit
March 25, 2025Bennington Health & RehabBennington, VT JComplaint
March 19, 2025Alaska Gardens Health and RehabilitationTacoma, WA GComplaint
March 11, 2025Regalcare at Courtyard-MedfordMedford, MA GStandard
March 6, 2025Elevate Care Windsor ParkChicago, IL GStandard
January 30, 2025J G Alexander Nursing CenterUnion, MS GStandard
January 14, 2025Avina of WeyauwegaWeyauwega, WI GComplaint
January 2, 2025Pearl of Elk Grove, theElk Grove Village, IL GComplaint
November 15, 2024Artesia Christian Home Inc.Artesia, CA LStandard
October 3, 2024Whispering Pines LodgeLongview, TX JStandard
August 26, 2024Encore VillageSchaumburg, IL GComplaint
July 24, 2024Broadway by the SeaLong Beach, CA KComplaint
July 19, 2024Baptist Village of Oklahoma CityOklahoma City, OK GStandard
July 8, 2024Nexus at BerwynBerwyn, IL GComplaint
June 10, 2024Cornerstone Care CenterSanger, CA GStandard
May 31, 2024South Elgin Living & Rehab CenterSouth Elgin, IL GStandard
May 1, 2024Miracle Mile Healthcare Center, LLCLos Angeles, CA JComplaint
March 14, 2024Blaire House of MilfordMilford, MA GComplaint
February 14, 2024Ahmc Seton Medical CenterDaly City, CA GStandard
September 29, 2023Kittson HealthcareHallock, MN GComplaint
July 12, 2023Cottonwood Rehabilitation and Healthcare CenterDurango, CO GStandard
July 15, 2022Foundation Skilled NursingFresno, CA GStandard
February 15, 2022Cornerstone Care CenterSanger, CA HStandard
November 18, 2021Eben Ezer Lutheran Care CenterBrush, CO GStandard
October 25, 2021Riverview Post AcuteSouth Point, OH GStandard
November 9, 2018Idaho State Veterans Home - BoiseBoise, ID GStandard

Most recent F758 citations

InspectionHomeTownLetter
May 13, 2025Spokane Falls CareSpokane, WA D
May 7, 2025The Laurels of Greentree RidgeAsheville, NC D
May 5, 2025Woodland ManorElkhart, IN D
May 2, 2025Del Rio Nursing and Rehabilitation CenterDel Rio, TX E
May 2, 2025Riverside Village Healthcare CenterRiverside, CA D
May 1, 2025Maplewood CenterWest Allis, WI D
May 1, 2025Rock Hill Health & RehabilitationBellingham, WA E
May 1, 2025Camden Healthcare & Rehab CenterCamden, TN D
May 1, 2025Autumn Lake Healthcare at Glade ValleyWalkersville, MD D
May 1, 2025Forest Haven Nursing and Rehabilitation CtrCatonsville, MD D
April 30, 2025Harmony Care at StamfordStamford, TX E
April 30, 2025Midtown ManorSalt Lake City, UT E
April 30, 2025The Benjamin Healthcare CenterBoston, MA D
April 30, 2025Ventura Health and Rehabilitation CenterBoynton Beach, FL D
April 30, 2025McLean Health CenterSimsbury, CT D
April 29, 2025The Springs Health and Rehabilitation CenterMurrieta, CA D
April 29, 2025Servicios Integrados De Rehabilitacion (siro) IncHormigueros, PR E
April 29, 2025The Villa at West BranchWest Branch, MI D
April 29, 2025Serenity Hill Nursing CenterWrentham, MA D
April 28, 2025The Pavilion at Sunny HillsFullerton, CA D
April 28, 2025Washington Veteran Home-RetsilPt Orchard, WA D
April 28, 2025Callaway Nursing HomeSulphur, OK E
April 28, 2025South Pointe Rehabilitation and Care CenterOklahoma City, OK D
April 28, 2025Phoenix of FairlawnAkron, OH D
April 28, 2025Paloma Springs Healthcare LLCT Or C, NM E

F758 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
California764
Ohio359
Illinois319
Kansas257
Missouri204
Texas185
Pennsylvania177
Virginia165
Michigan157
Oklahoma136
Washington135
Massachusetts134
Wisconsin131
Indiana130
Minnesota127
Florida119
New York112
Maryland110
Georgia90
Iowa80
Colorado78
Nebraska72
Connecticut66
North Carolina63
Oregon56
Louisiana51
New Jersey49
Utah48
West Virginia46
Tennessee43
New Mexico42
Mississippi34
South Carolina34
Arizona31
Wyoming29
Alabama27
Nevada27
Arkansas26
Idaho26
Montana25
Maine24
Delaware19
Kentucky17
New Hampshire15
Vermont15
North Dakota12
Hawaii10
South Dakota10
Rhode Island6
Alaska3
District of Columbia3
Puerto Rico2
Guam1

By inspection year: 2017 1, 2018 44, 2019 262, 2020 93, 2021 244, 2022 544, 2023 1,221, 2024 1,808, 2025 684.

Common questions

What is F758 in a nursing home inspection?
F758 is the federal requirement to "implement gradual dose reductions(gdr) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and prn orders for psychotropic medications are only used when the medication is necessary and prn use is limited". CMS files it under pharmacy service. A home cited under F758 did not meet that requirement at the inspection.
How often is F758 cited?
The CMS files as of September 1, 2026 list 4,901 F758 citations at 4,104 nursing homes, 0 of them in the 12 months to that date. 0.5% were rated as actual harm or immediate jeopardy.
Is a F758 citation serious?
It depends on the letter. Most F758 citations (99.4%) were rated as potential for more than minimal harm, D to F. 5 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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