Below average — CMS composite of the measures below.
A standard survey is most likely before around September 2026
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Hertford Rehabilitation And Healthcare Center during CMS and state inspections, most recent first.
The facility did not have an RN on duty for at least eight consecutive hours on one day due to a staff call out and lack of available facility or agency staff during a holiday weekend, as confirmed by the DON and Clinical President.
The facility did not ensure its assessment and staffing plan addressed specific staffing needs for each unit and shift, including nights and weekends, and failed to document contracts for essential services such as emergency services and dialysis. The Administrator was unaware of the requirements to specify nurse staffing by shift and to list all contract services in the assessment.
Flies were observed in multiple resident rooms, landing on residents and their belongings, with both staff and residents reporting the issue as widespread and bothersome. The facility's pest control program did not specifically address flies, and insect traps were not consistently maintained or present in all affected areas. The problem was linked to the frequent use of the smoking area door, which allowed flies to enter, and there was a lack of documentation and chemical treatment for flies.
A resident with severe cognitive impairment and no speech did not receive individualized or group activities as required by their care plan. Despite documented needs for cognitive and social engagement, records showed no participation in activities, and staff interviews confirmed a lack of awareness of the resident's preferences. The resident was consistently observed in bed with only the television on, and the responsible party reported not being consulted about the resident's interests.
A facility failed to promptly remove and return a discontinued controlled medication from the medication cart, resulting in the diversion of a narcotic prescribed to a resident. The medication was not administered before discontinuation, and the required process for documenting and returning the drug to the pharmacy was not followed, leading to a missing medication card and a substantiated case of misappropriation.
Two residents' MDS assessments were inaccurately coded regarding anticonvulsant and anticoagulant medication use. One resident receiving an anticonvulsant was not coded for it, and both residents were incorrectly coded as receiving anticoagulants despite no orders or administration. The MDS Nurse confirmed the errors were due to incorrect selection during assessment completion.
The facility did not provide written notification to residents and their representatives regarding transfers to the hospital, instead relying on verbal phone calls and inconsistent documentation. This deficiency affected multiple residents who were hospitalized for acute medical issues, with no written notifications found in their records.
The facility did not accurately document daily nurse staffing information, posting schedules that showed two twelve-hour shifts for both licensed and unlicensed staff, including MAs, while the actual hours worked by unlicensed staff were three eight-hour shifts. This discrepancy was confirmed by staff interviews and was present across all shifts for the entire review period.
The facility failed to have an RN on duty for at least 8 hours on six specific dates in June 2023, despite having a census of over 60 residents. The DON stated that the scheduled RN called out, and no coverage was found. The Administrator confirmed the requirement for an RN with a census over 60.
The facility failed to properly label, store, and remove expired medications on the Hall 300 medication cart. Observations revealed expired and improperly stored insulin, as well as undated vials and creams. Staff interviews indicated lapses in routine checks and adherence to medication management protocols.
The facility failed to maintain and monitor interventions by the QAA Committee, resulting in repeated deficiencies in care plan updates, ADL care, respiratory care, RN staffing, nurse staffing information posting, medication storage, and infection control. Interviews revealed that previous corrective actions were not sustained, indicating an ineffective QAA program.
The facility failed to protect residents from neglect by not providing necessary incontinence care to two residents who were dependent on staff for activities of daily living. This deficiency was identified through observation, record review, and interviews.
A resident with a stroke diagnosis reported hearing difficulties and required people to speak loudly and close to her ear. Despite these reports, there was no care plan or documentation addressing her hearing issues. Staff were aware of her difficulty but did not recognize the need for further evaluation. An otolaryngologist consultation was ordered only after surveyor intervention.
A resident with obstructive sleep apnea used a CPAP machine nightly without a physician order. Staff were aware of the CPAP use but could not explain the missing order. The Nurse Practitioner wrote a new order after the resident reported issues with the machine.
The facility failed to implement its infection prevention program policies when a nurse aide did not perform hand hygiene after providing incontinence care to a resident, and another nurse aide did not perform hand hygiene between resident rooms while passing meal trays. Both incidents were confirmed by the staff involved and the Infection Preventionist.
The facility failed to provide timely incontinence care to two residents dependent on staff for ADLs. One resident with multiple sclerosis and a stroke waited over five hours for care, while another resident with encephalopathy was found in a urine-soaked brief and blanket. Staff workload and possible understaffing contributed to the delays.
The facility failed to post nurse staffing information in a location readily accessible to residents and visitors over four consecutive days. The posting was found in an area only accessible to staff and residents on hall 200, contrary to the requirement for visibility to all residents and visitors.
The facility failed to provide written notice of discharge or transfer to the Responsible Party (RP) for a resident who was hospitalized due to chest pain. The RP confirmed they did not receive the notice, and the Social Worker could not recall if it was sent. The Administrator stated it was the SW's responsibility to send the notice.
The facility failed to update the care plan for a resident with hemiplegia and severe cognitive impairment, specifically in the area of contracture management. Despite physician orders and staff observations confirming the use of a hand splint, the MDS Nurse had not updated the care plan to reflect this intervention.
Failure to Provide Required RN Coverage
Penalty
Summary
The facility failed to provide a Registered Nurse (RN) on duty for at least eight consecutive hours on one of the 34 days reviewed. Record reviews of daily posted nursing staff forms, assignment sheets, and clock-in sheets revealed that on 5/25/25, there was no RN coverage for the required eight-hour period. Interviews with the Director of Nursing (DON) and the Clinical President confirmed that the absence of RN coverage was due to a staff call out, and no facility or agency staff were available to fill the position during the Memorial holiday weekend.
Failure to Address Unit and Shift-Specific Staffing and Contracted Services in Facility Assessment
Penalty
Summary
The facility failed to ensure its facility-wide assessment and staffing plan addressed the specific staffing needs for each unit and shift, including nights and weekends, as required. The staffing plan only listed the desired number of full-time equivalent nurses and CNAs, without specifying shift or unit-based requirements or considering changes in the resident population. Additionally, the facility assessment did not document whether contracts or agreements were in place for essential services such as goods provision, facility management, emergency services, transportation, and dialysis. During an interview, the Administrator acknowledged a lack of awareness regarding the need to detail nurse staffing by shift and unit, as well as the requirement to list and review all contract services used by the facility.
Failure to Maintain Effective Pest Control Program for Flies
Penalty
Summary
The facility failed to maintain an effective pest control program, as evidenced by the presence of flies in 5 out of 12 resident rooms observed on the 300 Hall. Multiple observations documented flies landing on residents' beds, overbed tables, heads, arms, and other body parts. Residents, including those with moderate cognitive impairment and those who were cognitively intact, reported being bothered by the flies and were seen swatting them away. Staff interviews confirmed that flies were prevalent in most rooms on the 300 Hall, and the issue was attributed to the frequent opening of the smoking area door, which allowed flies to enter the building. Review of the pest control service inspection report showed that while the facility addressed general pests, rodents, roaches, and wasps, there was no mention of a specific fly control program. The Maintenance Director was responsible for maintaining insect traps, but documentation of trap maintenance was lacking, and not all resident rooms had traps installed. Housekeeping staff did not apply any chemical treatments for flies, and the Director of Nursing acknowledged that the fly problem was worse than in previous years. The facility had identified the need for additional insect traps in resident rooms, but at the time of the survey, the deficiency persisted.
Failure to Provide Resident-Centered Activities for Non-Participating Resident
Penalty
Summary
The facility failed to provide an ongoing, resident-centered activities program that included one-on-one (1:1) activities for a resident with severe cognitive impairment and no speech, who did not participate in group activities. The resident's care plan indicated a need for cognitive stimulation and social activities, with interventions such as providing materials for individual activities, inviting the resident to scheduled activities, and ensuring compatibility with the resident's physical and mental capabilities. However, reviews of activity participation records, 1:1 program records, and group activity records for the month showed no documentation of the resident's participation in any activities. Observations over multiple days revealed the resident remained in bed with the television on, and no radio was present in the room. Interviews with staff, including nurse aides and the Activity Director, confirmed that the resident was not observed participating in any group or individual activities, and staff were unaware of the resident's specific activity preferences beyond having the television on. The responsible party expressed concern that the resident was not included in activity programs and stated that the resident enjoyed watching sports and listening to music prior to admission, but had not been asked about these interests by facility staff. The Activity Director and DON both indicated that the Activity Director was responsible for determining and providing appropriate 1:1 activities, but could not recall recent participation or specific activities provided to the resident.
Failure to Timely Remove and Return Discontinued Controlled Medication Resulting in Diversion
Penalty
Summary
The facility failed to implement effective systems for the timely removal and return of discontinued controlled medications, resulting in the diversion of a controlled substance prescribed to a resident. According to the facility's policy, discontinued medications are to be identified and removed from the medication supply in a timely manner, in accordance with state and federal regulations. However, after a physician discontinued an order for Oxycodone/Acetaminophen for a resident, the medication card containing 8 tablets remained in the medication cart and was not promptly removed by nursing administration. A review of medication administration records showed that none of the Oxycodone/Acetaminophen doses were administered to the resident before the order was discontinued. The discrepancy was discovered when the DON reconciled the narcotic medications and found that the count was off, with a medication card missing from the cart. The facility's consultant pharmacist confirmed that the medication had not been returned to the pharmacy as required, and that the process for returning discontinued narcotics involved sealing the medication and documenting its disposition, but this process was not followed in this instance. Interviews with facility staff revealed that there was no specific timeframe for removing discontinued medications from the cart, and that two nurses were supposed to verify and sign off on the amount being returned. The lack of adherence to these procedures allowed for the misappropriation of the controlled medication, as the medication card was missing and not accounted for in the return documentation. The incident was substantiated as misappropriation of facility property.
Inaccurate MDS Coding for Medication Use
Penalty
Summary
The facility failed to accurately code the Minimum Data Set (MDS) assessments for two residents in the areas of anticonvulsant and anticoagulant medication use. For one resident with a history of convulsions, stroke, and nontraumatic intracranial hemorrhage, the MDS assessment did not reflect the use of an anticonvulsant medication, despite a physician's order and administration of levetiracetam. Instead, the assessment incorrectly indicated the use of an anticoagulant medication, although there were no physician orders or administration records for such medication. The MDS Nurse acknowledged the error, stating it was likely due to mistakenly selecting the wrong medication category during assessment completion. For another resident with a history of stroke, the MDS assessment was also inaccurately coded to indicate the use of an anticoagulant medication, despite the absence of any physician orders or administration records for anticoagulants during the relevant period. The MDS Nurse confirmed this was an error in coding. In both cases, the responsibility for accurate MDS coding was attributed to the MDS Nurse by the facility Administrator.
Failure to Provide Written Notification of Hospital Transfer
Penalty
Summary
The facility failed to provide written notification to residents and their Resident Representatives regarding the reason for transfer or discharge to the hospital. This deficiency was identified through record reviews and staff interviews, affecting five residents who were hospitalized for various acute medical conditions, including critical low hemoglobin, gastrointestinal bleeding, need for a tunneled catheter, increased shortness of breath, and vomiting blood. In each case, the medical records lacked documentation of written notification of transfer for either the resident or their Responsible Party on the date of hospitalization. Interviews with facility staff revealed that the Social Worker had not been sending written notifications of transfer or discharge, instead relying on verbal communication via phone calls to inform Resident Representatives. Documentation of these conversations was inconsistently recorded, sometimes only in a personal notebook or in the resident chart. The Administrator confirmed awareness of the verbal notification process but expected that written notifications would also be provided, which was not occurring at the time of the deficiency.
Inaccurate Documentation of Daily Nurse Staffing Information
Penalty
Summary
The facility failed to accurately document daily nurse staffing information for all 34 days reviewed. Record reviews showed discrepancies between the posted nurse staffing sheets and the actual staff schedules and assignment sheets. Specifically, the posted staffing information consistently documented that both licensed and unlicensed staff, including Medication Aides (MAs), were scheduled to work two twelve-hour shifts per day. However, the actual hours worked by unlicensed staff were three eight-hour shifts per day. This discrepancy was present across all three shifts (7:00 AM - 3:00 PM, 3:00 PM - 11:00 PM, and 11:00 PM - 7:00 AM) for each day reviewed. Interviews with the Staffing Scheduler, the Clinical President, and the Administrator confirmed that the posted daily staffing information did not reflect the actual hours worked by unlicensed staff. The Staffing Scheduler stated she was trained to document staffing hours as two twelve-hour shifts for all staff, rather than the actual three eight-hour shifts worked by unlicensed staff. The Administrator acknowledged that the way the daily staffing was listed made it appear that the actual unlicensed staff hours were incorrect.
Failure to Have RN on Duty for Required Hours
Penalty
Summary
The facility failed to have a Registered Nurse (RN) on duty for at least 8 hours a day on six specific dates in June 2023, despite having a census of greater than 60 residents on those days. A review of the schedules for June 2023 revealed that no RN worked the required hours on 6/11/2023, 6/18/2023, 6/22/2023, 6/25/2023, 6/28/2023, and 6/29/2023. The daily nurse staff postings confirmed the census ranged from 67 to 70 residents on these dates. During an interview, the Director of Nursing (DON) stated that she had scheduled an RN for those days, but the RN called out, and she was unable to find coverage. The Administrator confirmed that an RN should be scheduled when the census exceeds 60 residents.
Medication Management Deficiency
Penalty
Summary
The facility failed to ensure proper labeling, storage, and removal of expired medications on the Hall 300 medication cart. During an observation, it was found that a glargine insulin injector pen had expired, another glargine insulin injector pen was open without an open date, and an unopened glargine insulin injector pen was not refrigerated as recommended by the manufacturer. Additionally, a vial of haloperidol and tubes of nystatin and ketoconazole antifungal creams were open without noted open dates. These findings were confirmed by the Director of Nursing (DON) and Nurse #1 during the observation. Interviews with staff revealed lapses in the medication management process. Nurse #1, an agency staff member, admitted it was her first day back and planned to clean the cart after her medication pass. Nurse #4, who worked the overnight shift, stated she did not routinely check the cart for expired or undated items, only removing them if noticed during medication passes. The Unit Manager reported attempting to check the carts weekly but believed the Hall 300 cart was last checked about a week ago. The DON stated that the medication carts were supposed to be checked nightly by the assigned nurse and audited monthly by the Unit Manager and pharmacy consultant, but no issues had been reported to her.
Repeated Deficiencies in Care and Compliance
Penalty
Summary
The facility failed to maintain and monitor the interventions put in place by the Quality Assessment and Assurance (QAA) Committee following previous surveys. This resulted in repeated deficiencies in several areas, including care plan updates, activities of daily living care, respiratory care, RN staffing, nurse staffing information posting, medication storage, and infection prevention and control. Specifically, the facility did not update the care plan for a resident with limited range of motion, failed to provide incontinence care for two residents, and did not obtain a physician order for a CPAP machine for a resident requiring respiratory care. Additionally, the facility did not have an RN on duty for at least 8 hours a day on several occasions and failed to post nurse staffing information in an accessible location. Expired medications were not removed, and infection control procedures were not followed by staff during incontinence care and meal tray delivery. These deficiencies were observed during the current complaint and recertification survey, as well as in previous surveys, indicating a pattern of non-compliance and an ineffective QAA program. Interviews with the Administrator revealed that the previous administrative team had completed education and auditing to resolve the deficiencies, but the current team had not maintained these improvements. The Director of Nursing was identified as responsible for ensuring compliance in several areas, but the facility lacked a robust plan for ongoing education and monitoring. The repeated failures across multiple surveys highlight the facility's inability to sustain effective quality assurance measures.
Failure to Provide Incontinence Care
Penalty
Summary
The facility failed to protect residents from neglect, specifically in providing necessary incontinence care. This deficiency was identified through observation, record review, and interviews with staff, residents, and responsible parties. Two residents, who were incontinent and dependent on staff for activities of daily living, did not receive the required incontinence care. This neglect was documented for two of the five residents reviewed.
Failure to Evaluate Resident's Hearing Difficulties
Penalty
Summary
The facility failed to ensure that a resident with reported hearing difficulties was evaluated. Resident #24, who was admitted with a diagnosis of stroke, reported having hearing problems and required people to speak loudly and close to her ear to communicate. Despite these reports, there was no care plan addressing her hearing difficulty, and the Minimum Data Set (MDS) quarterly assessment indicated she had adequate hearing without a hearing aid. Nursing progress notes and active physician orders also lacked documentation or orders for an evaluation of her hearing difficulties. Interviews with staff revealed that multiple caregivers, including a nurse aide and the Unit Manager, were aware that Resident #24 had trouble hearing and needed people to speak close to her ear. However, they did not recognize this as a sign of hearing impairment requiring further evaluation. The Nurse Practitioner and Director of Nursing were also unaware of the resident's hearing issues until notified by the surveyor. An otolaryngologist consultation was eventually ordered, but only after the surveyor's intervention. The Administrator was also unaware of the resident's hearing difficulties and stated that it would be addressed.
Failure to Obtain Physician Order for CPAP Machine
Penalty
Summary
The facility failed to obtain a physician order for a CPAP machine for a resident diagnosed with obstructive sleep apnea. The resident was admitted with a hospital discharge order for non-invasive ventilation CPAP, but the care plan and active physician orders did not include this. The resident, who was cognitively intact, confirmed using the CPAP machine every night and mentioned needing a new one due to excessive air blowing. Staff interviews revealed that the CPAP machine was used nightly, but there was uncertainty about the existence of a physician order. The Unit Manager and Director of Nursing acknowledged the need for a physician order but could not explain why it was missing. The Nurse Practitioner confirmed awareness of the resident's CPAP use and wrote a new order after the resident reported issues with the machine. The Director of Nursing suggested that the order might have been missed during a monthly review. The Administrator confirmed that the Director of Nursing was responsible for ensuring the presence of a physician order for the CPAP machine.
Failure to Implement Infection Prevention Program Policies
Penalty
Summary
The facility failed to implement its infection prevention program policies and procedures, as evidenced by two separate incidents involving nurse aides. In the first incident, Nurse Aide (NA) #3 did not perform hand hygiene after providing incontinence care to Resident #10. NA #3 donned gloves, cleaned the resident, and then placed a clean brief and shirt on the resident without changing gloves or performing hand hygiene. This was confirmed by NA #3 during an interview, where she admitted to not realizing she had failed to change her gloves and perform hand hygiene as required by the facility's policy. The Infection Preventionist (IP) also confirmed that NA #3 should have removed the soiled gloves and performed hand hygiene before dressing the resident in clean clothing. In the second incident, NA #1 failed to perform hand hygiene between resident rooms while passing meal trays. NA #1 was observed delivering meal trays to two different rooms without using hand sanitizer or washing her hands between the rooms. Additionally, NA #1 handled a resident's food with her bare hands without performing hand hygiene. During an interview, NA #1 admitted to forgetting to use hand sanitizer or wash her hands due to feeling busy. The IP confirmed that NA #1 had received education on hand hygiene but failed to follow the procedures, which required hand hygiene between each meal tray delivery and before handling food.
Failure to Provide Timely Incontinence Care
Penalty
Summary
The facility failed to provide timely incontinence care to two residents who were dependent on staff for activities of daily living (ADLs). Resident #10, who had multiple sclerosis and a stroke with right-sided hemiplegia, reported asking a Nurse Aide (NA) for incontinence care at 8:30 am, but the care was not provided until after 2:00 pm. Observations confirmed that Resident #10's incontinence brief was saturated and dark in color, indicating prolonged exposure to urine. The NA admitted to delaying the care, stating that she believed Resident #10 could wait until the end of the shift, despite the resident's request and the facility's policy of providing care every two hours and as needed. The Director of Nursing (DON) confirmed that the care should have been provided when requested in the morning. Resident #217, who had encephalopathy and pneumonitis, was found by his representative in a urine-soaked brief and blanket during a visit. The representative reported this to a nurse, who then called a Nurse Aide to provide the necessary care. The Nurse Aide revealed that she had been assigned to 20 residents, which delayed the incontinence care for Resident #217. Another Nurse Aide confirmed that the resident's brief, bed pad, and bed linen were soaked in urine when care was finally provided. The facility's daily nurse staff assignment sheet showed that the Nurse Aide was assigned to 14 residents, indicating a possible staffing issue. The Administrator confirmed that the nurse was responsible for ensuring Resident #217's care was provided. Both incidents highlight a failure to provide timely incontinence care, as required by the residents' care plans and facility policy. The delays in care were attributed to staff workload and possible understaffing, as indicated by the staff interviews and assignment sheets. The Director of Nursing and the Administrator acknowledged that the care should have been provided as per the residents' needs and facility protocols.
Failure to Post Nurse Staffing Information in Accessible Location
Penalty
Summary
The facility failed to post nurse staffing information in a location that was readily accessible to residents and visitors on four consecutive days during the survey. On 5/13/2024, the daily nursing staff posting could not be located in the lobby or any of the nursing halls during multiple observations throughout the day. Similar observations were made on 5/14/2024, where the posting was again not found in the designated areas. On 5/15/2024, the daily nurse staff posting was observed to be hung on the wall past the nursing station on hall 200 by the Rehab Service entrance, which was only accessible to staff and residents on hall 200. The posting was a white, landscaped 8x10-inch piece of paper inside a folder strapped to the wall, making it not visible or accessible for all residents or visitors to view. This issue persisted during observations on 5/16/2024 as well. In an interview with the Director of Nursing (DON) on 5/15/2024, she revealed that she was responsible for the scheduling and believed the daily nursing staff posting was in the correct location. She acknowledged that it should have been posted in a more visible place. The Administrator, interviewed on 5/16/2024, confirmed that the daily staff posting was supposed to be placed in an area visible to all residents and visitors, and he was aware that it was incorrectly placed in Hall 200 past the nursing station.
Failure to Provide Written Notice of Discharge or Transfer
Penalty
Summary
The facility failed to provide written notice of discharge or transfer to the Responsible Party (RP) for one resident who was hospitalized. The resident, who was cognitively intact, was admitted to the facility and later sent to the hospital due to chest pain. There was no documentation in the nursing progress notes indicating that the RP received written notice of the discharge or transfer. The RP confirmed in an interview that they did not receive such notice. The Social Worker (SW) could not recall if the notice was sent, and the Administrator stated it was the SW's responsibility to send the notice.
Failure to Update Care Plan for Contracture Management
Penalty
Summary
The facility failed to update the care plan for a resident with a diagnosis of stroke and hemiplegia, specifically in the area of contracture management. The resident had severe cognitive impairment and functional limitations in the range of motion of the upper and lower extremities. Physician orders were in place for the application and removal of a hand splint for contracture management, but the care plan did not reflect this intervention. Observations confirmed the resident was using the hand roll, and staff interviews revealed that the MDS Nurse had not yet updated the care plan despite receiving the necessary information from the Therapy Manager. Interviews with the MDS Nurse, Therapy Manager, and Director of Nursing confirmed that the MDS Nurse was responsible for updating the care plan but had not done so. The MDS Nurse acknowledged receiving an email from the Therapy Manager with a list of residents using splints, including the resident in question, but admitted that the care plan had not been completed. The Administrator also confirmed that the MDS Nurse was responsible for developing the care plan for the resident's contracture management.
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Illustrative
What surveyors actually found near you
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
Illustrative
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Nursing homes near Hertford
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Chowan River Nursing And Rehabilitation Center | 10.4 mi | ★★★★★ | 0 | 0 |
| Elizabeth City Health And Rehabilitation | 14.2 mi | ★★★★★ | 6 | 0 |
| Laurel Park Rehabilitation And Healthcare Center | 15.2 mi | ★★★★★ | 0 | 0 |
| Gates Health And Rehabilitation Center | 18.9 mi | ★★★★★ | 3 | 0 |
| The Carrolton Of Plymouth | 27.6 mi | ★★★★★ | 0 | 0 |
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