Below average — CMS composite of the measures below.
A standard survey is most likely before around October 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 Rich Square Nursing & Rehabilitation Center during CMS and state inspections, most recent first.
The facility failed to ensure a comprehensive and accurate facility-wide assessment by not involving direct care staff, residents, or family members, and by listing outdated administrative personnel. The staffing plan did not address shift-specific or weekend needs, nor did it specify required skills and competencies for licensed nursing staff and CNAs. The staff position list was inaccurate, and the current Administrator had not updated the assessment since starting employment.
A resident with a history of stroke and hypertension did not have documented evidence that they or their representative received education about advance directives or the right to accept or refuse treatment. Although the NP and Administrator stated that education was provided by phone, this was not recorded in the medical record, and the resident could not recall receiving such information.
Two residents were not provided with the required CMS SNF Advanced Beneficiary Notice (ABN) before their Medicare Part A skilled services ended, despite receiving a Notice of Medicare Non-Coverage (NOMNC) and remaining in the facility. Staff interviews revealed confusion over who was responsible for issuing the SNF ABN, leading to the deficiency.
Surveyors identified that the facility failed to accurately code the MDS assessments for three residents, resulting in omissions regarding anticonvulsant medication use, prescribed diet, and hearing aid use. One resident was not coded for receiving anticonvulsant medications despite active orders and administration, another was incorrectly coded for a mechanically altered diet instead of a regular diet, and a third was not coded for hearing aid use despite regular use confirmed by staff and observation.
Two residents did not have individualized care plans addressing their specific needs: one required side rails for positioning due to weakness, and another used hearing aids for hearing loss. Despite assessments and repeated observations confirming these needs, the MDS Nurse did not include them in the care plans, and this omission was acknowledged by the DON and Administrator.
Care plans were not updated for two residents: one did not have pain, antihypertensive, or anticoagulant medications included in the care plan despite physician orders, and another continued to have a wander guard intervention listed after the device was discontinued. The MDS Nurse, responsible for care plan updates, missed these revisions, and both the DON and Administrator confirmed the omissions.
A resident with pain and diabetic neuropathy received lidocaine 4% pain patches that remained on the skin for longer than the manufacturer's recommended 12 hours due to unclear physician orders. Nursing staff removed and replaced patches after approximately 24 hours, and the orders lacked clear removal times. Interviews with the nurse, Pharmacy Consultant, NP, and DON confirmed the orders did not specify the required 12-hour removal, resulting in the patches being left on too long.
A resident with Alzheimer's disease and diabetes, who had experienced significant weight loss, did not receive physician-ordered nutritional supplements (ice cream and a nutritional shake) during lunch meals on multiple occasions. Despite clear orders and documentation, dietary staff failed to add the supplements to the meal tray, and this omission was confirmed through observation and staff interviews. The deficiency was identified through record review, direct observation, and interviews with dietary staff, the RD, and the NP.
A nurse failed to perform hand hygiene between glove changes while administering medications to a resident, including eye drops, nasal spray, and a pain patch. The nurse donned and removed gloves multiple times without using hand sanitizer as required by facility policy, only performing hand hygiene upon leaving the resident's room. The DON confirmed this was not in accordance with infection control procedures.
The facility did not provide written notification to the Ombudsman for the hospital transfers of two residents, including multiple transfers for one resident due to acute medical conditions and another for abnormal lab results. Documentation of required notifications was missing, and staff interviews confirmed that the notifications were either not sent or could not be located.
A facility failed to perform a Significant Change in Status MDS assessment for a resident who was discharged from hospice services. The resident, admitted with hypertension and dementia, continued receiving hospice care upon admission. However, when hospice services ended, the required assessment was not completed. The MDS Coordinator, new to the facility, was unaware of the oversight, which the Administrator acknowledged as a failure to meet required time frames.
A resident with chronic respiratory failure was using supplemental oxygen without a physician's order, and there was no signage indicating oxygen use outside their room. Nursing staff failed to recognize the absence of both the order and signage, as confirmed by interviews with the Nurse Unit Manager and DON.
The facility failed to document education and refusal of influenza and pneumococcal vaccines for two residents, both severely cognitively impaired. There was no record of vaccine administration or education provided to the residents or their representatives. The DON confirmed the lack of written consent indicating education was provided when vaccines were refused.
The facility failed to document COVID-19 vaccine education and refusal for two residents who were severely cognitively impaired. The DON stated that the vaccine was offered before her employment, but the facility did not obtain written consent confirming education and refusal.
A facility failed to provide a resident and the ombudsman with written notice of transfer/discharge when the resident was hospitalized. The resident, who was cognitively intact, did not receive a notification letter, and the facility's EMR lacked documentation of the notice. Staff interviews revealed that the issue was not identified until months later, and the Social Worker admitted to not notifying the ombudsman due to inexperience.
A resident was transferred to the hospital without receiving the bed hold policy in writing, as required. The facility's staff, including the Clinical Nurse Consultant and the DON, confirmed that the policy was not issued during transfers at that time. The issue was not identified until months later, indicating a systemic oversight.
Deficient Facility Assessment and Inaccurate Staffing Plan
Penalty
Summary
The facility failed to conduct and document a comprehensive facility-wide assessment as required. The assessment did not involve all necessary parties in its development, specifically lacking input from direct care staff, residents, resident representatives, and family members. Additionally, the assessment listed outdated administrative personnel, including a former Administrator, Medical Director, and Social Worker, rather than the current staff. The staffing plan included in the assessment only provided the desired number of full-time equivalent (FTE) nurses and CNAs, but did not address specific staffing needs for each shift, weekends, or account for changes in the resident population. The staff type and position list was also inaccurate, listing a Staff Development Coordinator (SDC) position that did not exist at the facility. Further, the facility assessment did not specify the required skills and competencies for licensed nursing staff and CNAs. During an interview, the current Administrator confirmed she had not reviewed or updated the facility assessment since her employment began and acknowledged the inaccuracies in the staff position list. No additional documentation regarding the facility assessment was provided at the time of the survey exit. These deficiencies had the potential to affect all 54 residents in the facility.
Failure to Document Advance Directive Education
Penalty
Summary
The facility failed to provide written information to a resident and/or their representative regarding the right to accept or refuse medical or surgical treatment and the opportunity to formulate an advance directive. The resident, who was admitted with diagnoses including high blood pressure and a history of stroke, was found to be cognitively intact according to a recent assessment. Review of the resident's electronic medical record showed a full code physician order, but there was no documentation indicating that education about advance directives or the opportunity to formulate one had been offered to the resident or their representative. During interviews, the resident was unable to recall receiving any education about advance directives. The facility's Administrator and Nurse Practitioner both stated that education had been provided to the resident's representative via a phone call, but acknowledged that this conversation was not documented in the medical record. Attempts to contact the resident's representative for confirmation were unsuccessful.
Failure to Provide SNF ABN Prior to Medicare Part A Discharge
Penalty
Summary
The facility failed to provide the required Centers for Medicare and Medicaid Services (CMS) Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN) to two residents prior to the termination of their Medicare Part A skilled services, as identified through record reviews and staff interviews. In both cases, the residents were given a Notice of Medicare Non-Coverage (NOMNC) indicating the end of their Medicare Part A coverage, but there was no evidence in their medical records that a SNF ABN was reviewed with or provided to them. Both residents remained in the facility after their Medicare Part A coverage ended. Interviews with facility staff revealed confusion and lack of clarity regarding responsibility for issuing the SNF ABN. The Business Office Manager and Social Worker each believed the other was responsible for providing the SNF ABN, and the Administrator was under the impression that the Social Worker handled all beneficiary notices. This miscommunication resulted in the SNF ABN not being issued to the affected residents, as required.
Inaccurate MDS Coding for Medications, Diet, and Hearing Aid Use
Penalty
Summary
The facility failed to accurately code the Minimum Data Set (MDS) assessments for three residents in the areas of anticonvulsant medication use, prescribed diet, and use of a hearing aid. For one resident with Alzheimer's Disease and cerebrovascular disease, the MDS assessment did not reflect the administration of two anticonvulsant medications, gabapentin and divalproex sodium, despite active physician orders and documentation in the Medication Administration Record. The MDS Nurse acknowledged missing this information during the assessment process. Another resident, who was cognitively intact and had no swallowing issues, was incorrectly coded as receiving a mechanically altered diet on the MDS, even though physician orders and meal observations confirmed a regular diet with thin liquids. The Dietary Manager, responsible for this section of the MDS, admitted to making an error in coding. Additionally, a third resident with a cognitive communication deficit was not coded for hearing aid use on the MDS, despite observations and staff interviews confirming regular use of hearing aids. The MDS Nurse stated she was unaware of the resident's use of hearing aids at the time of assessment.
Failure to Develop Person-Centered Care Plans for Side Rail Use and Hearing Aid Management
Penalty
Summary
The facility failed to develop person-centered care plans for two residents in key areas. For one resident with Alzheimer's Disease, the Side Rail Use assessment indicated a request for side rails to assist with turning, repositioning, and transfers due to weakness. Despite repeated observations of the resident in bed with side rails in place, the care plan reviewed and updated did not include any documentation or plan for the use of side rails for positioning. Interviews with the MDS Nurse, DON, and Administrator confirmed that the MDS Nurse was responsible for care plan development and acknowledged that a care plan for side rail use should have been in place but was not. Another resident with dementia and behavioral disturbances was observed using hearing aids, although the most recent MDS assessment coded the resident as having adequate hearing without hearing aids. The care plan did not address hearing loss or the use of hearing aids, despite multiple observations of the resident using them and the resident's own statements about their use. The MDS Nurse stated she was unaware of the resident's use of hearing aids and had not developed a care plan for this need. Both the DON and Administrator confirmed that the MDS Nurse was responsible for ensuring care plans addressed hearing loss and hearing aid use, which had not occurred in this case.
Failure to Revise Care Plans for Medication Management and Elopement Interventions
Penalty
Summary
The facility failed to revise and update care plans for two residents in accordance with physician orders and changes in their care needs. For one resident with end stage renal disease, hypertension, and diabetes, the care plan did not include interventions or monitoring for pain management, antihypertensive medication, or anticoagulant therapy, despite physician orders for these medications. The MDS Nurse, responsible for updating care plans, confirmed that these areas were missing and acknowledged that the anticoagulant medication, added after her start date, was not incorporated into the care plan. Both the DON and Administrator confirmed that these omissions should have been addressed, with the DON noting that the anticoagulant should have been added when ordered and the other medications upon readmission. Another resident with Alzheimer's disease and severe cognitive impairment had a care plan that continued to list a wander guard intervention after the device had been discontinued by physician order. The MDS Nurse, who completed the relevant MDS assessment and quarterly care plan review, did not update the care plan to reflect the removal of the wander guard. Observations confirmed the absence of the device, and both the DON and Administrator stated that the care plan should have been revised to accurately reflect the resident's current interventions.
Failure to Clarify Lidocaine Patch Orders Leads to Extended Application
Penalty
Summary
A deficiency occurred when the facility failed to clarify physician orders for lidocaine 4% external pain patches, resulting in the patches remaining on a resident's skin beyond the manufacturer's recommended duration of 12 hours. The resident, who had diagnoses including unspecified pain and diabetic neuropathy, had two active physician orders for lidocaine patches—one for the left side with a specified removal time and one for the right side without a removal time. During medication administration observation, a nurse was seen removing patches that had been in place for approximately 24 hours and immediately applying new ones to the same areas. The nurse stated she was following the order times and did not clarify the removal time for the right-side patch with the physician. Interviews with facility staff, including the nurse, Pharmacy Consultant, Nurse Practitioner, and Director of Nursing, revealed that the orders did not align with the manufacturer's instructions, which require the patch to be removed after 12 hours and not reapplied for another 12 hours. The Pharmacy Consultant and Nurse Practitioner both confirmed that the orders should have specified a 12-hour on, 12-hour off schedule, and the Director of Nursing acknowledged that the orders were not accurate and should have included the removal time. At the time of observation, the resident's skin was intact without redness or irritation.
Failure to Provide Prescribed Nutritional Supplements to Resident with Weight Loss
Penalty
Summary
A deficiency occurred when a resident with Alzheimer's disease and diabetes, who had experienced significant weight loss, did not receive prescribed nutritional supplements as ordered by the physician and recommended by the Registered Dietitian (RD). The resident had active orders for daily ice cream and a nutritional shake to be added to the lunch tray to prevent further weight loss. Despite these orders being clearly documented and included on the meal ticket, observations on two consecutive days revealed that neither the ice cream nor the nutritional shake were present on the resident's lunch tray. Interviews with dietary staff confirmed that the supplements were omitted due to oversight during meal tray preparation. The resident's medical record showed a notable decline in weight over several months, with the RD documenting a 10.9% weight loss over 159 days and emphasizing the need for the supplements to meet nutritional requirements. The care plan identified the resident's nutritional risk and included interventions to maintain adequate nutritional status. Both the RD and the Nurse Practitioner confirmed that the supplements were necessary and should have been provided as ordered. The dietary department, including aides and supervisors, acknowledged responsibility for ensuring supplements were added to trays but failed to do so, resulting in the deficiency.
Failure to Perform Hand Hygiene Between Glove Changes During Medication Administration
Penalty
Summary
Nurse #2 failed to follow the facility's infection prevention and control program policies and procedures during a medication administration observation. Specifically, Nurse #2 did not perform hand hygiene before donning gloves, between glove changes, or immediately after removing gloves while administering multiple medications to a resident. The nurse was observed donning clean gloves without hand hygiene, using gloved hands to administer eye drops, removing gloves, donning new gloves without hand hygiene, administering nasal spray, and again removing gloves without performing hand hygiene. The nurse then adjusted the resident's oxygen tubing and handed the resident a medicine cup with pills using ungloved hands, followed by donning clean gloves without hand hygiene to apply a pain patch. Hand hygiene was only performed upon exiting the resident's room. The facility's policies clearly state that hand hygiene must be performed prior to donning gloves and immediately after removing them, and that glove use does not replace hand hygiene. During interviews, Nurse #2 acknowledged forgetting to use hand sanitizer between glove changes, and the Director of Nursing, who also serves as the Infection Preventionist, confirmed that the observed actions were not in accordance with facility policy.
Failure to Notify Ombudsman of Resident Hospital Transfers
Penalty
Summary
The facility failed to provide written notification to the Ombudsman regarding the transfer of two residents to the hospital. For one resident, there were three separate hospital transfers for conditions including chest pain, difficulty breathing, altered mental status, low blood pressure, and shortness of breath. In each instance, the medical record documented the resident's discharge and subsequent return to the facility, but there was no documentation that the Ombudsman had been notified of these transfers. Attempts to locate the previous Social Worker's documentation or to interview her were unsuccessful, and the Administrator reported being unable to find any records of Ombudsman notification, suggesting that documentation may have been removed when the previous Social Worker left the facility. For the second resident, a transfer to the hospital occurred for further evaluation of abnormal laboratory results. The Social Worker interviewed stated she typically emailed the list of transfers to the Ombudsman but could not find any record of notification for this particular transfer. The Administrator confirmed that no documentation could be found to show that the Ombudsman had been notified. The Social Worker acknowledged that the notification may have been overlooked during the relevant period.
Failure to Complete Significant Change MDS Assessment
Penalty
Summary
The facility failed to perform a Significant Change in Status Minimum Data Set (MDS) assessment for a resident who was reviewed for hospice care. The resident was admitted with diagnoses including hypertension and dementia and was receiving hospice services prior to and upon admission. A CMS Notice of Medicare Non-Coverage indicated that the resident's hospice services were ending, but a significant change assessment was not completed when the resident was discharged from hospice services. The MDS Coordinator, who had just begun working at the facility during the time of the transition, was not aware that the significant change assessment was not done. The Administrator acknowledged that MDS assessments should be completed within required time frames and attributed the oversight to the MDS Coordinator's transition into the facility.
Failure to Obtain Physician Order and Signage for Oxygen Use
Penalty
Summary
The facility failed to obtain a physician's order for the use of supplemental oxygen and did not apply appropriate signage indicating the use of oxygen outside a resident's room. The resident, who was readmitted to the facility with diagnoses including congestive heart failure and chronic respiratory failure, was observed using oxygen without a corresponding physician's order in their medical record. Nursing documentation noted the resident was on oxygen at 2 liters per minute via nasal cannula upon return to the facility, but no order was found in the electronic medical record. Additionally, there was no signage outside the resident's room indicating the use of oxygen, which is a safety requirement. Interviews with nursing staff, including a nurse and the Nurse Unit Manager, revealed a lack of awareness regarding the missing signage and the absence of a physician's order for oxygen use. The Director of Nursing acknowledged that nursing staff should have contacted the physician for an order upon the resident's return from the hospital and ensured the appropriate signage was in place.
Failure to Document Vaccine Education and Refusal
Penalty
Summary
The facility failed to document the provision of education regarding the influenza and pneumococcal vaccines and the refusal of these vaccines by two residents. Resident #41, who was severely cognitively impaired, had no documentation in their electronic medical record (EMR) indicating receipt of the influenza vaccine for the 2023-2024 season or any history of receiving a pneumococcal vaccine. The facility was unable to provide written documentation that Resident #41 or their representative had received education about these vaccines to consent or refuse their administration. Similarly, Resident #152, also severely cognitively impaired, had no documentation in their EMR of receiving the influenza vaccine for the 2023-2024 season or any history of receiving a pneumococcal vaccine. Although there was a record of refusal for these vaccines in 2021, the facility did not have documentation that Resident #152 or their representative had been educated about the vaccines for the current season. The Director of Nursing, who also served as the Infection Preventionist, confirmed that the facility did not obtain written consent indicating education was provided when residents or their representatives refused the vaccines.
Failure to Document COVID-19 Vaccine Education and Refusal
Penalty
Summary
The facility failed to document the provision of education regarding the COVID-19 vaccine for the 2023-2024 season and the refusal of the vaccine by two residents, Resident #41 and Resident #152. Resident #41, who was severely cognitively impaired, had no documentation in the electronic medical record (EMR) indicating that they or their representative received education about the COVID vaccine. Similarly, Resident #152, also severely cognitively impaired, had a recorded refusal of the COVID vaccine on January 4, 2023, but there was no documentation that education was provided to them or their representative regarding the vaccine. The Director of Nursing, who also served as the Infection Preventionist, stated that the COVID vaccine was offered and administered to all residents or their representatives before her employment at the facility. However, the facility did not obtain written consent confirming that education was provided and that the residents or their representatives refused the vaccine. This lack of documentation led to the deficiency identified during the survey.
Failure to Provide Written Notice of Transfer/Discharge
Penalty
Summary
The facility failed to provide written notice of transfer or discharge to a resident and the ombudsman when the resident was transferred to the hospital. The resident, who was cognitively intact, did not receive a written letter notifying her of the reason for her discharge to the hospital. The facility's electronic medical record did not contain any written notice of transfer or discharge for the resident's hospitalization. Interviews with facility staff revealed that the issue of not providing written notices was not identified until February 2024. The Clinical Nurse Consultant and the Director of Nursing confirmed the absence of written notices for transfers or discharges. The Social Worker, who was new to long-term care, admitted to not notifying the ombudsman of the resident's transfer. The Administrator acknowledged that the resident and the ombudsman did not receive the required notifications due to the oversight.
Failure to Provide Bed Hold Policy During Hospital Transfer
Penalty
Summary
The facility failed to provide the bed hold policy in writing to a resident at the time of transfer to the hospital. This deficiency was identified during a review of records, resident interviews, and staff interviews. Specifically, Resident #29, who was cognitively intact, was transferred to the hospital on 12/14/2023 due to feeling weak. However, there was no documentation in the resident's electronic medical record indicating that the bed hold policy was provided at the time of transfer. The resident later confirmed in an interview that she did not recall receiving the policy. Interviews with facility staff, including the Clinical Nurse Consultant and the Director of Nursing, revealed that the facility was not issuing the bed hold policy to residents or their representatives at the time of transfer during the period in question. The Director of Nursing, who started at the facility shortly before the incident, was unable to explain why the policy was not being issued. The Administrator also confirmed that the facility was unaware of the issue until February 2024, indicating a systemic oversight in the facility's procedures for handling transfers.
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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.
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Nursing homes near Rich Square
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Northampton Nursing And Rehabilitation Center | 9.5 mi | ★★★★★ | 3 | 0 |
| Bryan Health And Rehab | 12.8 mi | ★★★★★ | 0 | 0 |
| Scotland Manor Health And Rehabilitation Center | 13.2 mi | ★★★★★ | 3 | 0 |
| Ahoskie Health And Rehabilitation Center | 16.5 mi | ★★★★★ | 9 | 0 |
| Liberty Commons Nursing And Rehabilitation Center | 20.5 mi | ★★★★★ | 1 | 0 |
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