Below average — CMS composite of the measures below.
The next survey window likely opens around April 2027
Estimate from public CMS data, current as of August 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Yanceyville Rehabilitation And Healthcare Center during CMS and state inspections, most recent first.
Failure to Submit Level II PASRR Requests After New Mental Health Diagnoses: The facility did not request Level II PASRR evaluations for multiple residents after new serious mental illness diagnoses were identified. Records showed residents with prior Level I PASRR determinations later received diagnoses such as bipolar disorder and schizophrenia from the Psychiatric NP, with ongoing psychotropic treatment and MDS documentation reflecting those conditions. Staff interviews confirmed the PASRR requests were not submitted when the new diagnoses were added.
Improper food storage and sanitation issues were observed in dietary areas. Dry cereal and other foods were left unlabeled and undated, some stored near wet dishes, and multiple items in the walk-in cooler, freezer, and reach-in refrigerator were uncovered or only partially covered, unlabeled, undated, or expired. Thawing turkey was stored on a middle shelf with food beneath it, and several foods showed freezer burn or signs of spoilage. The walk-in refrigerator floor was wet and dirty with brown water, the ceiling above the steam table had peeling paint, and an ice machine had black buildup inside and on the lid.
Failure to Provide Individualized Activity Programs: Three residents with severe cognitive impairment and other significant conditions did not receive activity programs matched to their preferences and needs. One resident with dementia and another with Alzheimer’s disease were repeatedly observed sitting alone or in bed without music, meaningful engagement, or documented 1:1 activities after moving to the rehab hallway, while staff said activity support did not come to that unit. A blind resident with severe cognitive impairment also had no documented music or outdoor activities despite stated preferences, and the AD noted staff had been too busy to provide those activities.
No person-centered activity care plan was developed for a resident with legal blindness, adjustment disorder, and severe cognitive impairment. The resident’s preferences included listening to music and going outside, but the care plan had no activity goals or interventions. Documentation showed only TV, relaxing in the room, and 1:1 hydration/snack support, and the AD said the plan had not been completed because of a busy staff schedule.
Missing Hearing Aid Not Addressed: A resident with severe cognitive impairment and documented hearing difficulty was supposed to receive daily help with bilateral hearing aids, but record review showed no monitoring of placement or removal. During observation, the resident had only one hearing aid and said the other was missing; the RR stated the resident had been admitted with two hearing aids, one was lost months earlier, and the facility had not contacted her about replacement options. Staff and the SW were not consistently aware of the missing device, and the administrator stated she did not know why the issue was not reported for follow-up.
Improper Pureed Food Consistency: Two residents ordered pureed diets were served meals that were thin and runny instead of pudding-like, with liquid separating from the solids. Staff reported the pureed food had repeatedly been thinner than appropriate, and a tray-line observation also found pureed turkey that was not smooth or pudding-like, with water separating from the product.
The facility was found deficient in maintaining cleanliness in its kitchen areas, with significant grease buildup on stove burners, dried food and liquid residues on equipment, and dusty ceiling vents. The kitchen staff failed to adhere to cleaning protocols, and the Dietary Manager was responsible for ensuring cleanliness but did not enforce the protocols.
The facility failed to properly contain garbage and refuse in three dumpsters and one grease interceptor container, leading to an accumulation of trash and debris in the surrounding area. Observations revealed overflowing garbage bags, loose paper products, and leaking grease. Interviews with staff indicated that housekeeping, dietary, and maintenance were responsible for maintaining the area, but inconsistent contractor pick-ups and lack of cleaning contributed to the issue.
The facility failed to provide an adequate activity program for cognitively impaired residents, leaving many without engagement or interaction during scheduled activities. Residents with specific interests in music, religious services, and group activities were not consistently involved, and documentation of participation was lacking. Additionally, a resident was observed without engagement or a working television, highlighting deficiencies in meeting individual needs.
A resident with Diabetes, who was cognitively intact, did not participate in care plan meetings due to a miscommunication with the Social Work Assistant. Despite receiving invitations, the resident was not facilitated to attend, and meetings proceeded without his involvement.
A facility failed to complete an admission MDS and CAA within the required timeframe for a resident with multiple health issues, including fall potential and Parkinson's Disease. The assessments were delayed due to understaffing in the MDS department, as reported by the MDS nurses and the Administrator.
A facility failed to complete a significant change MDS assessment within the required 14 days for a resident. The assessment was completed 16 days after the reference date due to understaffing in the MDS department. The Administrator was unaware of the delay, which was attributed to a high volume of assessments and low staffing.
The facility failed to provide dignified feeding assistance to three residents who required help with meals. Staff were observed standing beside the residents' beds while feeding them, rather than sitting, due to the absence of chairs in the rooms. This practice compromised the residents' dignity, as confirmed by staff interviews and observations.
A resident's credit card was misappropriated by a nurse aide, leading to unauthorized charges totaling $11,670.68. The issue was discovered when the resident's family noticed the charges and reported them to the police. The facility was informed of the investigation, and the nurse aide was suspended pending court proceedings. The facility failed to ensure the security of the resident's belongings, resulting in the misappropriation.
A resident with severe cognitive impairment was discharged from an LTC facility without receiving a written notification of transfer or discharge, including appeal rights. The Resident Representative confirmed the absence of written notice. Facility staff, including a social worker and the Administrator, were unaware of the requirement for written notification for discharges.
A resident with multiple mental health diagnoses was not readmitted to a facility after hospital discharge due to lack of paperwork and claimed bed unavailability, despite being stable. The ADON instructed staff not to accept the resident, leading to the family taking the resident to the emergency room. Interviews revealed beds were available, and the decision was not based on clinical reasons.
A resident assessed as a safe smoker was found with a lighter, contrary to facility policy. The resident, with conditions including COPD and diabetes, was allowed to keep cigarettes but not lighters. Staff interviews revealed inconsistencies in policy enforcement, as some staff believed the resident could keep a lighter. The facility's policy stated that lighters should be stored at the nursing station, highlighting a lapse in supervision and policy adherence.
Failure to Submit Level II PASRR Requests After New Mental Health Diagnoses
Penalty
Summary
The facility failed to submit requests for Level II PASRR evaluations after new serious mental illness diagnoses were identified for residents who had previously been determined Level I PASRR. Record review, staff interviews, and Psychiatric NP interviews showed that the facility did not request Level II PASRR reviews when residents developed diagnoses such as bipolar disorder or schizophrenia after admission, even though the Level I determinations stated that further PASRR screening was required if a significant change occurred suggesting mental illness or a change in treatment needs. For one resident, the record showed a Level I PASRR determination was valid for the stay and that no further screening was required unless a significant change occurred. The resident was admitted with major depressive disorder, later received Risperidone, and was assessed by the Psychiatric NP, who diagnosed bipolar disorder and continued Risperidone for that diagnosis. The diagnosis was later added to the resident’s diagnosis list, and the MDS reflected active depression and bipolar disorder with daily antipsychotic and antidepressant use. The Psychiatric NP stated that a Level II PASRR should have been requested when the new serious mental disorder diagnosis was added, and the Social Worker stated it was her responsibility to submit the request but that it was overlooked. For another resident, the PASRR record showed a Level I determination with no expiration and no further screening unless a significant change occurred. The resident later received a bipolar disorder diagnosis from the Psychiatric NP, and the record showed ongoing psychotropic treatment and MDS documentation of depression and bipolar disorder. The Psychiatric NP confirmed the diagnosis, and the current Social Worker stated the PASRR review should have been completed when the bipolar disorder diagnosis was made. The Administrator also stated that a PASRR review should have been completed when the diagnosis was received. Additional residents had similar findings. One resident admitted with bipolar disorder later received a schizophrenia diagnosis and antipsychotic treatment, but there was no evidence that a Level II PASRR request was submitted. Another resident initially had no bipolar disorder diagnosis, later received a bipolar disorder diagnosis from the Psychiatric NP, and the record showed continued treatment with mood stabilizers and antidepressants, but no evidence of a Level II PASRR request was found. Interviews with the Psychiatric NP, Social Work staff, and the Administrator confirmed that the facility did not submit the required PASRR requests after the new mental health diagnoses were identified.
Improper Food Storage and Unsanitary Kitchen Conditions
Penalty
Summary
Food was found improperly stored in multiple dietary areas, including the dry storage room, walk-in cooler, walk-in freezer, and reach-in refrigerator. In the dry storage area, cups of rice crisp cereal and other dry cereal were observed covered but not labeled or dated, with some stored on an air-dry rack next to wet, recently washed dishes. In the walk-in refrigerator, partially covered pans of broccoli salad and tuna salad, stacked cups of thickened liquids that were wet and unlabeled, and a pan of thawing precooked turkey stored on a middle shelf with food beneath it were observed. The turkey was identified by the District Dietary Manager as precooked frozen turkey placed in water to prevent drying during thawing. In the same refrigerator, a box of cabbage and a bag of shredded cheese were stored beneath or beside the thawing meat, and additional cups of thickened liquids were later observed stacked under unopened cardboard boxes. In the walk-in freezer, a pan of Brussels sprouts was only partially covered and showed ice accumulation, dryness, shriveled leaves, pale color, and freezer burn. An open plastic bag of meat also showed ice buildup, dryness, pale color, and freezer burn, and it was not labeled or dated. Wet cardboard boxes labeled pizza dough were stored under the freezer compressor, and a thin layer of ice was present on the freezer floor and on the transparent curtain near the door. In the reach-in refrigerator, a bin of yellow pureed food had no label or date, a bin of lettuce and sliced tomatoes was labeled with an expired date, and unlabeled cups containing reddish liquid and brownish food were also present. The Dietary Manager identified some of these items as egg salad, tomato soup, and tuna salad, but did not know when they had been stored. The walk-in refrigerator floor was observed to be wet and dirty with brown water, and on follow-up it still had brown water and a muddy floor. The District Dietary Manager stated holes in the floor caused water to rise when someone stepped on it and said the facility had known about the issue for several months. The Maintenance Director stated the refrigerator extended outside the building on a concrete slab over mud and grass, that screws had left holes in the diamond metal plate flooring, and that rainwater seeped through during heavy rainfall. The ceiling above the steam table had two patches with peeling, hanging paint, and an ice machine in the dining hall had black stains on the lid and inside the machine. The Maintenance Director stated the ice machine had not yet received its quarterly cleaning, and the Administrator stated it had previously been cleaned monthly.
Failure to Provide Individualized Activity Programs
Penalty
Summary
The facility failed to provide an ongoing activity program that met the individual interests and needs of three cognitively impaired residents. Resident #32 had diagnoses including dementia with psychotic behavior and Alzheimer's disease, was severely cognitively impaired, and was dependent on staff for all ADLs. Her MDS showed preferences for listening to music, keeping up with news, participating in group activities, and spending time outdoors. Although her care plan called for activities compatible with her abilities and interests, 1:1 bedside or in-room activities when she could not attend group events, and staff assistance and escort to activities, the record contained no activity notes after 3/9/26 through 5/28/26 showing participation in activities of interest. After Resident #32 transferred from the LEU to the 500 hallway, observations showed her sitting alone in a wheelchair in the dining room and near the nursing station, staring ahead or at a towel, with no music, television, or staff interaction. She was also observed lying in bed talking to herself while a television played at low volume on the opposite side of the room, out of her view. Nurse Aide #1 stated activity staff did not come to the rehab unit, the resident could not attend activities without assistance, and there was no music system or television available in the dining room. The Activity Director stated the resident enjoyed preaching, pastor services, color sorting, and matching games, acknowledged that no 1:1 activities were completed and no music or television was available in the dining room, and said the resident would not be triggered for 1:1 activities until the care plan was updated. Resident #44 had diagnoses including Alzheimer's disease, dementia, and major depressive disorder, was severely cognitively impaired, and was dependent on staff for all ADLs. Her MDS identified preferences for listening to music, being around pets, attending religious services, participating in group activities, and going outdoors in good weather. Her care plan required staff support for emotional, intellectual, and social needs, including inviting her to activities, matching activities to her interests and abilities, and providing assistance or escort. After she moved from the LEU to the 500 hallway, there were no activity notes or documentation, and observations showed her sitting alone in the dining room or near the nursing station with no television, music, or staff interaction, and later lying in bed while the television played at low volume and she appeared disinterested. Nurse Aide #1 stated activity staff never came to the rehab unit, there was no music or television available in the dining room, and she could not take the resident to group activities because she needed to provide care to other residents. The Activity Director stated the resident preferred music, acknowledged she had not received activities since moving to the 500 hallway, and said 1:1 visits occurred about once per month. Resident #9 had legal blindness and adjustment disorder with mixed anxiety and depressed mood, and his MDS showed severe cognitive impairment. His activity preferences included listening to music and going outside, but his care plan contained no goals or interventions related to activities. May 2026 documentation showed only self-directed activities such as watching TV and relaxing in his room, along with 1:1 notes for hydration and snacks, with no documentation that he listened to music or went outside. Observations found him lying in bed facing the wall with no music playing, no TV on, and no independent activities available in his room. Nurse Aide #2 stated he was blind, did not like group activities, and she had not seen activity staff provide music or outdoor activities. The Activity Director stated she knew his preferences included music and going outdoors, but due to a busy staff schedule, staff had not been able to provide those preferred activities.
No Person-Centered Activity Care Plan Developed
Penalty
Summary
Facility staff failed to develop a person-centered care plan for Resident #9 in the area of activities. Resident #9 was admitted with diagnoses including legal blindness and adjustment disorder with mixed anxiety and depressed mood, and the comprehensive MDS assessment dated [DATE] showed severe cognitive impairment. The assessment of daily activity preferences indicated it was somewhat important for him to listen to music and go outside. However, the care plan last revised on 3/11/26 contained no goals or interventions related to activities. Review of May 2026 activity participation documentation showed self-directed activities of watching TV and relaxing in the room, and 1:1 activity documentation noted staff provided hydration and snacks. The Activity Director stated Resident #9’s preferences included listening to music and going outdoors but that, due to a busy staff schedule, an activity care plan had not been developed. The Administrator stated the Activity Director was responsible for creating the activity care plan and did not know why it had not been done.
Missing Hearing Aid Not Addressed
Penalty
Summary
The facility failed to identify that a resident’s hearing aids were missing and failed to determine whether an appointment was needed to maintain the resident’s hearing abilities. Resident #81 was admitted with diagnoses including cognitive communication deficit, and the quarterly MDS indicated severe cognitive impairment and moderate hearing difficulty with the use of hearing aids. The care plan stated the resident wore bilateral hearing aids and required staff assistance each day to place them in the morning and remove them at night, with staff to ensure the hearing aids were in place. Record review showed no entries on the MAR or TAR for placement, removal, or monitoring of the resident’s hearing aids. During observation, the resident had one hearing aid in the right ear and none in the left ear, and stated one hearing aid was missing and that she wanted both so she could hear better. The resident representative stated the resident had arrived with two hearing aids, one had been lost about six months earlier, and no one from the facility had contacted her about options for replacement. Nursing staff, the NA, the social worker, and the administrator each indicated they were aware or became aware of the missing hearing aid at different times, but the social worker had not been informed and the administrator stated she was not aware the hearing aid was missing.
Improper Pureed Food Consistency
Penalty
Summary
The facility failed to provide pureed food items with a pudding-like consistency for residents ordered a pureed-texture diet. During a lunch meal observation in the 500-hallway dining room, two residents with meal tickets indicating a regular diet with pureed consistency received trays containing pureed tuna salad, broccoli salad, potato salad, and bread served on divided plates, along with pureed peaches and pears in individual cups. The pureed foods appeared thin and runny, with liquid separating from the solids, and when staff tilted the spoon, the food ran off and did not hold its shape. Nurse Aide #1 and the Scheduler both stated they had repeatedly noticed the pureed food was thinner than appropriate and had reported the concern to the Administrator and Dietary Staff. The residents were not fed until the Dietary Manager arrived to the dining room and observed that the pureed trays were incorrect. The Dietary Manager confirmed the pureed foods were not of a pudding consistency and that liquid had separated, and the trays were remade. Additional observation on the tray line showed pureed turkey on a plated tray was also not pudding-like, with water separating from the product. Dietary Manager #2 stated the turkey had been prepared to the correct consistency but believed condensation from the steam table caused it to become runny, and the District Dietary Manager stated pureed foods must maintain a pudding consistency. The Administrator stated it was her expectation that residents receive the correct diet with the correct consistency and that food consistency should be checked when prepared, on the tray line, and before leaving the kitchen.
Facility Fails to Maintain Cleanliness in Kitchen Areas
Penalty
Summary
The facility failed to maintain cleanliness in the food preparation and service areas, as observed during two kitchen inspections. The inspections revealed significant grease buildup on stove burners, walls, and the front of the stove, along with burnt food and dried liquid splatters. Additionally, the plate warmers contained dried liquid spills and food particles, while the steam table had floating food particles in standing water and greasy buildup on the lids. The drying racks and meal carts also exhibited dried food and liquid residues, indicating a lack of proper cleaning. Furthermore, the ceiling vents above the food preparation and service areas were covered in black dust and debris, which was observed blowing over the steam table and clean dishware storage racks. Interviews with the Maintenance Director and Regional Dietary Director confirmed that the kitchen vents had not been cleaned in several months, and the kitchen staff had not adhered to the cleaning protocols. The Dietary Manager was identified as responsible for ensuring the cleanliness of the kitchen, but the cleaning protocols were not followed, leading to the observed deficiencies.
Improper Garbage Disposal and Maintenance
Penalty
Summary
The facility failed to properly contain garbage and refuse in three dumpsters and one grease interceptor container, leading to an accumulation of trash and debris in the surrounding area. During an initial observation, surveyors noted that the dumpsters and grease interceptor were located near a wooded area at the back of the facility, with large amounts of garbage bags overflowing from the tops. Additionally, loose paper products, boxes, mattresses, furniture, old pallets, clothing, blankets, and food products were found outside the dumpsters on the ground. The grease interceptor container was also leaking grease onto the ground and parking lot. A follow-up observation confirmed that the trash bags filled with garbage remained on the ground, and the area had not been thoroughly cleaned, as evidenced by the remaining paper and food products, pallets, blankets, clothing, and grease around the dumpsters. Interviews with the Maintenance Director and Regional Dietary Director revealed that the dumpster area had been in this condition for some time, with inconsistent pick-ups by the contractor responsible for larger items. The Maintenance Director acknowledged that housekeeping, dietary, and maintenance staff were responsible for maintaining the dumpster area daily, while the Regional Dietary Director was unaware of the last cleaning of the grease interceptor container, which should have been cleaned monthly. The Administrator also confirmed that housekeeping, maintenance, and dietary staff were responsible for keeping the dumpster area clean daily.
Failure to Provide Adequate Activity Program for Cognitively Impaired Residents
Penalty
Summary
The facility failed to provide an ongoing activity program that met the individual interests and needs of several cognitively impaired residents. Observations and interviews revealed that scheduled activities were not consistently conducted, and many residents, including those with specific interests in music, religious services, and group activities, were not engaged in meaningful activities. For instance, on multiple occasions, activities such as daily devotion, puzzles, and painting were either not conducted or only involved a select few residents, leaving others without engagement or interaction. Resident #29, who had a preference for music, news, and current events, was observed sitting without any activity or interaction during scheduled activity times. Similarly, Resident #52, who enjoyed music and religious services, was not provided with the necessary materials or engagement during activities. Resident #137, who had interests in music and group activities, was also left without participation in scheduled activities. The lack of documentation for these residents' participation in activities further highlighted the deficiency in meeting their needs. Additionally, Resident #68, who was severely cognitively impaired and preferred activities like listening to music and being around pets, was observed lying in bed without any engagement or working television. Interviews with staff, including the Activity Director, revealed a lack of awareness and documentation regarding the activities provided to Resident #68. The Activity Director, who was new to the position, had not completed assessments or documentation for the residents, contributing to the deficiency in providing appropriate activities for the residents.
Resident Participation in Care Plan Meetings Not Facilitated
Penalty
Summary
The facility failed to ensure that a resident participated in the development and implementation of their person-centered plan of care. Resident #110, who was cognitively intact and diagnosed with Diabetes, was admitted to the facility and was scheduled for care plan meetings on multiple occasions. Despite receiving invitation letters for these meetings, there was no documentation of Resident #110's participation. The resident confirmed that he had not attended any care plan meetings since his admission, as no one facilitated his attendance. The Social Work Assistant revealed that she expected the resident to reach out to her to choose a time slot for the meetings, which led to a miscommunication. She did not follow up with the resident after handing him the invitation letter to confirm his participation, resulting in the meetings proceeding without his involvement. The Administrator acknowledged the miscommunication between the resident and the Social Work Assistant, which contributed to the resident's lack of participation in his care plan meetings.
Delayed MDS and CAA Completion Due to Staffing Issues
Penalty
Summary
The facility failed to complete an admission Minimum Data Set (MDS) and Care Area Assessments (CAA) within the required 14 days of admission for a resident. The resident was admitted with conditions including fall potential related to medications, neuromuscular issues, incontinence, Parkinson's Disease, nutritional problems, hydration issues, and potential for skin breakdown. The admission MDS was completed 13 days late, and the CAA was completed 10 days late, with care plan decisions finalized 6 days after the CAA. Interviews with MDS nurses revealed that the department was understaffed in December 2024, leading to delays in completing assessments. The Administrator was unaware of the delay and attributed it to the high volume of assessments and low staffing in the MDS department.
Delayed Completion of Significant Change MDS Assessment
Penalty
Summary
The facility failed to complete a significant change Minimum Data Set (MDS) assessment within the required 14 days of the Assessment Reference Date for one resident. Resident #61, who was admitted to the facility, had a significant change MDS assessment with an Assessment Reference Date of 12/13/24. However, the assessment was not signed off as completed until 12/29/24, which was 16 days after the reference date, exceeding the regulatory timeframe. Interviews with the MDS nurses revealed that the MDS department was understaffed during December 2024, leading to difficulties in completing assessments on time. The Administrator was unaware of the delay and attributed it to the high volume of assessments and low staffing in the MDS department.
Failure to Provide Dignified Feeding Assistance
Penalty
Summary
The facility failed to promote care in a dignified manner for three residents who required assistance with meals. Observations revealed that staff members were standing beside the residents' beds while providing feeding assistance, rather than sitting down, which compromised the residents' dignity. Resident #62, who was moderately cognitively impaired and under hospice care, was observed being fed by a nurse aide who stood beside the bed due to the absence of a chair in the room. Similarly, Resident #14, who was severely cognitively impaired, was assisted with eating by a nurse aide standing beside the bed, as there were no chairs available in the room. Resident #68, also severely cognitively impaired and on a special diet due to malnutrition risk, was fed by a nurse aide standing beside the bed, again due to the lack of a chair in the room. Interviews with the nurse aides confirmed that they frequently assisted these residents with feeding while standing, as chairs were not available in the rooms. The facility's administrator acknowledged that staff were trained to sit while assisting residents with eating, but this practice was not followed, leading to the deficiency in providing dignified care.
Misappropriation of Resident's Credit Card by Staff
Penalty
Summary
The facility failed to protect a resident's right to be free from misappropriation of property, resulting in a suspected monetary loss of $11,670.68. The incident involved a resident who was cognitively intact and had been admitted to the facility. The issue came to light when the resident's family noticed unauthorized charges on the resident's credit card statement and reported it to the local police department. The police investigation revealed that the charges began two days after the resident was admitted to the facility. The investigation identified Nurse Aide #7 as the suspect in the unauthorized use of the resident's credit card. The facility's Administrator and Assistant Director of Nursing were informed by a County Deputy about the ongoing investigation and the impending charges against the nurse aide. Despite being contacted by the facility, Nurse Aide #7 denied the allegations. The facility suspended the nurse aide pending the outcome of the court proceedings. Interviews with the resident's family and the arresting officer confirmed the unauthorized use of the credit card while the resident was at the facility. The Business Office Manager was unaware that the resident had a credit card upon admission, and the facility discouraged residents from keeping cash or credit cards on their person. The facility provided lock boxes for safekeeping of valuables, but it appears this measure was not utilized in this case. The facility's failure to ensure the security of the resident's belongings led to the misappropriation of the resident's property.
Failure to Provide Written Discharge Notification
Penalty
Summary
The facility failed to provide a written notification of transfer or discharge, including notification of appeal rights, to a resident and their representative. The resident, who had severe cognitive impairment, was initially transferred to the hospital for psychiatric evaluation and involuntary commitment. Upon returning to the facility, the resident was discharged home without receiving the required written notice. The Resident Representative confirmed that neither she nor the resident received a written notice of the discharge. Interviews with facility staff, including a social worker and the Administrator, revealed a lack of awareness regarding the requirement to provide written notification for discharges to the hospital or community.
Facility Fails to Readmit Resident After Hospital Discharge
Penalty
Summary
The facility failed to permit a resident to return after hospitalization, despite the hospital assessing the resident as stable and ready for discharge back to the facility. The resident, who had multiple diagnoses including anxiety, depression, schizophrenia, and bipolar disorder, was initially involuntarily committed due to aggressive behaviors and medication refusal. Upon stabilization, the hospital discharged the resident back to the facility, but the facility did not accept the resident due to a lack of discharge paperwork and claimed unavailability of beds. The Assistant Director of Nursing (ADON) instructed staff not to accept the resident back without proper paperwork, despite the resident being stable and having no behavioral issues upon return. The facility did not have documentation of unmanageable behaviors upon the resident's return, and the ADON did not contact the hospital for discharge orders until the following day. The resident's family was informed they needed to pick up the resident, and the resident was eventually taken to the emergency room by the family due to the facility's refusal to readmit her. Interviews with staff and the resident's representative revealed that the facility had available beds at the time of the resident's return, contradicting the initial claim of unavailability. The facility's decision not to readmit the resident was based on the lack of discharge paperwork and the ADON's instructions, rather than any clinical reason. The resident's representative felt pressured to take the resident home, despite being unable to care for her, leading to the resident being taken to the emergency room for further care.
Failure to Secure Smoking Materials for Resident
Penalty
Summary
The facility failed to secure smoking materials, specifically a lighter, for a resident who was assessed as a safe smoker. The resident, who had diagnoses including chronic obstructive pulmonary disease, diabetes mellitus type 2, and nicotine dependence, was readmitted to the facility and assessed as cognitively intact. The care plan indicated that the resident could smoke independently and did not require supervision, with smoking supplies to be stored at the nurse's station. However, during observations, the resident was found to have a lighter in her possession, which was against the facility's policy that no residents should keep lighters or matches. Staff interviews revealed inconsistencies in the understanding and enforcement of the smoking policy. A Medication Aide stated that the resident was a safe smoker and could keep her smoking materials, including a lighter, which contradicted the facility's policy. The Assistant Director of Nursing and the Assistant Social Worker confirmed that while the resident could keep cigarettes, lighters should be stored at the nursing station. The Administrator reiterated that residents assessed as safe smokers should not have lighters, indicating a lapse in policy enforcement and supervision, leading to the deficiency.
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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 Yanceyville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Stratford Healthcare Center | 11.8 mi | ★★★★★ | 0 | 0 |
| Riverside Health & Rehab Cntr | 13 mi | ★★★★★ | 0 | 0 |
| Piney Forest Health And Rehabilitation Center | 13.7 mi | ★★★★★ | 0 | 0 |
| Roman Eagle Rehabilitation And Health Care Center | 14.5 mi | ★★★★★ | 0 | 0 |
| Penn Nursing Center | 18.1 mi | ★★★★★ | 0 | 0 |
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