Average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
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 Williamsburg Post Acute & Rehabilitation during CMS and state inspections, most recent first.
Facility staff failed to ensure that routine and necessary medications were available and administered as ordered for three residents with complex medical needs. Multiple medications were repeatedly documented as unavailable, on order, or delayed, with no consistent evidence that physicians were notified or alternative therapies arranged according to facility policy. Nursing staff interviews revealed inconsistent understanding of procedures for handling unavailable medications, and the interim DON acknowledged issues with pharmacy refill processes.
Three residents with complex medical histories did not receive multiple prescribed medications as ordered due to unavailability, lack of timely pharmacy delivery, and inconsistent staff response. Despite facility policy requiring physician notification and consideration of alternative therapies, there was no documentation that these steps were taken. Nursing staff interviews revealed uncertainty about proper procedures, and leadership acknowledged process gaps that contributed to the medication errors.
The facility did not designate a qualified Infection Preventionist to oversee the Infection Prevention and Control Program, resulting in incomplete infection control documentation and a lack of consistent, specialized oversight for several months after the departure of the previous staff member responsible for this role.
Facility staff failed to notify physicians and resident representatives about significant changes in condition and medication availability for two residents with complex medical needs. Despite repeated documentation of unavailable medications and abnormal vital signs, there was no evidence that required notifications were made, as confirmed by staff interviews and policy review.
The facility staff did not adhere to expiration dates for OTC medications. A medication cart check revealed a bottle of Thiamine Vitamin B-1 with an expiration date of July 2024, marked as opened in October 2024. An RN acknowledged the error, and the DON was informed. Facility policy requires expired medications to be disposed of within 30 days of expiration.
A resident with multiple medical conditions, including chronic pain, did not receive prescribed wound treatments and pain medications on several occasions. The facility's staff failed to document or notify the physician about these omissions, and the DON and Administrator were unaware until informed by surveyors.
A resident's antifungal powder was found unsecured on a bedside table, contrary to facility policy requiring medications to be stored in locked compartments. The RN Unit Manager acknowledged the oversight, noting that staff should have secured the medication during their visits to the room.
The facility staff failed to properly store, label, and date food items in two of the facility's refrigerators/freezers. During a kitchen tour, it was observed that opened bags of crinkle-cut french fries and round meat patties were not labeled or dated. Additionally, the beverage and walk-in refrigerators contained dirt and debris, including food and beverage spillage. The Dietary Manager acknowledged these issues, which violated the facility's policy on food storage and refrigerator maintenance.
Failure to Ensure Availability and Administration of Routine Medications
Penalty
Summary
Facility staff failed to ensure that routine and necessary medications were available and administered as ordered for three residents. For one resident with multiple complex diagnoses including hemiplegia, heart failure, atrial fibrillation, and a history of stroke, there were repeated instances documented in the clinical record where medications such as saline nasal mist, Umeclidinium-Vilanterol inhaler, cholecalciferol, lidocaine patches, and fiber supplements were not available for administration. Progress notes repeatedly indicated that medications were 'awaiting pharmacy delivery,' 'med missing,' or 'med not on cart,' with no evidence that the attending physician was consistently notified or that alternative therapies were arranged as per facility policy. Another resident with Parkinson's disease, diabetes, and a history of CVA had orders for medications including Eliquis, sertraline, and carbidopa-levodopa. Documentation showed that these medications were not available on multiple occasions, with notes such as 'reordered,' 'awaiting pharmacy,' and 'med on order.' Despite the facility's policy requiring notification of the physician and pharmacy when medications are unavailable, there was no documentation that the physician was contacted regarding the unavailability of these critical medications. A third resident with chronic obstructive pulmonary disease, diabetes, and multiple other chronic conditions also experienced repeated unavailability of prescribed medications, including dapagliflozin, Incruse Ellipta, Buspar, and ipratropium. Medication administration records and progress notes over several months indicated that these medications were frequently not available, on order, or delayed due to insurance issues, with no evidence that the medical provider was notified in a timely manner. Interviews with nursing staff revealed inconsistent understanding of the procedures to follow when medications are unavailable, and the interim DON acknowledged that some residents were not entered into the pharmacy's automatic refill program, contributing to the ongoing medication availability issues.
Failure to Ensure Residents Are Free from Significant Medication Errors
Penalty
Summary
Facility staff failed to ensure that three residents were free from significant medication errors, as evidenced by multiple instances where prescribed medications were not administered according to physician orders. For one resident with a history of stroke, heart failure, and pneumonia, medications including Levoquin, Umeclidinium-Vilanterol, and dexamethasone were documented as unavailable on several occasions. Despite the presence of alternative medications in the Omnicell and a facility policy requiring physician notification and alternative therapy consideration, there was no documentation that the physician was notified or that alternative medications were considered or administered. Another resident with Parkinson's disease, diabetes, and a history of CVA did not receive Eliquis, Carbidopa-Levodopa, and sertraline as ordered. The clinical record showed repeated notations of medications being on order or awaiting pharmacy delivery, even though some of these medications were available in the Omnicell. There was no evidence that the physician was notified about the unavailability of these medications, nor was there documentation of any action taken to address the missed doses as required by facility policy. A third resident with multiple chronic conditions, including COPD, diabetes, and vascular dementia, also experienced missed doses of several medications such as Dapagliflozin, Incruse Ellipta, Buspar, and Ipratropium. Medication administration records and nurses' notes repeatedly indicated that medications were not available, on order, or delayed due to insurance issues, with no evidence that the medical provider was notified in a timely manner. Interviews with nursing staff revealed inconsistent understanding of the procedures to follow when medications were unavailable, and the Interim Director of Nursing acknowledged that some residents were not entered into the pharmacy's automatic refill program, contributing to the medication errors.
Failure to Designate Qualified Infection Preventionist for Infection Control Program
Penalty
Summary
The facility failed to designate a qualified individual as the Infection Preventionist (IP) responsible for overseeing the Infection Prevention and Control Program (IPCP). Review of facility documents revealed that the infection control tracking logs and related documentation were incomplete for several months, with missing information such as onset date, infection site, diagnosis, lab results, organism, antibiotics, isolation status, healthcare-associated infection status, and resolution date for multiple residents. The infection control binder also showed incomplete tracking logs, McGeer's criteria, mapping, and monthly reports from May onward. Interviews with the Interim Director of Nursing and the Regional Director of Clinical Services confirmed that the facility had not filled the IP position after the former Assistant Director of Nursing left in April, resulting in several staff members overseeing the program without clear designation or consistent specialized training. Certification records provided did not cover the period from May through August, indicating a gap in qualified oversight. Facility policies required the IP to have specific training and responsibilities, but no evidence was provided that these requirements were met during the identified period.
Failure to Notify Physician and Resident Representative of Changes in Condition and Medication Availability
Penalty
Summary
Facility staff failed to notify physicians and resident representatives of significant changes in condition and medication availability for two residents. For one resident with a history of multiple strokes, heart failure, and other complex medical conditions, staff did not inform the physician about changes in condition or the unavailability of prescribed dexamethasone for pneumonia. Progress notes repeatedly documented that the medication was pending pharmacy delivery over several days, but there was no evidence of physician notification as required by facility policy. Interviews with nursing staff confirmed that the expected protocol was to notify the physician and family if a medication was unavailable or delayed, but this was not followed. For another resident with chronic obstructive pulmonary disease, diabetes, heart failure, and other serious diagnoses, staff failed to notify the physician or nurse practitioner of multiple low blood pressure and pulse readings, as well as ongoing shortness of breath after a breathing treatment. The clinical record showed that the resident had not received several prescribed medications due to unavailability, with documentation indicating medications were on order or awaiting insurance approval. Despite these issues, there was no evidence that the physician or nurse practitioner was informed about the missed doses or the resident's ongoing symptoms. Facility policy required nursing staff to notify the attending physician of unavailable medications and changes in resident condition, explain the circumstances, and seek alternative orders if necessary. Interviews with nursing staff and the interim DON revealed inconsistent understanding and implementation of these procedures. The deficiencies were identified through clinical record review, staff interviews, and policy review, with no documentation of required notifications to physicians or resident representatives in the cases reviewed.
Failure to Remove Expired OTC Medications
Penalty
Summary
The facility staff failed to adhere to the expiration dates for over-the-counter (OTC) medications in bulk containers. During a medication cart check on the Colonial Unit, a bottle of Thiamine Vitamin B-1 was found with an expiration date of July 2024, yet it was marked as opened on October 17, 2024, which is after the expiration date. Registered Nurse (RN) #1 acknowledged that the medication should have been removed from the cart and could not explain why it was marked as open after its expiration. The facility policy requires expired medications to be disposed of within 30 days of expiration with another nurse present. The Unit Manager and the Director of Nursing (DON) were informed of the observation, and the DON stated that she checked other medication carts in the facility for expired drugs.
Failure to Administer Medications and Treatments as Ordered
Penalty
Summary
The facility staff failed to maintain professional standards of medication and treatment administration for a resident with multiple medical conditions, including osteomyelitis, chronic pain syndrome, and PTSD. The resident, who was cognitively intact but dependent on staff for daily activities, reported persistent itching and pain, indicating a need for medicated cream and more pain medication. Physician orders for wound treatments and pain medications were not consistently followed, as evidenced by missing nursing signatures on the Medication and Treatment Administration Records (MAR/TAR) for several dates in February and April 2024. The omissions included wound treatments such as foam border gauze, xeroform dressing, collagen sheet, and betadine, as well as pain medications like fentanyl patches, hydromorphone, methocarbamol, and Percocet. The nursing staff did not document reasons for these omissions, nor did they notify the physician or the resident's family. Interviews with nursing staff confirmed that if treatments and medications were not documented, they were not administered. The Director of Nursing (DON) and Administrator were unaware of these omissions until informed by surveyors, and no further information was provided by the facility regarding these failures.
Medication Storage Deficiency
Penalty
Summary
The facility staff failed to store medication securely for a resident, leading to a deficiency in medication storage practices. During an observation, a surveyor found a 3-ounce bottle of antifungal powder with a prescription label, including the resident's name and other identifying information, on the resident's bedside table. The medication was not stored in a locked compartment as required by facility policy and professional principles. The resident mentioned that his wife had brought the medication in a few days prior, and he was unsure if it was being used by the nursing staff. An interview with the RN, who also served as the Unit Manager, revealed that the medication should not have been left unsecured and that it was against both his expectations and the facility's policy. The RN acknowledged that staff had been in the room multiple times that day and should have noticed and secured the medication. The facility's policy on medication storage mandates that all drugs and biologicals be stored safely, securely, and in an orderly manner. The Facility Administrator was informed of the findings, but no further information was provided.
Deficiencies in Food Storage and Cleanliness
Penalty
Summary
The facility staff failed to properly store, label, and date food items in two out of four refrigerators/freezers located within the facility's main kitchen. During a kitchen tour with the Dietary Manager (DM), it was observed that a partial bag of crinkle-cut french fries and a partial bag of round meat patties, both previously opened, were not labeled or dated in the vegetable and meat freezers, respectively. The DM acknowledged that these items should have been labeled and dated to identify potential food allergens and to ensure food safety. Additionally, the facility staff did not maintain cleanliness in the beverage refrigerator and the walk-in refrigerator. Observations revealed dirt and debris, including food and beverage spillage, on the floors of these refrigerators. The DM admitted that the condition was unacceptable and required cleaning. The facility's policy on food storage and refrigerator maintenance, dated 10/1/21, mandates that food storage areas be kept clean and that all foods in refrigerators or freezers be covered, labeled, and dated. The policy also requires that refrigerators and freezers be kept clean and free of debris.
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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 Williamsburg
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Woodhaven Hall At Williamsburg Landing | 2.3 mi | ★★★★★ | 6 | 1 |
| Jamestown Health And Rehabilitation | 3.6 mi | ★★★★★ | 0 | 0 |
| Windsormeade Of Williamsburg | 3.9 mi | ★★★★★ | 0 | 0 |
| Riverside Lifelong Health & Rehabilitation Patri | 4.9 mi | ★★★★★ | 0 | 0 |
| Walter Reed Post Acute | 13.9 mi | ★★★★★ | 0 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.