NHC Healthcare, Bristol

Inspectors wroteBased on resident interview, staff interview, clinical record review, and facility document review, the facility staff failed to ensure the resident environment remains as free of accident hazards as is possible as evidenced by failure to lock the shower chair breaks prior to transfer resulting in a fall with a subsequent fracture for 1 of 16 sampled residents (Resident #7).

Inspectors wroteBased on staff interview, clinical record review, and facility document review, the facility staff failed to follow medical provider orders for medication administration for 6 of 16 sampled residents (Resident #10, #11, #12, #13, #14, and #15).

Inspectors wroteBased on staff interview, record review and facility document review, the facility staff failed to report an allegation of verbal abuse for one of 16 residents in the survey sample, resident # 1. For resident # 1 (R1), the facility staff failed to report an allegation of staff to resident verbal abuse. R1's diagnoses included but were not limited to dementia with behavior disturbance, psychotic disturbance, mood disturbance, anxiety, and adult failure to thrive. The minimum data set assessment (MDS) with an assessment reference date of 7/7/25 assigned the resident a brief interview for mental status score of 3 out of 15 indicating severe cognitive impairment. Attempts to interview R1 were unsuccessful. On 8/19/25 this surveyor asked the facility Administrator for any Facility Reported Incidents or investigations involving R1 from May of 2024. [...]

Inspectors wroteBased on observation and staff interviews, the facility staff failed to follow professional standards of practice as evidenced by the presence of physician pre-signed blank Virginia Department of Health DDNR (Durable Do Not Resuscitate) Order forms on 2 of 2 nursing care units.

Inspectors wroteBased on observation, staff interview, and facility document review, the facility staff failed to ensure the resident environment remained free of accident hazards on 2 of 2 nursing care units, second and third floors.

Inspectors wrote2. For Resident #2, the facility staff failed to accurately complete the resident's DDNR (Durable Do Not Resuscitate) Order form. All boxes on the DDNR Order form were left unchecked. This DDNR Order form was part of the resident's electronic health record and filed in a DDNR binder on the nursing unit. Resident #2's diagnosis list indicated diagnoses, which included, but not limited to Other Early-Onset Cerebellar Ataxia, Adult Failure to Thrive, Unspecified Dementia with Behavioral Disturbance, and Post-Traumatic Hydrocephalus Unspecified. The most recent admission MDS (minimum data set) with an ARD (assessment reference date) of 7/07/21 coded the resident as being severely impaired in cognitive skills for daily decision making with short-term and long-term memory loss. [...]

Inspectors wroteBased on staff interview, facility document review and clinical record review the facility staff failed to ensure that residents receive treatment and care by following physician's orders for 1 of 24 Residents, Resident #12

Inspectors wroteBased on staff interview and clinical record review the facility staff failed to ensure 1 of 24 residents was free from unnecessary medications, Resident #12.

Inspectors wroteBased on staff interview and clinical record review, the facility staff failed to notify the Physician of blood sugars greater than 400, for one of 23 Residents, Resident #43. Per Clinical Record Review Resident #43 was admitted to the facility on [DATE]. Diagnosis included, but were not limited to: Chronic, Pain, Diabetes Mellitus, Aftercare following explanation of shoulder joint prosthesis, Altered Mental Status, History of Falling, Orthostatic Hypotension, and Muscle Weakness (Generalized). Section C (cognitive patterns) of the Residents quarterly MDS (minimum data set) assessment with an ARD (assessment reference date) of 07/12/18 included a BIMS (brief interview for mental status) summary score of 15 out of a possible 15 points. The Residents CCP (comprehensive care plan) included the problem area; Diabetes related to the diagnosis DM (diabetes mellitus). [...]

Inspectors wroteBased on observation, staff interview, clinical record review and facility document review it was determined that the facility staff failed to store respiratory equipment in a clean and sanitary manner for 6 of 24 Residents in the sample survey, Resident #73, Resident #19, Resident #29, Resident #32, Resident #34 and Resident #68. The Findings Included: 1. For Resident #73 the facility staff failed to store a nasal cannula and a nebulizer in a clean and sanitary manner. Resident #73 was an [AGE] year old female who was admitted on [DATE]. Admitting diagnoses included, but were not limited to: fractured femur, history of falling, chronic obstructive pulmonary disease, Alzheimer's, hypertension and dementia with behaviors. The most current Minimum Data Set (MDS) assessment located in the clinical record was a 14-Day MDS assessment with an Assessment Reference Date (ARD) of 8/5/18. [...]

Inspectors wroteBased on staff interview and clinical record review, the facility staff failed to follow physician orders in regards to pain management for one of 23 Residents, Resident #43.

Inspectors wroteBased on staff interview and clinical record review it was determined that the facility staff failed to ensure a complete and accurate Minimum Data Set (MDS) assessment for 1 of 24 Residents in the sample survey, Resident #73. The Findings Included: For Resident #73 the facility staff failed to code/capture the use of oxygen on a 14-Day Medicare Minimum Data Set (MDS) assessment with an Assessment Reference Date (ARD) of 8/5/18. Resident #73 was an [AGE] year-old female who was admitted on [DATE]. Admitting diagnoses included, but were not limited to: fractured femur, history of falling, chronic obstructive pulmonary disease, Alzheimer's, hypertension and dementia with behaviors. The most current Minimum Data Set (MDS) assessment located in the clinical record was a 14-Day MDS assessment with an Assessment Reference Date (ARD) of 8/5/18. [...]

Inspectors wroteBased on observation, resident interview, staff interview, and clinical record review, the facility staff failed to provide oral care to 1 of 23 residents (Resident #34).

Inspectors wroteBased on staff interview and clinical record review it was determined that the facility staff failed to follow physician orders for 2 of 24 Residents in the sample survey, Resident #73 and Resident #393. The Findings Included: 1. For Resident #73 the facility staff failed to administer oxygen at 4 liters per minute and failed to administer physician ordered Divalproex and Ipratropium-Albuterol. Resident #73 was an [AGE] year-old female who was admitted on [DATE]. Admitting diagnoses included, but were not limited to: fractured femur, history of falling, chronic obstructive pulmonary disease, Alzheimer's, hypertension and dementia with behaviors. The most current Minimum Data Set (MDS) assessment located in the clinical record was a 14-Day MDS assessment with an Assessment Reference Date (ARD) of 8/5/18. [...]

Inspectors wroteBased on staff interview and clinical record review, the facility staff failed to ensure 1 of 23 residents (Resident #35) was free of an unnecessary medication.

Inspectors wroteBased on staff interview and clinical record review the facility failed to keep an accurate clinical record for two of 23 Residents, Resident #43 and Resident #34.