Riverside Lifelong: Family Not Told of Wounds - VA
Licensed Practical Nurse #6 at Riverside Lifelong H & R Warwick Forest told federal inspectors she had assumed the resident's daughter had been notified when the wounds were first identified. But after conducting a chart audit, she realized no one had contacted the family initially.
The nurse finally called the daughter on July 21 — 12 days after staff discovered both an unstageable sacral wound and a stage 2 wound on the resident's buttocks.
LPN #6 wasn't working the day the wounds were found. She told inspectors it's "not acceptable to first identify a wound as unstageable," acknowledging problems with how staff initially assessed the resident's condition.
The Director of Nursing described the sacral area as having yellow slough on July 9, with a sheared area on the buttocks. Yellow slough indicates dead tissue that can impede healing and increase infection risk.
While the family remained unaware, the Director of Nursing did contact hospice services on July 9, the same day the wounds were discovered.
The inspection occurred after a complaint was filed about the facility. Federal inspectors interviewed multiple staff members over several days in August to piece together what happened.
During the pre-exit interview on August 25, inspectors shared their findings with the Administrator, Director of Nursing, and Corporate Consultant. The facility leadership offered no comments and voiced no concerns about the delayed family notification.
The violation falls under federal regulations requiring nursing homes to immediately inform residents and their representatives of changes in condition. Unstageable wounds represent serious injuries where the full extent of tissue damage cannot be determined due to slough or other covering.
Stage 2 wounds involve partial thickness loss of skin layers. Combined with an unstageable injury, these wounds indicated significant deterioration in the resident's condition that family members had a right to know about immediately.
The 12-day delay meant the resident's daughter missed nearly two weeks of potential involvement in care decisions during a critical period when wounds were developing and being assessed.
LPN #6's admission that initially classifying the wound as unstageable was unacceptable suggests staff may have lacked proper training in wound assessment protocols. Accurate staging helps determine appropriate treatment approaches.
The facility's response during the exit interview — offering no comments or concerns — indicates administration did not dispute the inspectors' findings about the delayed notification.
Federal inspectors classified this as a violation with minimal harm or potential for actual harm affecting few residents. However, the failure to notify family members of significant changes in condition represents a fundamental breach of communication requirements.
The inspection report does not indicate what corrective measures the facility planned to implement to prevent similar communication failures in the future.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Riverside Lifelong H & R Warwick Forest from 2025-08-25 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 21, 2026 · Our methodology
RIVERSIDE LIFELONG H & R WARWICK FOREST in NEWPORT NEWS, VA was cited for violations during a health inspection on August 25, 2025.
But after conducting a chart audit, she realized no one had contacted the family initially.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.