Westport Rehab: Care Plan Wrong for Paralyzed Resident - VA
The man, identified in inspection records only as R1, was admitted to Westport Rehabilitation and Nursing Center with paraplegia, among other diagnoses. His most recent assessment recorded that walking had not been attempted due to medical condition or safety concerns. He used a wheelchair. He had a foley catheter. He was, by every clinical measure on file, not walking anywhere.
His care plan said otherwise. A document dated January 2025 and revised as recently as September 27, 2025, listed fall prevention interventions that included ensuring the resident wore shoes when ambulating and reminding him to use his call light before getting up. The revision happened less than a month before federal inspectors arrived.
Two nurses who had cared for him said the same thing when asked. LPN #1 told inspectors on October 20 that R1 "could not walk and he had a foley." When shown the shoe intervention and asked whether the care plan was correct, she said no. When asked if it should have been revised, she said yes. LPN #2, interviewed the following morning, said he could not walk and used a wheelchair.
Nobody had revised it.
R1 had been transferred to a hospital before the inspection and was not in the facility when inspectors arrived. His sister had been visiting the day his catheter was changed, shortly before he left.
Inspectors cited the facility for failing to keep the care plan current, a finding rated at minimal harm. The director of nursing, the administrator, and the assistant director of nursing were informed of the findings on the morning of October 22.
No further information was provided before inspectors left the building.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Westport Rehabilitation and Nursing Center from 2025-10-22 including all violations, facility responses, and corrective action plans.
Download the official CMS inspection PDF from Medicare.gov
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: September 5, 2026 · Our methodology
WESTPORT REHABILITATION AND NURSING CENTER in RICHMOND, VA was cited for violations during a health inspection on October 22, 2025.
The man, identified in inspection records only as R1, was admitted to Westport Rehabilitation and Nursing Center with paraplegia, among other diagnoses.
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.