Bells Nursing and Rehab: Unreported Fracture Violation - TN
The resident, identified in federal inspection records only as Resident #94, has aphasia. She cannot speak for herself. She cannot explain how she was hurt. She cannot tell a nurse what happened or ask why no one is calling a doctor. She is paralyzed on her right side, which is also severely contracted at baseline, and she is bed bound. When a bruise appeared on that right arm, running dark red from her wrist to her elbow, she had no way to report it herself.
Someone else had to do that. Nobody did. Not right away.
A licensed practical nurse, identified in the inspection report as LPN D, was called to look at the bruise on the evening of July 13, 2025, after shift change at 7:20 p.m. He saw it. He described it himself, months later, to federal inspectors: dark red, wrist to elbow. He confirmed in a telephone interview on August 13, 2025, that he failed to immediately notify the provider and the Director of Nursing.
The previous shift had already left for the evening.
The bruise was on a woman who is paralyzed on the side where the bruise appeared, in a facility where she cannot advocate for herself. LPN D did not call the provider. He did not call the DON. He instructed staff to use caution when repositioning her and moved on.
The next morning, July 14, management learned about the bruise. An assessment documented a dark red discoloration on the resident's forearm measuring 24 centimeters long and 7 centimeters wide. The provider was notified. No new orders were written. The resident denied pain or discomfort, though given her aphasia, the weight of that denial is difficult to assess. The report notes she was not able to communicate how the injury may have occurred.
It was not until July 15, 2025, that an x-ray was performed at the nursing home. The radiology results, timestamped 9:16 a.m., revealed a fracture to the right humerus, the upper arm bone.
Resident #94 was transferred to a hospital emergency department. The ED triage notes, dated July 15 at 1:51 p.m., record that she was admitted with bruising to the right arm and a humeral fracture confirmed by the x-ray taken at the facility. Staff reported to Emergency Medical Services that the bruising had first been observed on July 14, 2025, and that they were unsure how the injury occurred because the patient is bed bound and paralyzed on the right side, which is also severely contracted at baseline.
The bruising had actually been observed on July 13.
The facility's own Regional Nurse Consultant confirmed during an interview on August 13, 2025, that Resident #94 had an injury of unknown origin on July 13, and that management was not made aware until July 14. She confirmed that all injuries of unknown origin should be reported by staff when found.
An injury of unknown origin on a paralyzed, bed-bound resident who cannot speak is exactly the kind of event that demands an immediate call. It demands a call because the cause is unknown. It demands a call because the resident cannot explain what happened. It demands a call because the range of explanations, when a woman who cannot move her arm and cannot talk ends up with a bone broken in that arm, is not a range that permits waiting until morning.
The administrator of Bells Nursing and Rehabilitation Center confirmed during an interview on August 14, 2025, that allegations of abuse, injuries of unknown origin, and allegations of misappropriation of resident property should be reported to the state.
The inspection was a complaint investigation. The visit took place on August 14, 2025. Federal inspectors cited the facility for failing to ensure that an injury of unknown origin was reported immediately, as required. The level of harm was cited as minimal harm or potential for actual harm. A few residents were identified as affected.
That designation, minimal harm, sits uneasily against the facts in the record. Resident #94 had a fractured humerus. She spent time in an emergency department. She is a woman who cannot move her right arm, cannot speak, and cannot tell anyone what broke her bone or when the pain started or whether anyone hurt her. The question of how her arm was fractured was never answered in the inspection report. It remains, in the language of the citation itself, an injury of unknown origin.
What the record shows is a bruise seen on the night of July 13 by a nurse who chose not to make a phone call. A fracture discovered by x-ray the following afternoon. A woman transferred to an emergency department nearly two days after someone first noticed something was wrong with her arm. A report to EMS that placed the discovery of the bruising one day later than it actually occurred.
LPN D, in his own words to inspectors, confirmed he failed to act. The Regional Nurse Consultant confirmed the timeline. The administrator confirmed what the reporting obligations are.
Resident #94 could not confirm anything. She never could.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Bells Nursing and Rehabilitation Center from 2025-08-14 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.
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Last verified: November 6, 2026 · Our methodology
BELLS NURSING AND REHABILITATION CENTER in BELLS, TN was cited for violations during a health inspection on August 14, 2025.
The resident, identified in federal inspection records only as Resident #94, has aphasia.
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.