Bells Nursing and Rehab: Unreported Fracture Violation - TN
The resident, identified in inspection records only as Resident 94, was found to have a fracture to the right humerus, the upper arm bone, according to a radiology report dated July 15, 2025. By that point, the bruising had been visible since at least the evening of July 13. Nobody in management knew about it until July 14.
Bells Nursing and Rehabilitation Center, located in Bells, Tennessee, was cited following a complaint inspection completed August 14, 2025. The violation centered on a single failure: a nurse saw a serious injury on a vulnerable resident and did not immediately report it as required.
The bruise was not subtle. When Licensed Practical Nurse D was called to look at Resident 94 on the evening of July 13, after the shift change at 7:20 p.m., he found dark red discoloration running the full length of the forearm, from wrist to elbow. Inspection records document the affected area measured 24 centimeters long and 7 centimeters wide.
LPN D confirmed to inspectors that he failed to immediately notify the provider and the Director of Nursing.
Resident 94 could not explain what happened. The resident is bed bound, paralyzed on the right side, and has aphasia, a condition that impairs the ability to communicate. When assessed, the resident denied pain or discomfort in the affected area. No new orders were issued that night. The previous shift had already left. Staff were told to use caution when repositioning the resident, and that was the extent of the response.
The question of how the injury occurred was never answered. The resident is paralyzed on the right side and bedridden, with the right arm described as severely contracted at baseline. When staff reported to Emergency Medical Services on July 15, they said the bruising had been observed the day before and that they were unsure how it happened, given the resident's condition. A bed-bound person with a paralyzed, contracted arm does not typically fracture that arm without some external force.
Inspectors reviewed the emergency department triage notes from the hospital where Resident 94 was taken on July 15. Those notes, timestamped 1:51 p.m., show the resident was admitted with bruising to the right arm and a humeral fracture confirmed by an x-ray performed at the nursing home. The facility had the imaging. They knew what they were looking at before the ambulance was called.
The facility's own Regional Nurse Consultant, interviewed by phone on August 13, confirmed that all injuries of unknown origin should be reported by staff when found. The same consultant confirmed that Resident 94 had an injury of unknown origin on July 13, and that management was not made aware until July 14.
That confirmation matters. This was not a dispute between the facility and inspectors about whether a rule applied. The facility's own regional clinical leadership acknowledged the injury should have been reported immediately, and acknowledged it was not.
The administrator, interviewed on August 14, confirmed that allegations of abuse, injuries of unknown origin, and allegations of misappropriation of resident property should be reported to the state. That statement, offered near the end of the inspection, was accurate as a matter of policy. It did not address why no one had acted on it in the days after Resident 94's arm was broken.
What the inspection record describes is a gap in accountability that ran through an entire night. A nurse saw a large, dark red bruise covering the forearm of a paralyzed, nonverbal resident. He did not call the doctor. He did not call the Director of Nursing. The shift had changed, the previous staff had gone home, and no one with authority to investigate or report was notified. The resident lay in her bed, unable to say what had happened to her, while the window for an immediate investigation closed.
Injuries of unknown origin in nursing homes carry a particular weight precisely because of residents like Resident 94. When someone cannot speak, cannot move, cannot summon help, and cannot describe what was done to them, the obligation to investigate and report falls entirely on the staff around them. The reporting requirement exists because the resident cannot report for herself.
The bruise was visible for more than twenty-four hours before it became an emergency department record. The fracture was confirmed by x-ray at the facility before anyone called EMS. At some point between the evening of July 13 and the afternoon of July 15, the injury moved from something staff were watching to something that required a hospital.
What happened in between is not fully documented in the inspection record. LPN D confirmed his own failure. Management confirmed they were not notified until the following day. The Regional Nurse Consultant confirmed the delay was not acceptable. The administrator confirmed what the rules require.
None of that tells Resident 94 anything. She has aphasia. She was never able to communicate how the injury occurred.
The inspection cited the violation at a level of minimal harm or potential for actual harm, affecting a few residents. That classification reflects the regulatory framework's assessment of scope and severity. It does not capture what it means to be paralyzed, nonverbal, and dependent on the people around you to notice when something is wrong and to say something about it immediately. In this case, they noticed. They waited.
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.
Corrections: We strive for accuracy in everything we publish. If you believe any fact in this article is incorrect, please contact us with details, and we will review and correct it promptly.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
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.
By that point, the bruising had been visible since at least the evening of July 13.
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.