Riverview Health & Rehab Ctr

F-F610

3. Administration failed to provide ongoing abuse and behavioral training to staff related to care for residents with repeated acts of abuse and hypersexual behaviors.

Cross Refer

F-F740

On 2/5/2025, a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had caused, or had the likelihood to cause, serious injury, harm, impairment, or death to residents.

The facility's Administrator and Director of Nursing (DON) were informed of the Immediate Jeopardy (IJ) on 2/5/2025 at 5:54 pm. The noncompliance related to Immediate Jeopardy (IJ) was identified to have existed

on 10/28/2024.

A Credible Allegation of Compliance was received on 2/10/2025. Based on observations, record review, resident and staff interviews, and review of facility policies as outlined in the Credible Allegation of Compliance, it was validated that the corrective plans and the immediacy of the deficient practice was removed as of 2/10/2025. The facility remains out of compliance while the facility continues management level oversight as well as continues to develop and implement a Plan of Correction. (POC).This oversight process includes the analysis of facility staff's conformance with the facility's policies and procedures regarding preventing, reporting, and investigating abuse.

Findings include:

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 46 of 53 115641 Department of Health & Human Services Printed: 09/08/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 115641 B. Wing 02/12/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Riverview Health & Rehab Ctr 6711 Laroche Avenue Savannah, GA 31406

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0835 Review of the blank document titled, Job Title: Administrator revealed the job description is to direct the day-to-day functions of the Nursing Center in accordance with current federal, state, and local regulations Level of Harm - Immediate that govern long-term care centers, and as may be directed by the Regional [NAME] President, to provide jeopardy to resident health or appropriate care for our patients. Essential Regulatory Functions: Number 7. Operates the Nursing Center in safety accordance with the established guidelines of the Organization and in compliance with federal state and local regulations. Number 8. Enforce the Nursing Center guidelines. Number 9. Maintains a working knowledge of Residents Affected - Some current licensure standards and survey process.Number 13. Acts as a liaison between the Nursing Center and regulatory agencies, patient advocacy groups and fiscal intermediaries. Number 15. Assists department heads in the planning, conducting, and scheduling in-service training classes and orientation programs. Number 19. Assumes responsibility for procedural guidelines relative to the prevention and reporting of patient abuse. Essential Associate Relations Functions: Number 42. Supervises all department supervisors and administrative staff. Meets with department heads at regular intervals.

Review of the blank document titled, Job Title: Nursing Services Director of Nursing Services revealed the job description is to plan, organize, develop and direct the overall operation of our Nursing Services Department in accordance with current federal, state, and local regulations governing our nursing center, and as may be directed by the Administrator and the Medical Director, to provide appropriate care. Essential Skill/Knowledge Function: Number 38. Maintain effective lines of communication with attending physicians. Number 40. Maintain knowledge of documentation procedures including appropriate use of forms, timelines, and Medicare documentation. Number 41. Maintains a working knowledge of current licensure standards and survey process. Essential Clinical Services Functions: Number 42. Direct, evaluate and supervise patient care and initiates corrective action as necessary. Number 49. Report problems of the Administrator, conducts daily patient rounds, and initiates corrective actions as necessary. Number 69. Assume responsibility for procedural guidelines relative to the prevention and reporting of patient abuse. Number 79. Maintain appropriate personnel file documentation including reference checks, screenings, corrective actions, evaluations, skills verification, and others as necessary.

Review of the facility policy titled, Abuse Policy dated December 2023 documented B. Training Components: Abuse Policy Requirements: It is the policy of this facility that all new and existing employees receive training

on all forms of abuse, neglect, exploitation of residents, misappropriation of resident property, corporal punishment, injuries of unknown origin, and involuntary seclusion, including freedom from physical or chemical restraints. Training is to include prohibiting and prevention and identification, recognition, reporting and understanding behavioral symptoms that may increase risk of abuse and neglect. C. Prevention: The facility is to prevent abuse by establishing a safe environment, identifying, correcting and intervening in situations in which abuse is more likely to occur ensure the health and safety of all residents in regard to visitors and provide residents information on how and to whom to report concerns or grievances without fear of reprisal. D. Identification: All staff to monitor residents and trained on how to identify potential signs and symptoms if abuse, neglect, exploitation of residents, misappropriation of resident property Occurrences, patterns and trends that constitute abuse will be investigated. E. Investigation: Reports of abuse, neglect, exploitation of residents, misappropriation of resident property . are promptly and thoroughly investigated. F. Protection. The resident(s) will be protected from the alleged offender(s). G. Reporting and Response: Allegations of abuse, neglect, exploitation of residents, misappropriation of resident property are reported per federal and state law.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 47 of 53 115641 Department of Health & Human Services Printed: 09/08/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 115641 B. Wing 02/12/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Riverview Health & Rehab Ctr 6711 Laroche Avenue Savannah, GA 31406

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0835 The facility failed to ensure that Resident R30 and Resident R125 were free from sexual abuse by Resident R64. Specifically, Administration failed to investigate and report allegations from Licensed Practical Nurse (LPN) CC of Level of Harm - Immediate witnessed sexual abuse acts which Resident R64 was seen fondling Resident R30's breast with her adult brief undone. jeopardy to resident health or Furthermore, the Administration failed to investigate and report allegations from LPN BB who witness Resident R64 safety tongue kissing Resident R30 in the tv common area without consent.

Residents Affected - Some The facility failed to ensure Resident R60 was free from verbal and physical abuse by Certified Nursing Assistant (CNA) AA. Administration failed to thoroughly investigate and report a witnessed and handwritten account of physical abuse by CNA AA towards Resident R60 when CNA AA threw a mechanical lift pad at Resident R60, landing on her face.

The facility was not able to provide any documentation to show a thorough investigation, including follow-up interviews with staff, additional resident interviews related to experiences, observations related to potential sexual abuse was conducted, or reporting the incidents to family or local authorities.

Interview on 2/4/2025 at 2:51 pm, the DON confirmed that she is the Abuse Coordinator. She stated that all staff are aware to report any allegations of abuse to her. She revealed that she was aware of the incident Resident R64 and Resident R30 that occurred on 12/25/2024. She revealed she did not do a thorough investigation for the incident since Resident R64 admitted that he did it. There was no follow-up interviews with residents or staff done because she had a written statement and Resident R64 admitted to it. Furthermore, the DON stated she did not do any other follow up because she assumed that the girl who reported it would call the family and the police to report the incident on 12/25/2024. When asked about the physical abuse incident 10/28/2024, the DON stated CNA AA was immediately put on suspension following the allegation.

Interview on 2/12/2025 at 1:21 pm, the Administrator stated that he was aware of both 10/28/2024 and 12/25/2024 incidents which was reported by the DON. The 10/28/2024 incident he thought it was reported by

the DON, the team discussed it and the ball got dropped because the follow up was not done for either incident. He stated his expectations are for staff to know how to do their jobs, since they have the tools to do their job. During further interview, he stated that if his expectations are not carried out, he revealed the negative effect if any staff is not able to perform their job duties then harm to others can happen.

The facility implemented the following actions to remove the IJ:

1. On 2/5/2025, the facility failed to provide oversight and supervision to ensure residents Resident R30, Resident R60, and Resident R125 were protected from abuse by Resident R64 and abuse by CNA AA to Resident R30.

2. On 2/5/2025 upon the report from the State surveyor, CNA AA has been suspended pending further investigation.

3. On 2/5/2025 resident Resident R64 placed on 1:1 supervision upon report from State surveyor of other alleged incidents.

4. As of 2/9/2025 resident Resident R64 has discharged from facility.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 48 of 53 115641 Department of Health & Human Services Printed: 09/08/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 115641 B. Wing 02/12/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Riverview Health & Rehab Ctr 6711 Laroche Avenue Savannah, GA 31406

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0835 5. On 2/5/2025 the facility notified the Medical Director who has been involved in the removal of the Immediate Jeopardy. Level of Harm - Immediate jeopardy to resident health or 6. As of 2/7/2025 the facility had completed meeting/assessing with all residents who were deemed safety vulnerable for potential abuse for identification of safety concerns related to the reported incidents. No safety concerns were identified. Residents Affected - Some 7. On 2/7/2025 The facility administration reviewed all audits related to residents' vulnerable for potential abuse for identification of safety concerns. No safety concerns were identified.

8. On 2/5/2025 the facility administration contacted an external consultant(s) to assist with policy review, education development and leadership training on abuse prevention and reporting.

9. On 2/7/2025 education was provided to Administration from external consultant on job description.

10. On 2/5/2025 the facility administration notified President of Governing Board of Directors.

11. On 2/5/2025 the facility administration reviewed and made any necessary changes to the abuse prevention and abuse reporting policies and procedures. As of 2/8/2025, 132 of 150 of facility team members (36 CNAs, 25 LPNs, 7 RNs, 15 administrative staff, 3 activities (88%) staff, 13 dietary staff, 19 EVS staff, 4 maintenance staff, been educated on 3 abuse social prevention, workers, 5 unit abuse reporting helpers/clerks, and 1 DON comprehensive and 1 LNHA) have assessments.

The remaining 18 (5 CNAs, 1 LPN, 2 PRN RNs, 6 dietary staff, 3 prevention, EVS staff, abuse and 1 reporting unit and helper/clerk) comprehensive team assessments members will their be next educated scheduled on abuse workday.

13. As of 2/8/2025, 5 of 5 (100% (percent)) agency staff (4 LPN and 1 CNA) have been educated on abuse prevention, abuse reporting and comprehensive assessments.

14. As of 2/8/2025, 16 of 22 (78%) contracted therapy staff have been educated on abuse

prevention, abuse reporting and comprehensive assessments.

The remaining 6 PRN contracted therapy staff will be educated on abuse prevention, abuse

reporting and comprehensive assessments of their next scheduled workday.

15. On 2/6/2025 a review and update of the facility orientation program and agency orientation

program has been completed with respect to abuse prevention and abuse reporting requirements.

16. On 2/5/2025 a Performance Improvement Plan (PIP) was initiated related to abuse prevention and abuse reporting. ADHOC meeting held on 2/5/2025.

All corrective actions were completed by 2/9/2025.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 49 of 53 115641 Department of Health & Human Services Printed: 09/08/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 115641 B. Wing 02/12/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Riverview Health & Rehab Ctr 6711 Laroche Avenue Savannah, GA 31406

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0835 All immediacy of the U was removed on 2/10/2025.

Level of Harm - Immediate The State Survey Agency (SSA) validated the facility's written IJ Removal Plan as follows: jeopardy to resident health or safety 1. Observation on 2/11/2025 revealed Resident R64 was discharged , Resident R25, Resident R30, RG0, and Resident R125 were noted to safe with no concerns. Residents Affected - Some 2. Interview on 2/11/2025 revealed DON suspend CNA AA via phone pending investigation.

3. Resident R64 is no longer a current resident at the facility, he was discharged on [DATE REDACTED]. A review of the records revealed the facility started paper charting 1: 1 hourly monitoring for Resident R64 for the following: 2/5/2025 at 7:05 pm - 5:32 am, (Interview with Administrator on 2/11/2025 at 3:00 pm revealed the video recording of where Resident R64 was on 1 :1 monitoring with staff.) 2/6/2025 at 7:00 am- 7: 00 pm, 2/6/2025 at 7:00 pm- 2/7/2025 at 7:00 am, 2/7/2025 at 7:00 am- 7: 20 pm, 2/7/2025 at 7:25 pm 2/8/2025 at 7:00 am, 2/8/2025 at 7:00 am- 3: 00 pm, 2/8/2025 at 3: 15 pm, 2/9/2025 at 7: 00 am - 3:00 pm.

4. Record review revealed Resident R64 was discharged on [DATE REDACTED] to a personal care home.

5. Phone Interview on 2/11/2025 at 2:30 pm with the physician and Medical Director of the facility revealed

she was notified and contacted of the incidents with the above residents and have participated in clinical meetings daily in the mornings with the clinical team of the facility. On 2/5/2025 the facility referred to Resident R30 for psych services for assessment and support. Evidenced by Progress Note dated 2/6/2025: Resident reassessed for safety and potential physical/psychosocial outcomes based upon the incidents identified. Vital signs at baseline. No signs of pain or distress, no facial grimacing or nonverbal moaning currently. Bed at safest level with floor mat at bedside. Assessment outcomes were reviewed with the primary care physician. Evidenced by: Confirmed care plan revisions have been made on 2/6/2025.

Evidenced by: Progress note dated 2/5/2025 revealed resident's family was contacted by Social

Services: The resident's family was contacted about an investigation of alleged abuse. Confirmed mental health services were offered, and the resident's family gave verbal consent for the mental health services.

6. By evidence of record review, it was confirmed that the facility had completed a meeting assessing with all residents who were deemed vulnerable for potential abuse.

7. Interview with Administrator on 2/7/2025 at 1:30pm revealed steps were made for improvement, weekly audits, review of reportable, education, and discussing change in clinicals meetings.

8. An interview with the Administrator on 2/11/2025 at 1:30 pm revealed contact was made with external consultants and the board to assist with policy review, education development and leadership training on abuse prevention and reporting.

9. By evidence of interview on 2/14/2025 at 12:49 pm with the Administrator and Record review revealed

education was provided to Administration from an external consultant on job description.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 50 of 53 115641 Department of Health & Human Services Printed: 09/08/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 115641 B. Wing 02/12/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Riverview Health & Rehab Ctr 6711 Laroche Avenue Savannah, GA 31406

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0835 10. By interview on 2/11/2025 at 1:30pm with Administrator revealed the President of Governing Board of Directors with notified about the abuse allegations. Level of Harm - Immediate jeopardy to resident health or 11. By interview on 2/11/2025 Record review revealed administration reviewed and made any necessary safety changes to the abuse prevention and abuse reporting policies and procedures.

Residents Affected - Some 12. A review of facility in-service record dated 2/8/2025 revealed 36 CNAs, 25 LPNs, 7 RNs, 15 administrative staff, three activities staff, 13 dietary staff, 19 EVS staff, four maintenance staff, three social workers, five-unit helpers/clerks, one DON and one LNHA have been educated on abuse prevention, abuse reporting and comprehensive assessments.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 51 of 53 115641 Department of Health & Human Services Printed: 09/08/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 115641 B. Wing 02/12/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Riverview Health & Rehab Ctr 6711 Laroche Avenue Savannah, GA 31406

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0835 Also verified the above education by the following staff interview on 2/11/2025 at 6:15 am with Certified Nursing Assistant (CNA) XX, 2/11/2025 at 6:17 am with Licensed Practical Nurse (LPN) JJ, 2/11/2025 at Level of Harm - Immediate 6:21 am with LPN YY, 2/11/2025 at 6:26 am with CNA ZZ, 2/11/2025 at 6:31 am with CNA NN, 2/11/2025 at jeopardy to resident health or 6:36 am with CNA AAA, 2/11/2025 at 6:46 am with LPN GG, 2/11/2025 at 6:48 am with LPN BBB, 2 safety /11/2025 at 6:51 am with CNA CCC, 2/11/2025 at 6:54 am with CNA DDD, 2/11/2025 at 7:58 am with Maintenance Director, 2/11/2025 at 8:30 am with Maintenance Assistant, 2/11/2025 at 8:15 am with Residents Affected - Some Housekeeping GGG, 2/11/2025 at 8:46 am with Environmental Services Manager, 2/11/2025 at 8:23 am with Social Services Director, 2/11/2025 at 9:16 am with Social Worker HHH, 2/11/2025 at 8:50 am with Activities Assistant III, 2/11/2025 at 8:35 am with Admission Coordinator JJJ, 2/11/2025 at 8:48 am with Medical Records KKK, 2/11/2025 at 10:30 am with Director of Business Development, 2/11/2025 at 6:01 am with CNA MMM, 2/11/2025 at 6:20 am with CNA NNN, 2/11/2025 at 6:31 am with RN Supervisor OOO, 2/11/2025 at 6:31 am with LPN PPP, 2/11/2025 at 6:46 am with Unit Manager (UM) EE, 2/11/2025 at 7:40 am with Assistant Food Service Manager, 2/11/2025 at 7:45 am with Dietary Manager, 2/11/2025 at 8:00 am with Occupational Therapist (OT) WWW, 2/11/2025 at 8:08 am OT XXX, 2/11/2025 at 8:00 am Physical Therapist Assistant (PTA), 2/11/2025 at 6:18 am with Unit Secretary (US) ZZZ, 2/11/2025 at 6:23 am with Staffing Coordinator MM, 2/11/2025 at 6:28 am with LPN AAAA, 2/11/2025 at 6:32 am with LPN QQ, 2/11/2025 at 6:42 am with Floor Tech (FT) BBBB, 2/11/2025 at 6:42 am with CNA CCCC, 2/11/2025 at 6:47 am with CNA CCC, 2/11/2025 at 6:50 am with Housekeeping DDDD, 2/11/2025 at 6:56 am with FT EEEE, 2/11/2025 at 7:52 am with DA FFFF, 2/11/2025 at 8:07 am with Receptionist GGGG, 2/11/2025 at 8:21 am with Admissions Coordinator HHHH, 2/11/2025 at 8:17 am with Housekeeping IIII, 2/11/2025 at 8:20 am with Financial Assistant JJJJ, 2/11/2025 at 8:28 am with Activities Director, 2/11/2025 at 12:53 pm with UM SS, 2/11/2025 at 12:56 pm with Director of Finances, 2/11/2025 at 12:57 pm with US KKKK, 2/11/2025 at 1:07 pm with CNA NNNN, 2/11/2025 at 1:09 pm with Wound Care CNA OOOO, 2/11/2025 at 1:12 pm with CNA PPPP, 2/11/2025 at 1:15 pm with US QQQQ, 2/11/2025 at 1:18 pm with Activities Assistant FF, 2/11/2025 at 1:20 pm with LPN LL, 2/11/2025 at 1:22 pm with Director of Rehabilitation, 2/11/2025 at 1:32 pm with OT RRRR, 2/11/2025 at 1:35 pm with PT SSSS, 2/11/2025 at 1:37 pm with PTA TTTT, 2/11/2025 at 1:40 pm with Speech Therapist (ST) UUUU, 2/11/2025 at with 1:46 pm with Rehab Technician VVVV, 2/11/2025 at 1:56 pm with LPTA WWWW, 2/11/2025 at 1:59 pm with Laundry XXXX, 2/11/2025 at 2:09 pm with ST YYYY, 2/11/2025 at 2:49 pm with EVS Assistant Supervisor, 2/11/2025 at 2:56 pm with CNA DD, 2/11/2025 at 3:00 pm with Housekeeper DDDDD, 2/11/2025 at 3:02 pm with CNA EEEEE, 2/11/2025 at 3:04 pm with Central Supply Clerk FFFFF, 2/11/2025 at 3:07 pm with Registered Dietician, 2/11/2025 at 3:28 pm with LPN TT, 2/11/2025 at 3:30 pm with CNA GGGGG, 2/11/2025 at 3:32 pm with CNA HHHHH, 2/11/2025 at 3:34 pm with DA IIIII, 2/11/2025 at 3:36 pm with [NAME] JJJJJ, 2/11/2025 at 3:43 pm with CNA VV, 2/11/2025 at 3:45 pm with LPN KK, 2/11/2025 at 3:50 pm with DA KKKKK, 2/11/2025 at 3:51 pm with MDS Coordinator LLLLL, 2/11/2025 at 4:02 pm with MDS Coordinator MMMMM, 2/11/2025 at 4:05 pm with DA NNNNN, 2/11/2025 at 4:06 pm with Financial Coordinator OOOOO, 2/11/2025 at 4:08 pm with Payroll Clerk PPPPP, 2/11/2025 at 4:10 pm with Human Resources Director, 2/11/2025 at 4:12 pm with [NAME] RRRRR, 2/11/2025 at 6:54 pm with LPN TTTTT, 2/11/2025 at 5:41 pm with Infection Preventionist, 2/11/2025 at 5:46 pm with Receptionist YYYYY, 2/11/2025 at 5:58 pm with LPN QQQQQ, 2/11/2025 at 5:59 pm with DA A1, 2/11/2025 at 6:11 pm with LPN D1, 2/11/2025 at 6:19 pm with CNA E1, 2/12/2025 at 12:03 pm with Nurse Educator, 2/12/2025 at 12:19 pm with DON, 2/12/2025 at 12:49 pm with Administrator.

A review of the facility in-service record dated 2/9/2025 revealed 18 (five CNAs, one LPN, two PRN RNs, six dietary staff, three EVS staff, and one unit helper/clerk) team members were educated on abuse prevention, abuse reporting, and comprehensive assessments.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 52 of 53 115641 Department of Health & Human Services Printed: 09/08/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 115641 B. Wing 02/12/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Riverview Health & Rehab Ctr 6711 Laroche Avenue Savannah, GA 31406

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0835 Also verified the above education by the following staff interviews 2/11/2025 at 2:44 pm with Housekeeper ZZZZ, 2/11/2025 at 2:46 pm with Housekeeper AAAAA,2/11/2025 at 2:52 pm with Housekeeper BBBBB, Level of Harm - Immediate 2/11/2025 at 7:10 with am Dietary Aide (DA) QQQ, 2/11/2025 at 7:15 am with [NAME] RRR, 2/11/2025 at jeopardy to resident health or 7:20 am with DA SSS, 2/11/2025 at 7:25 am with DA TTT, 2/11/2025 at 7:30 am with DA UUU, 2/11/2025 at safety 7:35 am with DA VVV, 2/11/2025 at 6:54 pm with LPN TTTTT, 2/11/2025 at 7:05 pm with RN UUUUU, 2/11/2025 at 7:11 pm with CNA VVVVV, 2/11/2025 at 7:20 pm with CNA WWWWW, 2/11/2025 at 5:37 pm Residents Affected - Some with CNA XXXXX, 2/11/2025, 2/11/2025 at 6:03 pm with CNA B1, 2/11/2025 at 6:08 pm with CNA C, 2/11/2025 at 1:18 pm with Activities Assistant FF, 2/11/2025 at 6:02 am with Wound Care Registered Nurse (RN) LLL.

An interview with the Administrator on 2/11/2025 at 1:05 pm revealed that 91% of staff have been educated

on abuse.

13. Review of facility in-service record dated 2/8/2025, five of five (100%) agency staff (four LPNs and one CNA) have been educated on abuse prevention, abuse reporting and comprehensive assessments.

Also verified the above education by the following staff interviews on 2/11/2025 at 1:01 pm with LPN LLLL, 2/11/2025 at 1:04 pm with LPN MMMM, 2/11/2025 at 5:58 pm with LPN RR, 2/11/2025 at 6:57 pm with LPN SSSSS, 2/11/2025 at 6:42 am with CNA CCCC.

14. Review of facility in-service record dated 2/8/2025, five of five (100%) agency staff (four LPNs and one CNA) have been educated on abuse prevention, abuse reporting and comprehensive assessments.

Also verified the above education by the following staff interviews on 2/11/2025 at 1:01 pm with LPN LLLL, 2/11/2025 at 1:04 pm with LPN MMMM, 2/11/2025 at 5:58 pm with LPN RR, 2/11/2025 at 6:57 pm with LPN SSSSS, 2/11/2025 at 6:42 am with CNA CCCC.

15. By evidence of record review revealed 2/6/2025 a review and update of the facility orientation

program and agency orientation program has been completed with respect to abuse prevention and abuse reporting requirements

16. By evidence of an interview with the Administrator on 2/11/2025 at 1:30 pm confirmed on 2/5/2025 a Performance Improvement Plan (PIP) was initiated related to abuse prevention and abuse reporting. ADHOC meeting held on 2/5/2025. Record review confirmed ADHOC meeting held on 2/5/2025.

All corrective actions were completed by 2/9/2025.

All immediacy of the U was removed on 2/10/2025.

48338

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 53 of 53 115641