Carter Nursing And Rehabilitation

F 0600 Level of Harm - Actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

linen from her bed after Resident R29 had a bowel movement in her bed. Resident R29 stated after she fell to the floor, SRNA1 made inappropriate comments such as, I knew you would do that, and, I should have called in today. Resident R29 stated SRNA1 also told her, You do this for attention. Resident R29 further stated that SRNA1 and SRNA11 assisted her back to bed but did not provide hygiene care to remove the feces. She stated SRNA1 and SRNA11 failed to dress her and then covered her with a feces-covered blanket. Resident R29 stated the SRNAs stated they would return with supplies to clean her. However, she stated, after three hours, they had not returned. Resident R29 stated she pressed her call light for assistance and was cleaned up by SRNA10. Resident 29 stated she feared SRNA1 due to being handled roughly during care. She also stated SRNA1 routinely told her she deserved to have HIV. Resident 29 stated SRNA1 and SRNA11 treated her with no respect and had mentally, verbally, and physically abused her. Resident R29 stated she did not tell other staff, including SRNA10 about SRNA1's inappropriate remarks, because she was scared SRNA 1 would lash out at her. During an

interview on 08/26/2025 at 10:00 AM, with Resident R29's roommate Resident R130, she stated SRNA1 and SRNA11 treated Resident R29 awful after she fell, explaining the staff accused Resident R29 of falling for attention, and left Resident R29 in feces for an extended period. Resident R130 further stated the pungent odor of bowel movement made her sick to her stomach, and her family had to leave the facility to purchase a room spray. During an interview on 08/28/2025 at 9:17 PM with Resident R130's Family Member (FM) 6, she stated after Resident R29 fell, SRNA1 stated, I knew this would happen.

I knew I should have called off today, and You should have had a depend on. FM6 further stated she did not believe SRNA1 or SRNA11 cleaned the feces from Resident R29 after assisting her back to bed, as the strong and prolonged smell of bowel movement remained in the room. She stated the odor made her mother sick, and

she had to leave the facility to buy a room deodorizer. FM6 stated Resident R29 remained in the uncleaned condition for approximately three to four hours before another staff member cleaned Resident R29. FM6 further stated when SRNA10 later cleaned Resident R29, she overheard SRNA10 repeatedly apologizing for the condition she had been left in by SRNA1 and SRNA11. During an interview on 08/28/2025 at 11:29 PM with SRNA10, she stated Resident R29 was upset because she had been left in feces and not been cleaned. She stated Resident R29 explained that SRNA1 and SRNA11 told Resident R29 they would get supplies to clean her but never returned. SRNA10 further stated the feces appeared to have been on Resident R29 for a while before she provided cleaning. SRNA10 stated it was inappropriate for SRNA1 and SRNA11 to leave the resident in that condition.During an interview on 08/28/2025 at 9:17 PM with SRNA1, she stated she did not make inappropriate remarks to Resident R29. She also stated she did not leave Resident R29 soiled for three hours.The State Survey Agency (SSA) Surveyor attempted to reach SRNA11 per telephone on 08/26/2025, 08/27/2025, and 08/28/2025. However, she did not answer

the telephone.During an interview on 08/28/2025 at 9:54 PM, Licensed Practical Nurse (LPN) 1 stated Resident R29 appeared angry while she conducted a skin assessment following the fall. LPN1 further stated she believed

the resident was having an anxiety attack and repeatedly told her, I'm sorry I messed on myself.During an

interview on 08/28/2025 at 5:04 PM with the Administrator, she stated Resident 29 had not reported anything to her, and she had been unaware of the incident until the State Survey Agency (SSA) Surveyor brought it to her attention on 08/26/2025. She stated she was going to immediately talk with Resident 29 and left the room.During additional interview with the Administrator on 08/28/2025 at 5:24 PM, she stated

she suspended SRNA1 and SRNA11, reported the incident to the Office of Inspector General (OIG) and

the local police, and began the investigation on 08/26/2025. She stated Resident R29 told her about the poor care and neglect by SRNA1 and SRNA11 but did not tell her about SRNA1's abusive remarks to her. She stated Resident R29 requested that neither staff member provide her care in the future.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Carter Nursing and Rehabilitation

250 McDavid Boulevard Grayson, KY 41143

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 0609 Level of Harm - Actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

depend on. FM6 further reported she did not believe SRNA1 or SRNA11 cleaned the feces from Resident R29 after assisting her back to bed, as the strong and prolonged smell of bowel movement remained in the room.

She stated the odor made Resident R29's roommate sick, and she had to leave the facility to buy a spray deodorizer.

FM6 stated Resident R29 remained in this soiled condition for approximately three to four hours before another staff member cleaned her. FM6 further stated when SRNA10 cleaned Resident R29, she overheard SRNA10 repeatedly apologizing to Resident R29 for the condition she had been left in by SRNA1 and SRNA11. During an interview on 08/28/2025 at 11:29 PM with SRNA10, she reported Resident R29 was upset SRNA1 and SRNA11 had left her lying

in feces for hours after they told her they would return after gathering supplies to clean her. SRNA10 stated

the feces appeared to have been on Resident R29 for a while, and it was inappropriate for SRNA1 and SRNA11 to leave Resident R29 in that condition. SRNA10 further stated she did not report the incident because Resident R29 frequently complained, and she did not want to say anything that might get SRNA1 and SRNA11 in trouble.During an

interview on 08/28/2025 at 5:04 PM with the Administrator, she stated Resident 29 had not reported anything to her, and she had been unaware of the incident until the State Survey Agency (SSA) Surveyor brought it to her attention on 08/26/2025. She stated she was going to immediately talk with Resident 29 and left the room.During additional interview with the Administrator on 08/28/2025 at 5:24 PM, she stated

she suspended SRNA1 and SRNA11, reported the incident to the Office of Inspector General (OIG) and

the local police, and began the investigation on 08/26/2025. She stated Resident R29 told her about the poor care and neglect by SRNA1 and SRNA11, and the resident requested that neither staff member provide her care in the future. She stated Resident R29 did not tell her about SRNA1's abusive remarks to her. She also stated

the facility had not yet completed an investigation of the incident.During an interview on 08/26/2025 at 6:00 PM, the Administrator stated she expected staff to always report inappropriate comments or behaviors to her.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Carter Nursing and Rehabilitation

250 McDavid Boulevard Grayson, KY 41143

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 0658

precautions for residents and was a requirement for staff to stay within their scope of practice.

Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Federal health inspectors cited Carter Nursing and Rehabilitation in Grayson, KY for a deficiency under regulatory tag F-F0812 during a standard health inspection conducted on 2025-08-29.

Category: Nutrition and Dietary Deficiencies

The facility was found deficient in the following area: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Scope/Severity Level F: widespread, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 5 deficiencies cited during this inspection of Carter Nursing and Rehabilitation.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-12.

Federal health inspectors cited Carter Nursing and Rehabilitation in Grayson, KY for a deficiency under regulatory tag F-F0880 during a standard health inspection conducted on 2025-08-29.

Category: Infection Control Deficiencies

The facility was found deficient in the following area: Provide and implement an infection prevention and control program.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 5 deficiencies cited during this inspection of Carter Nursing and Rehabilitation.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-12.