Harlan Health And Rehabilitation Center
Harlan Health and Rehabilitation Center in Harlan, KY — inspection on March 21, 2025.
Found 2 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
During the interview, R99 indicated his teeth hurt all the time, and had been hurting for about one year, nodding his head up-and-down and stating, yep to both of these questions (which were asked separately). R99 also indicated that teeth pain made it difficult to eat at times, again nodding his head up-and-down and stating, yep. R99 also indicated that there were times that he was hungry due to inability to eat because of the tooth pain, as he nodded his head up-and-down stating, yep.
Observation on 03/21/2025 at 2:04 PM revealed Registered Nurse (RN)6 assessed R99, who was in bed, for pain. RN6 asked R99 if he could sit up and the resident followed the instruction, sitting on the side of the bed. RN6 asked R99 if he was having any pain and R99 nodded his head up-and-down stating yep, teeth. RN6 then asked R99 Your teeth are hurting right now? R99 nodded his head up-and-down, stating yep. RN6 asked R99 Scale of 1-10, how bad? R99 replied yep, and proceeded to hold his hand up.
When RN6 asked R99 if his pain was a '5', R99 motioned his left thumb up. RN6 then asked Is it a 10? to which R99 stated yep.
Observation at this time revealed RN6 examined R99's mouth which revealed that the resident was missing multiple teeth in both the front and the back of the mouth, as well as, on both the top and bottom. In addition, the resident had multiple discolored teeth, with some that were partially black in appearance.
Interview with Certified Nursing Assistant (CNA) 8, on 03/20/2025 at 9:34 AM, revealed that during R99's oral care, the resident would wince in pain, like someone touching a nerve. CNA8 added that he thought that was why R99 had a hard time eating. CNA8 added that he had previously informed nursing staff about the resident's dental pain, but was informed the facility was waiting on a dentist.
Further interview revealed CNA8 could not remember the specifics of when or who he told about R99's dental pain.
During an interview with Licensed Practical Nurse (LPN)8 on 03/20/2025 at 3:05 PM, LPN 8 stated R99's teeth looked bad, noting that some teeth were missing. LPN8 stated there was no assigned staff responsible for dealing with referrals and making appointments, saying, No one handles the appointments specifically; we do our best to make sure they're followed up on.
Further interview with LPN8 revealed when a resident complains of tooth/oral pain, nursing staff were required to notify the physician and document in the Health Status Note/Progress Note.
Review of R99's chart for 2025 revealed no documentation regarding teeth/oral pain or notification to the physician about such an issue.
On 03/19/2025 at approximately 9:00 AM, a Regional Corporate representative brought in a typed Word Document, which she stated was a list of the times that the facility had attempted to contact the oral surgeon to whom R99 was referred.
185166
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 185166 B.
Wing 03/21/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Harlan Health and Rehabilitation Center 200 Medical Center Drive Harlan, KY 40831
During an interview with the Speech-Language Pathologist 1 (SLP1) on 03/19/2025 at 2:24 PM, SLP1 stated until 03/19/2025, R99 had not been assessed by speech therapy. SLP1 stated that upon assessment, R99's teeth were bad, they're terrible, and that could be the reason R99 had lost weight. SLP1 stated that after assessing R99 on 03/19/2025, she changed R99's diet from regular with large portions, to mechanical soft meats and feeding assistance.
Further interview with SLP1 on 03/20/2025 at 3:02 PM, revealed that once the resident's diet consistency was changed, R99 consumed 90 percent of his meal.
Interview with Registered Dietician (RD) 1 on 03/20/2025 at 3:04 PM, revealed that she was a corporate regional dietitian and was answering questions for the facility's RD, who was out of the country and unavailable for interview.
She stated that assessments were completed annually, on change in condition, or upon request. RD1 stated R99's last RD Assessment was in 06/2024, and at that time, R99 weighed 171.6 pounds.
Per RD1, the facility's RD documented that at that time, the resident's usual weight was 165, with a Body Mass Index (BMI) of 30.4 (mild obesity.) Continued interview with RD1 revealed that as of 03/10/2025, R99 now weighed 128.4 pounds, adding, Wow, what happened? RD1 verified that the resident's average intake had declined.
Although RD1 indicated that the facility's RD had made interventions such as an appetite supplement, a dietary supplement, and large servings.
However, no information was provided to indicate that R99's ongoing issues with multiple missing/painful teeth and a regular diet, had either been considered as a possible cause of the resident's continued weight loss nor addressed the issue.
185166
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 185166 B.
Wing 03/21/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Harlan Health and Rehabilitation Center 200 Medical Center Drive Harlan, KY 40831