River Haven Nursing And Rehabilitation Center

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

trying to educate staff to use it. He said there had been a lot of staff turnover in the last few months since

he started working at the facility. The Maintenance Director further stated he was unsure of the cause of the mold because he had not had time to crawl into the attic to investigate it. During interview with the Director of Nursing (DON) on 08/26/2025 at 11:30 AM, she stated she was unaware of mold being in the shower rooms. She further stated mold could cause respiratory problems and skin rashes for residents or staff.

During interview with the Administrator on 08/26/2025 at 11:45 AM, she stated maintenance was responsible for checking for (water) leaks. She stated she expected mold issues in shower rooms to be identified and treated. The Administrator reported she expected staff to follow facility policy as well as state and federal guidelines. She further stated going forward, shower rooms would be inspected periodically to identify issues before they became problems.

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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

08/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

River Haven Nursing and Rehabilitation Center

867 McGuire Avenue Paducah, KY 42001

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 - Minimal harm or potential for actual harm Residents Affected - Few

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

Telephonic (Phone) attempts were made from 08/19/2025 through 08/26/2025, to interview Resident R8; however, were unsuccessful as the phone calls went straight to voicemail and no return calls were received. During

interview with the DON on 08/26/2025 at 11:30 AM, she stated that she expected all staff to report abuse allegations to her or the abuse coordinator. She said if an abuse allegation was brought to her, she would investigate and report it to OIG (Office of Inspector General) within 2 hours and continue the investigation.

The DON explained physical abuse, mental abuse, psychosocial, misappropriation of property, and sexual abuse all fell under the category of abuse. She reported even if the resident who made the allegation had a history of making false accusations, the allegation still needed to be investigated as abuse and needed to be reported within 2 hours with a 5-day follow up performed. During additional interview with the facility's Administrator on 08/26/2025 at 11:45 AM, she stated she expected staff to follow the facility's policy, and state and federal guidelines regarding reporting abuse.

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

08/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

River Haven Nursing and Rehabilitation Center

867 McGuire Avenue Paducah, KY 42001

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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

interview on 08/20/2025 at 11:00 AM, the (current) Administrator stated there was no investigation file regarding the alleged sexual abuse incident that occurred on or around 03/10/2025 involving Resident R8 and CNA

1. 6. In interview on 08/20/2025 at 4:00 PM, CNA 5 stated she recalled Resident R8 used to talk her (the aide's) head

off about somebody trying to hit on him. She said Resident R8 had already told everyone including the Administrator about the incident. The CNA further stated Resident R8 told her it was a male staff member that was gay, but they had like 4 gay male staff members, so she never knew who it was. In interview on 08/20/2025 at 4:46 PM,

the facility's former Administrator stated he was familiar with Resident R8, and said the incident in question had been reported to APS by the resident. He reported he had been aware Resident R8 made allegations about a staff member touching him inappropriately; however, had not performed an investigation. The former Administrator said the facility had a soft file (unofficial file) on the incident, but he did not know where the soft file was because he was no longer the Administrator. Review of soft file documentation (requested after

the interview with the former Administrator), provided by the facility's current Administrator, revealed it contained no documented evidence of information related to the alleged incident that happened around 03/10/2025, involving Resident R8. In interview on 08/21/2025 at 8:19 AM, CNA 6 stated that he remembered the incident with Resident R8, and had gone into the resident's room on the incident to check on him. He said Resident R8 had a suitcase on his bed and all of the resident's clothes were pulled out of the suitcase leaving no room on the bed. CNA 6 explained he moved the suitcase to make room on Resident R8's bed and got the resident some ice water. He reported after doing that, he leaned down and asked Resident R8 if he needed anything else and then assisted the resident's girlfriend, who was another resident, into his room. The CNA stated Resident R8 had said anything to him at that time about any allegations, and had only heard about it from his coworkers about five days after the incident. He said the Director of Nursing (DON) and Administrator came up with a solution of not allowing any male caregivers in Resident R8's room. CNA 6 further stated the Administrator never questioned him about the incident, and the only person who had questioned or interviewed him was an APS worker. In interview on 08/21/2025 at 8:55 AM, the Social Services Director (SSD) stated the only incident she recalled was concerning Resident R8 was when the resident reported a male staff member touching him on his shoulder. The SSD said Resident R8 told them he did not want fags in his room. She stated she did not report that incident to anyone because the Administrator knew about it and had told her about it. The SSD reported when a resident made an allegation of sexual abuse, staff should tell the Administrator about it so

they could take it from there. In interview on 08/26/2025 at 11:30 AM, the DON stated if an abuse allegation was brought to her, she would begin to investigate it and report it to OIG (Office of Inspector General) within two hours and then continue her investigation. She further stated even if a resident, with a history of making false accusations, was the person making an allegation, the allegation still needed to be investigated as abuse; reported; and have a 5-day follow up performed. In interview on 08/26/2025 at 11:45 AM, the facility's current Administrator stated she was the person responsible for investigating abuse allegations now; however, had not been Administrator at the time of the incident involving Resident R8. She further stated investigations should be conducted as per facility policy.

Event ID:

Facility ID:

If continuation sheet