Vanceburg Hills

Review of R76's undated Admission Record revealed the the facility admitted the resident on 04/10/2024 with diagnoses which included alcoholic cirrhosis of liver, congestive heart failure, pain, and unilateral inguinal hernia.

Review of R76's quarterly Minimum Data Set (MDS), with an assessment reference date (ARD) of 07/18/2024 revealed a Brief Interview for Mental Status (BIMS) score of 15 out of 15 which indicated the resident was cognitively intact.

Continued review of the MDS revealed the facility assessed the resident to have received scheduled and PRN (as needed) pain medications.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

185238

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 185238 B.

Wing 08/22/2024

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

Vanceburg Hills 58 Eastham Street Vanceburg, KY 41179