River Bend Health And Rehabilitation
River Bend Health and Rehabilitation in Asheville, NC — inspection on January 30, 2026.
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
unaccounted-for narcotic medications at facility expense. An interview on 1/30/26 at 10:04 AM with
Nursing and to the Tennessee Board of Nursing where he was originally licensed.
345432 01/30/2026
River Bend Health and Rehabilitation 213 Richmond Hill Drive Asheville, NC 28806
Review of Resident #6's narcotic record revealed Nurse #1 (an agency nurse) had signed out one (1) oxycodone 10 mg tablet on 11/14/25 at 7:30 PM and 11:30 PM.
Review of Resident #6's narcotic record revealed Nurse #2 (an agency nurse) signed as a witness to Nurse #1's disposal of one (1) oxycodone 10 mg tablet on 11/14/25 at an illegible time. b. Resident #9 was admitted to the facility on [DATE].
The physician's order dated 11/06/25 revealed Resident #9 had an order to receive oxycodone 10 mg tablet every 3 hours as needed for pain.
Review of Resident #9's narcotic record revealed Nurse #1 had signed out one (1) oxycodone 10 mg tablet on 11/14/25 at 7:30 PM and 10:30 PM.
Review of Resident #9's narcotic record revealed Nurse #2 signed as a witness to Nurse #1's disposal of one (1) oxycodone 10 mg tablet on 11/14/25 at an illegible time.
Review of the initial report of alleged misappropriation dated 11/17/25 revealed the facility became aware of the allegation of misapproprriation of residents' property on 11/17/25 at 9:00 AM when Nurse #3 reported a concern to the Director of Nursing (DON) about as needed narcotics being signed out for a resident who usually did not ask for pain medication.
The facility reported the allegation to the North Carolina Division of Health Service Regulation (DHSR) on 11/17/25 at 2:02 PM and the local law enforcement on 11/17/25 at 2:30 PM.
The investigation report dated 11/21/25 revealed on 11/17/25 that the DON was notified by Nurse #3 that as needed pain medication was signed out for a resident who did not usually request it. A review of the narcotic sign out sheet revealed Nurse #2 had signed as a witness to Nurse #1's disposal of narcotic medications for Residents #6 and #9. An interview on 1/30/26 at 8:38 AM with Nurse #3 revealed she had reported her concerns about excessive pain medication being signed out for residents by Nurse #1 to the DON after she noticed that Resident #6 had some as needed oxycodone medication missing.
Nurse #2 stated Resident #6 denied taking the pain medication and they were not signed as administered on the MAR.
Review of an email dated 11/17/25 at 10:30 PM from Nurse #2 to DON showed Nurse #2 communicated she had signed the narcotic sheets as a witness to the disposal of medications for Residents #6 and #9 at Nurse #1's request without observing the medication disposal.
Attempts to interview Nurse #1 and Nurse #2, who were both no longer employed at the facility, were unsuccessful. An interview on 1/29/26 at 1:46 PM with the DON revealed Nurse #2 was an agency nurse who had worked multiple shifts at the facility since 6/12/25 but had not worked at the facility since 11/15/25.
The DON explained Nurse #1, who was also an agency nurse that worked only one 12-hour shift at the facility from 7:00 PM on 11/14/25 until 7:00 AM on 11/15/25M.
The DON stated when Nurse #3 signed the narcotic sheet, she noticed the number of narcotics signed out, became concerned and reported it to the DON.
The DON further stated she contacted Nurse #2 who told her she signed as the narcotic waste witness without visualizing the waste. An interview on 1/30/26 at 10:04 AM with the Administrator revealed Nurse #1 and Nurse #2 were blocked from working at the facility as of 11/17/25.
She stated it was the standard practice for nurses to visually witness narcotic medication being wasted prior to signing as a witness on the narcotic sheet and she did not know why Nurse #2 had not.
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.