River Bend Health And Rehabilitation
River Bend Health and Rehabilitation in Asheville, NC — inspection on February 26, 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
3:25 PM she stated if someone had concerns about abuse, they were supposed to report it
#1's face when it happened if he suspected abuse.An interview was conducted with the Administrator
abuse, or saw something concerning related to abuse, they were supposed to report it immediately to their supervisor.
She indicated that the supervisor should then contact her immediately to report the abuse allegation.
The Administrator stated if NA #1 had concerns about NA #2 putting her hands on Resident #1's face and pushing her head to the side then it should have been reported immediately so it could have been investigated to determine if it was or was not abuse at that time and not months later.
The Administrator indicated she was not aware it was an agency nurse, Nurse #1, who NA #1 had reported the allegations involving NA #2 to in January 2026.
She revealed that Nurse #1 should have reported the abuse allegation to her supervisor, the DON, or her (Administrator) immediately so it could have been investigated by the facility.
She further revealed that Nurse #1 did not follow the facility's policy on reporting abuse.
345432 02/26/2026
River Bend Health and Rehabilitation 213 Richmond Hill Drive Asheville, NC 28806
under impression read: acute right hip fracture-The right femur x-ray under impression read: acute
and gave orders to send Resident #1 to the hospital.
She stated Resident #1 left the facility at 1:16
they were assessed by a Nurse, because a Nurse had schooling and could better assess them for an injury than an NA.A progress note by Nurse #1 dated 11/25/25 at 1:16 PM documented Resident #1 was transferred by Emergency Medical Services (EMS) to the hospital for evaluation and treatment following the x-ray results.A hospital Discharge summary dated [DATE] indicated Resident #1 was admitted to the hospital on [DATE] after presenting to the emergency room following a fall and sustaining a fracture of her right olecranon and a fracture of her right femoral neck.
The discharge summary indicated she had procedures to surgically repair the right femoral neck fracture and right olecranon fracture on 11/25/25. A face sheet indicated Resident #1 was re-admitted to the facility on [DATE] after hospitalization.
Her diagnoses included displaced mid cervical (middle portion of femoral neck) fracture of the right femur, displaced placed fracture of olecranon process. An interview was conducted with the Director of Nursing (DON) on 2/25/26 at 3:25 PM.
The DON stated after Resident #1's x-rays returned on 11/25/25 showing she had fractured her right arm and right hip the provider was notified, and she was transferred to the hospital.
The DON did not recall what time the facility received the x-ray results or who called the provider about the x-ray results.
The DON reported that the facility started investigating how Resident #1's fractures occurred on 11/25/25.
The DON said when NA #2 was interviewed she reported Resident #1 had a fall on 11/24/25 around 6:30 PM.
The DON reported NA #2 said Resident #1 fell in her room on 11/24/25 and that Resident #1 had gotten herself up.
She stated NA #2 said after Resident #1 got herself up she went and laid on her bed.
The DON recalled NA #2 said when Resident #1 fell she screamed and Nurse #2 came down the hallway a couple minutes later and asked what happened.
The DON explained NA #2 reported she had told Nurse #2 that Resident #1 fell and Nurse #2 went into Resident #1's room and assessed her.
The DON said Nurse #2 was also interviewed and said NA #2 did not tell her that Resident #1 had fallen.
She did not know why Nurse #2 would say NA #2 did not tell her that Resident #1 had fallen.
The DON said Residents were not supposed to be moved after a fall until they were assessed by a nurse for injury.An interview was conducted with the Medical Director on 2/26/26 at 3:03 PM.
The Medical Director stated what was done for Resident #1 was appropriate. He stated the on-call provider was notified and x-rays were ordered.
The Medical Director said it was not unusual if x-rays orders were placed at night that they were not done until the next day. He stated when the x-ray results returned showing the fractures on 11/25/25 Resident #1 was transferred to the hospital. He stated Resident #1's x-rays not being completed until 11/25/25 and her not being transferred to the hospital until 11/25/25 was not impactful to her care.
The MD did not think Resident #1 being moved or attempting to get up would make her fractures worse. He stated the facility should follow their fall protocol. He said it made sense that an NA should not move a resident after a fall until they were assessed by a nurse for injury because Nurses had more training to assess for injuries.An interview was conducted with the Administrator on 2/26/26 at 10:30 AM.
She stated NAs should not get a resident up after a fall.
The Administrator explained after a fall the NA should get a nurse so the nurse could assess the resident for injuries and decide if the resident was okay to be moved.
The Administrator stated NA #2 was interviewed and had said Resident #1 was playing with the tray lid covers, lost her balance and fell on [DATE].
She said NA #2 reported Resident #1 had gotten herself up after falling, she had told Nurse #2 that Resident #1 fell, and that Nurse #2 had then gone into the room and checked on Resident #1.
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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.