Mountain Ridge Health And Rehab

F 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

the ground or have a fall or accident. They are to immediately notify the licensed nurse. All staff will be educated on or before their next shift by the Administrator or designee. Newly hired staff will be educated by

the Interim DON during orientation. Starting on [DATE REDACTED] the Interim DON, Administrator, Minimum Data Set Nurses will review 5 days a week, the incident/accident reports, 24-hour report, the order listing report for medication changes, the Discharge report, and grievance log to ensure that all falls and injuries, resulting from a fall on their head, have been handled according to this plan. Completion Date: [DATE REDACTED]On [DATE REDACTED] the facility's credible allegation of immediate jeopardy removal was validated by the following:Review of facility audits revealed the facility completed audits of all incidents, hospital transfers, grievance logs, and facility reportable incidents from [DATE REDACTED] to [DATE REDACTED]. Incident reports were audited by the facility for falls with injury, head/ neck injury, and reviewed for if residents with injury was moved inappropriately. The facility did not identify any issues from the incident report audit. The facility completed an audit of resident hospital transfers to identify any hospital transfers related to a fall with injury or head/ neck injury; there were no issues identified. Facility reportable incidents were reviewed and did not contain any reportable incidents related to falls with injury. Grievance log audits were completed to identify any grievance related to physical injury; there were no issues identified.Grievance logs, facility reportable incident logs, incident logs, and hospital transfer logs were reviewed. There were no issues related to falls with injury, head/ neck injury, or residents being moved in appropriately. All facility audits were reviewed and verified as completed.Review of education revealed specific post fall education was developed by the Medical Director and included assessment steps to take after a resident has a fall, when to not move a resident, and when to call emergency medical services (EMS). The education included additional injury and/or adverse outcomes if a resident was moved after a head or neck injury.Review of in-service education logs revealed the education material developed by the Medical Director was used to educate licensed nurses on assessing a resident

after a fall, when not to move a resident after a fall, and additional injury that could incur if a resident was moved. It was verified the Staff Development Nurse and involved floor nurse received the education.In-service logs revealed all staff were educated to notify the nurse and to not move a resident

after a fall.Addit[TRUNCATED]

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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

10/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Mountain Ridge Health and Rehab

611 Old US Highway 70 East Black Mountain, NC 28711

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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

mechanical lift should include validation of; two qualified staff members' active participation, appropriate lift sling selection, correct positioning in sling, secure placement of sling to attachment points, confirmation lift base legs spread, resident is raised above bed, chair or applicable surface and again, confirm sling straps are secure. This education was initiated on 10/4/25 and completed by 10/7/25. On 10/14/25 The Staff Development Coordinator started a second round of training for the Licensed Nurses. This training will be completed by 10/16/25. Any Licensed Nurse not receiving this education by this date will receive education via phone call by the Staff Development Coordinator prior to their next scheduled shift. This information will be presented in new Licensed Nurse orientation by the Staff Development Coordinator. The facility does not utilize agency staff. All Licensed Nurses will receive lift competency training, which is, the safe process based on manufacturer instructions and facility guidelines for transferring a resident via lift, to include; always having a partner is required and they must be actively assisting, appropriate lift sling selection (when the resident is placed in the center of the sling, it should extend 3 to 6 inches past their body on each side), correct positioning in sling, secure placement of sling to attachment points, confirmation lift base legs spread, resident is raised above bed, chair or applicable surface and again, confirm sling straps are secure before moving lift demonstrating they are qualified to perform lift transfers. This was done by the Staff Development Coordinator. The competency training includes the use of a lift, 2 nurse aides and/or the Staff Development Coordinator as the second person (if needed), sling, and Manikin brand medical model.

This was initiated on 10/17/25 and all Licensed Nurses will complete the training on or before their next scheduled shift. All Nurse Aides have been train[TRUNCATED]

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