Blumenthal Health And Rehabilitation Center

Federal health inspectors cited Blumenthal Health and Rehabilitation Center in Greensboro, NC for a deficiency under regulatory tag F-F0554 during a standard health inspection conducted on 2025-09-13.

Category: Resident Rights Deficiencies

The facility was found deficient in the following area: Allow residents to self-administer drugs if determined clinically appropriate.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 28 deficiencies cited during this inspection of Blumenthal Health and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-12-09.

Federal health inspectors cited Blumenthal Health and Rehabilitation Center in Greensboro, NC for a deficiency under regulatory tag F-F0582 during a standard health inspection conducted on 2025-09-13.

Category: Resident Rights Deficiencies

The facility was found deficient in the following area: Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 28 deficiencies cited during this inspection of Blumenthal Health and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-12-09.

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

aware the previous facility Social Worker had not been maintaining any paper grievances for several months during an internal mock survey by the company last month. The Administrator reported she was currently handling grievances since 8/1/25 until they can hire a new Social Worker. The Administrator presented a draft plan of correction to show they were working on a plan to correct that issue. The draft plan of the plan of the correction was found to be incomplete due to a lack of information regarding who was going to be responsible for grievances in the future and there was no information as to how grievances would be monitored to ensure compliance.

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

09/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Blumenthal Health and Rehabilitation Center

3724 Wireless Drive Greensboro, NC 27455

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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Practitioner stated she had seen Resident #178 on 3/11/25. She reported Resident #178 had history of inappropriate verbal statements to staff and no reports against any residents. She indicated Resident #178 was assessed with a basic interview of mental status (BIMS) of 12 which indicated Resident #178 had moderate cognitive impairment. She further stated Resident #178 continued to report he did not touch the female inappropriate and was moving a fly away from the individual. She stated she did not feel the resident had any malicious intent to harm or inappropriately touch anyone. She noted there had been no evidence or report of Resident #178 inappropriately touching any other residents reported by facility staff prior to incident. She stated there were no medication adjustments recommended based on this incident, however psychotherapy was the recommended intervention of choice to work with Resident #178 on cognitive behaviors on how to handle verbal emotions, motivation interactions/therapy. She reported Resident #178 had multiple psychotherapy visits until 4/17/25. She reported based on her evaluation the therapy was effective at the time, and the resident did not present as threat to other residents.

The Investigation Report completed on 3/14/25 and submitted to the state by the former Administrator revealed Resident #178 was observed on 3/7/25 at 1:30 PM by a nurse aide rubbing his hand near the vaginal area on top of clothing of Resident #163. The incident occurred in the dining room and was witnessed by the nurse aide. Both residents were immediately separated, and Resident #178 was placed

on 1:1 supervision pending psychiatric evaluation. Both residents received skin assessments with no negative findings by nursing. Both residents and staff were interviewed. Resident #163 was unable to be interviewed due to advanced dementia and Resident #178 stated he was shooing a fly away from Resident #163. The NP, Physician, police and responsible person for both residents were notified of the incident.

Resident #178 was referred to psychiatric services for an evaluation on 3/7/25. Resident #178 was evaluated via telehealth on 3/7/25 and in-person on 3/11/25, there were no medication changes for Resident #178. Resident #178 continued with every hour checks until cleared by psychiatric services and a nurse aide was assigned to the dining area during meals.

A telephone interview was conducted on 9/9/25 at 10:08 AM with Resident #163's RP who stated he received a call from the Director of Nursing who informed him of the 3/7/25 incident. He stated that due to Resident #163's advanced dementia she was not aware of and had no insight into what happened.

Resident #178's RP was contacted on 9/11/25 at 10:09 AM and was unavailable for interview.

The Greensboro police department was contacted on 9/8/25 at 12:16 PM and the officer that responded to call was unavailable for interview.

Review of the social service note dated 3/7/25 revealed Resident #178 as well as the former Social Worker spoke with the physician from mental health via a telehealth visit due to the incident where Resident #178 was

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

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

09/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Blumenthal Health and Rehabilitation Center

3724 Wireless Drive Greensboro, NC 27455

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)

Federal health inspectors cited Blumenthal Health and Rehabilitation Center in Greensboro, NC for a deficiency under regulatory tag F-F0628 during a standard health inspection conducted on 2025-09-13.

Category: Resident Rights Deficiencies

The facility was found deficient in the following area: Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.

Scope/Severity Level B: isolated, no actual harm with potential for minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 28 deficiencies cited during this inspection of Blumenthal Health and Rehabilitation Center.

Correction Status: No revisit needed.

The facility reported correction as of 2025-11-11.

Federal health inspectors cited Blumenthal Health and Rehabilitation Center in Greensboro, NC for a deficiency under regulatory tag F-F0636 during a standard health inspection conducted on 2025-09-13.

Category: Resident Assessment and Care Planning Deficiencies

The facility was found deficient in the following area: Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 28 deficiencies cited during this inspection of Blumenthal Health and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-12-09.

Federal health inspectors cited Blumenthal Health and Rehabilitation Center in Greensboro, NC for a deficiency under regulatory tag F-F0637 during a standard health inspection conducted on 2025-09-13.

Category: Resident Assessment and Care Planning Deficiencies

The facility was found deficient in the following area: Assess the resident when there is a significant change in condition

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 28 deficiencies cited during this inspection of Blumenthal Health and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-12-09.

Federal health inspectors cited Blumenthal Health and Rehabilitation Center in Greensboro, NC for a deficiency under regulatory tag F-F0638 during a standard health inspection conducted on 2025-09-13.

Category: Resident Assessment and Care Planning Deficiencies

The facility was found deficient in the following area: Assure that each resident’s assessment is updated at least once every 3 months.

Scope/Severity Level B: isolated, no actual harm with potential for minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 28 deficiencies cited during this inspection of Blumenthal Health and Rehabilitation Center.

Correction Status: No revisit needed.

The facility reported correction as of 2025-10-20.

Federal health inspectors cited Blumenthal Health and Rehabilitation Center in Greensboro, NC for a deficiency under regulatory tag F-F0640 during a standard health inspection conducted on 2025-09-13.

Category: Resident Assessment and Care Planning Deficiencies

The facility was found deficient in the following area: Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.

Scope/Severity Level B: isolated, no actual harm with potential for minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 28 deficiencies cited during this inspection of Blumenthal Health and Rehabilitation Center.

Correction Status: No revisit needed.

The facility reported correction as of 2025-10-20.

Federal health inspectors cited Blumenthal Health and Rehabilitation Center in Greensboro, NC for a deficiency under regulatory tag F-F0641 during a standard health inspection conducted on 2025-09-13.

Category: Resident Assessment and Care Planning Deficiencies

The facility was found deficient in the following area: Ensure each resident receives an accurate assessment.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 28 deficiencies cited during this inspection of Blumenthal Health and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-12-09.

Federal health inspectors cited Blumenthal Health and Rehabilitation Center in Greensboro, NC for a deficiency under regulatory tag F-F0656 during a standard health inspection conducted on 2025-09-13.

Category: Resident Assessment and Care Planning Deficiencies

The facility was found deficient in the following area: Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 28 deficiencies cited during this inspection of Blumenthal Health and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-12-09.

Federal health inspectors cited Blumenthal Health and Rehabilitation Center in Greensboro, NC for a deficiency under regulatory tag F-F0657 during a standard health inspection conducted on 2025-09-13.

Category: Resident Assessment and Care Planning Deficiencies

The facility was found deficient in the following area: Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 28 deficiencies cited during this inspection of Blumenthal Health and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-12-09.

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

Resident #85 was observed on 9/10/25 at 11:18 AM. His facial hair and fingernails were unchanged from

the observation from 9/8/25 at 11:02 AM. Resident #85 was interviewed at the time of the observation, and

he reported a NA had brought him one washcloth “a while ago” and told him to wash his face and body it with it. He showed one dry washcloth and that he didn't have water, soap, or a towel to wash.

NA #10 was interviewed when she returned to Resident #85's room on 9/10/25 at 11:24 AM. NA #10 reported she had been assigned to Resident #85 “a few times” and she had left Resident #85 with one washcloth to protect his privacy while he was using the urinal. NA #10 reported she had planned to return to Resident #85's room to assist him with a bath. When asked about his facial hair and his fingernails, NA #10 agreed that both were long and needed trimming. When asked if she had offered to provide shaving and nail care to Resident #85, NA #10 reported that she had never offered him shaving or nail trimming.

Resident #85 was observed again on 9/10/25 at 3:39 PM. Resident #85's facial hair had been shaved, but his fingernails remained in the same condition as the observations on 8/8/25 and 9/9/25. Regarding the status of Resident #85's nails, which remained untrimmed and the debris from under the free edge of the nail uncleaned, Resident #85 reported in an interview, “She (NA #10) left and said she would try to do it later.” NA #10 was interviewed again on 9/10/25 at 3:45 PM and she reported she would cut Resident #85's fingernails “later, after dinner.” Nurse #6 was interviewed 9/10/25 at 3:53 PM at Resident #85's bedside and she agreed that Resident #85's nails were too long and should have been trimmed.

Unit Manager (UM) #1 was interviewed on 9/11/25 at 3:24 PM and she reported she had not noticed Resident #85's facial hair or long nails. UM #1 explained that she did daily rounds to check on residents, but

she was not checking to ensure that care and ADLs, including facial shaving and nail care, were being completed. UM #1 reported she was mostly concerned with residents being clean, dry, and fed.

The Director of Nursing (DON) was interviewed by phone on 9/12/25 at 4:58 PM. The DON reported he was not aware Resident #85 had facial hair was greater than ¼ inch in length, and the free edge of his fingernails were greater than ¼ inch past the tips of his fingers or there was dark material noted under the nails. The DON explained that agency staff were providing care, and the facility had been working with the agency staff to improve the quality of care. The DON reported he expected ADL care to be provided to residents, including shaving and nail care.

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

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

09/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Blumenthal Health and Rehabilitation Center

3724 Wireless Drive Greensboro, NC 27455

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)

Federal health inspectors cited Blumenthal Health and Rehabilitation Center in Greensboro, NC for a deficiency under regulatory tag F-F0679 during a standard health inspection conducted on 2025-09-13.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: Provide activities to meet all resident's needs.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 28 deficiencies cited during this inspection of Blumenthal Health and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-12-09.

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

room. The Unit Manager reported she did an initial assessment of Resident #8 and took her vitals. The resident reported no pain and had no apparent injuries. The Unit Manager and NA assisted the resident back to bed. Upon leaving the room, she recalled the hall nurse came down the hall and the Unit Manager then told her about the unwitnessed fall. The Unit Manager reported she told the hall nurse to be sure to do neurological checks (also called neurochecks, are an assessment of an individual's nervous system functions which includes motor and sensory responses and level of consciousness) on the resident, notify Resident #8's family and physician of the fall, and complete the Risk Management tasks (referring to the reporting and documentation of the fall). When asked, Unit Manager #1 reported she recalled the name of

the NA (NA #2) who responded to the resident's call for help after the fall but could not recall the name of

the hall nurse who was on duty that day. When asked what her thoughts were regarding the lack of follow up being completed, the Unit Manager stated, I feel it was unacceptable. She stated that she would have expected the hall nurse to have done what she was asked to do. A follow up interview was conducted with Unit Manager #1 on 9/12/25 at 9:53 AM. During the interview, the Unit Manager was asked again if she could recall the name of the nurse that she told to follow up with Resident #8 after her unwitnessed fall of 8/21/25. The Unit Manager stated she could not recall for certain who it was.An interview was conducted on 9/12/25 at 7:20 AM with Nurse #1. Nurse #1 was identified by the nursing staff schedule on 8/21/25 and 9/11/25 as the nurse who was assigned to provide coverage for Resident #8's hall on 8/21/25. During the interview, the nurse reported she did not recall Resident #8 having an unwitnessed fall on 8/21/25. When additional details were discussed, the nurse then stated she did remember hearing about the unwitnessed fall. However, she reported the only time she heard about this fall was when the resident told her about it a couple of days after the fall. The resident told the nurse that no one came to follow up and check on her

after the fall. The nurse reiterated that she was not made aware of the unwitnessed fall on the day it occurred. She stated it sounded like it was a communication problem in passing along this information.

When asked, the nurse outlined what she would have done if she had been told of Resident #8 having an unwitnessed fall. Nurse #1 stated she would have gone in to see the resident and checked her neurological status (including orientation and behaviors), checked her skin (cuts, bruises), and looked at her Medication Administration Record (MAR) to see if she was on an anticoagulant that could cause excessive bleeding.

Neurological checks would have been initiated on the resident, the MD and resident's Responsible Party would have been called, and she would have completed all the necessary documentation, including a fall report.An interview was conducted on 9/11/25 at 1:23 PM with the facility's Director of Nursing (DON).

During the interview, the facility's failure to follow up, monitor, and report Resident #8's unwitnessed fall of 8/21/25 was discussed. The DON reported he was made aware of the unwitnessed fall and failure to assess the resident after the fall when a Grievance Report was filed by the resident on 8/22/25. When asked what he would have expected to have been done, the DON stated the first thing that needed to be done was to assess the resident prior to transferring her to the bed, take vital signs, do a full assessment (including skin and pain), start neurological checks, and notify the family and MD. He also noted that the appropriate reports and documentation needed to be completed. Upon inquiry, the DON stated the facility did not complete a plan of correction related to this incident.

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

09/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Blumenthal Health and Rehabilitation Center

3724 Wireless Drive Greensboro, NC 27455

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

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

identified. Since the mock survey, smoking assessments have been conducted on all residents and the smokers were identified as either independent smokers or those that required supervision. Smoking aprons were ordered and received last week. Use of the smoking aprons began yesterday (9/9/25). The Administrator and VP reported the facility's smoking policy was discussed during each resident's smoking assessment and these changes were again reviewed with the residents on 9/9/25. The contradiction documented on Resident #7's smoking assessment (and care plan) which indicated the resident could smoke independently yet was required to smoke with supervision was addressed. The Administrator responded by stating that the smoking assessment (and care plan) should have indicated a smoker was either an independent or a supervised smoker. Upon inquiry, the VP of Operations reported the facility did not have a plan of correction (POC) in place related to smoking because the facility was still in the process of implementing a plan.An observation of the smoking courtyard was conducted 9/11/25 at 8:54 AM.

Resident #7 was observed to be talking with another male resident in the courtyard designated for smoking. No staff members were in the courtyard for supervision at the time of the observation. Resident #7 was observed to be smoking a cigarette. The resident was neither supervised nor was he wearing a smoking apron. A follow up interview was conducted on 9/11/25 at 12:42 PM with the Administrator. During

the interview, the Administrator was informed of the observation made of a smoker (who was designated as requiring supervision) smoking in the courtyard without staff supervision. The Administrator responded by stating that there needed to be supervision.An interview was conducted on 9/11/25 at 1:23 PM with the facility's DON. During the interview, the DON confirmed he completed all the residents' smoking assessments recently conducted. The DON reported he was made aware of the error he made on Resident #7's smoking assessment and needed to correct this resident's assessment to indicate he required supervision with smoking and was not an independent smoker. A follow up interview was conducted on 9/11/25 at 4:10 PM with the DON, who was joined by the Activities Director. When asked if nursing was responsible to schedule staff for smoking supervision in the courtyard, the DON reported the Activities Director would be taking over the scheduling of staff for smoking supervision at this point. Upon further inquiry, the DON and Activities Director stated the NA assigned to supervise smoking on 9/11/25 worked on

the hall when no one was requiring supervision with smoking. The DON and Activities Director surmised that Resident #7 may have sneaked out there without telling the assigned NA that he was going out to smoke. They stated Resident #7 should have let the NA know he was going out to smoke so she could have gone with him.

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

09/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Blumenthal Health and Rehabilitation Center

3724 Wireless Drive Greensboro, NC 27455

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)

Federal health inspectors cited Blumenthal Health and Rehabilitation Center in Greensboro, NC for a deficiency under regulatory tag F-F0694 during a standard health inspection conducted on 2025-09-13.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: Provide for the safe, appropriate administration of IV fluids for a resident when needed.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 28 deficiencies cited during this inspection of Blumenthal Health and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-12-09.

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

charge of the Medication Aide should have checked the flow rate of the oxygen and corrected the rate to 2 liters per minute. UM #2 reported that nursing staff were responsible for the oxygen cautionary signs, and

an oxygen cautionary sign should have been posted on Resident #13's doorway. UM #2 did not know why

the sign was not posted.

An interview was conducted with Nurse #6 on 9/10/25 at 3:53 PM. Nurse #6 reported she was responsible for overseeing the Medication Aide and checking the oxygen flow rates for residents. Nurse #6 reported she was not aware of Resident 13's oxygen flow rate was 3.5 liters per minute. Nurse #6 was unable to recall if

she had checked the oxygen flow rate on 9/8 or 9/10/25 for Resident #13.

The Nurse Practitioner was interviewed on 9/11/25 at 12:20 PM and he reported that while the delivery of oxygen at 3.5 liters per minute had not harmed Resident #13, the nurse should check all oxygen concentrators for the correct oxygen delivery rate and post oxygen cautionary signs on the door to the resident's room.

The Director of Nursing (DON) was interviewed by phone on 9/12/25 at 4:58 PM. The DON reported that a nurse was assigned to oversee the Medication Aide and part of the nurses' responsibility was checking oxygen flowrates. The DON reported he expected all nurses to ensure all oxygen flow rates were accurate to the physician orders. The DON reported any resident using oxygen should have a cautionary oxygen sign on their door, and he did not know why Resident #13 did not have a sign. The DON reported he expected all residents using oxygen to have a cautionary sign posted.

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

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

09/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Blumenthal Health and Rehabilitation Center

3724 Wireless Drive Greensboro, NC 27455

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 0697 Level of Harm - Actual harm Residents Affected - Few

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

during a dressing change should be treated for pain. On 9/10/25 at 1:50 PM, an interview with the Nurse Practitioner was conducted. The Nurse Practitioner said that all residents should be treated for pain if they were in pain during dressing changes. An interview with the wound care Nurse Practitioner was conducted

on 9/10/25 at 2:20 PM. The wound care Nurse Practitioner said that Resident #136 had a lot of pain during some of his dressing changes, particularly during any attempts to debride, or remove dead tissue from the wound. The Nurse Practitioner said that he would be given pain medication but at times she would just have to stop the debridement.

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

09/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Blumenthal Health and Rehabilitation Center

3724 Wireless Drive Greensboro, NC 27455

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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

for the facility since April 2025, and the facility did not always have enough staff available to help the residents with their care needs. NA #10 explained she typically had 26 residents assigned to her on 1st shift (7 AM-7 PM), and if she worked the 700 hall then she had up to 40 residents. She then stated that when she had that many residents assigned to her, she couldn't get baths or showers done. NA #10 continued to explain that the shower sheet at the nurse's station did not match what's on the computer. She indicated showers on the weekend didn't always get done because there were not enough staff. NA #10 also indicated the last time she had 40 residents assigned to her was in August, although she was unable to recall the exact day or shift.A phone interview was conducted on 09/11/25 at 10:52 AM with the Wound Nurse. She stated on 08/20/25 at 5:25 PM when she went to perform wound care on Resident #162's her brief and bedding were soaked with urine. She reported the situation to the DON, and he advised her to complete a grievance form which she did. She also reported it to Unit Manager #1. She did not know if anyone at the facility investigated the grievance. A phone interview was conducted on 09/11/25 at 11:00 AM with NA #9. She verified she was the direct care NA for Resident #162 on 08/20/25. She stated she had worked at the facility daily for the last 3 months and that they are constantly short staffed leaving the NAs with up to 20-30 residents from 7 AM to 7 PM. She explained Resident #162 required 2 people for bed mobility and there were no staff members seen in the hall to assist her with performing Resident #162's incontinence care on 08/20/25. NA #9 continued to explain it was impossible to complete her tasks when

she had 20 to 30 residents. Incontinence care was provided however there was normally a delay with completing it. NA #9 confirmed she did one round on Resident #162 after breakfast at approximately 9:45 AM at which time she provided incontinence care, however she did not do another round on her because

she did not have any help to safely provide care. NA #9 continued to explain that the facility was not equipped to provide safe and adequate care to residents due to being short staffed all the time. An

interview was conducted on 09/11/25 at 11:16 AM with Unit Manager #1. She stated she recalled the situation when Resident #162 was observed saturated with urine by the Wound Nurse on 08/20/25. She explained the Wound Nurse notified her Resident #162's brief and sheets were soaked with urine. Unit Manager #1 then stated she did speak to the NA which told her she had not provided incontinent care to Resident #162 yet because she was behind with her tasks. Unit Manager #1 continued to explain that the facility did have several call outs on 08/20/25 and it was hard for the NAs to complete their tasks when they had call outs and were short staffed. The Unit Manager also indicated that the NAs provide the care; however, it was delayed. She had witnessed the NAs having up to 20 residents a piece on 1st shift. An

interview was conducted on 09/11/25 at 4:07 PM with the DON. He stated he did recall the Wound Nurse reporting Resident #162's brief, sheets, and blankets being saturated with urine. He stated he told the nurse to complete a grievance form about what was observed. He then stated he conducted an education in-service to the NAs and disciplinary action was taken against the direct care NA.

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

09/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Blumenthal Health and Rehabilitation Center

3724 Wireless Drive Greensboro, NC 27455

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)

Federal health inspectors cited Blumenthal Health and Rehabilitation Center in Greensboro, NC for a deficiency under regulatory tag F-F0732 during a standard health inspection conducted on 2025-09-13.

Category: Nursing and Physician Services Deficiencies

The facility was found deficient in the following area: Post nurse staffing information every day.

Scope/Severity Level B: isolated, no actual harm with potential for minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 28 deficiencies cited during this inspection of Blumenthal Health and Rehabilitation Center.

Correction Status: No revisit needed.

The facility reported correction as of 2025-10-20.

Federal health inspectors cited Blumenthal Health and Rehabilitation Center in Greensboro, NC for a deficiency under regulatory tag F-F0761 during a standard health inspection conducted on 2025-09-13.

Category: Pharmacy Service Deficiencies

The facility was found deficient in the following area: Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 28 deficiencies cited during this inspection of Blumenthal Health and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-12-09.

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Based on observations and staff interviews, the facility failed to: prevent cross-contamination of dishware

during the operation of the dishwashing machine; ensure dietary staff's personal belongings were not stored in the food preparation area; maintain food service equipment clean and free from debris; and store dishware clean and dry. These deficient practices had the potential to affect residents residing in the facility.1. During the initial tour of the kitchen on 9/8/25 at 11:20 a.m., Dietary Staff #1 was observed wearing plastic gloves as she scraped the excess food debris and placed the dirty dishware on a dish rack

in preparation for cleaning in the dishwashing machine. The Dietary Staff #1 crossed to the opposite side of

the machine and removed a rack of clean glassware without removing the soiled gloves and washing her hands. She placed the rack of glassware onto a preparation table for use during the lunch tray line service.

Dietary Staff #1 revealed she had been working at the facility for three days and had not received any training on cross-contamination. She was not aware she was to remove her gloves and wash her hands

after handling soiled dishware. On 9/8/25 at 11:30 a.m., the Dietary Manager stated Dietary Staff #1, a new employee, had only been working in the kitchen for three days. The Dietary Manager had not completed Dietary Staff #1's training because he had been busy trying to ensure residents received their meals on time. 2. On 9/8/25 at 11:40 a.m. a large, pink travel mug was observed on the bottom shelf of a food preparation table in the kitchen. Dietary [NAME] #1 stated the mug belonged to one of the dietary staff. On 9/8/25 at 11:45 a.m., a dietary staff was observed entering the kitchen and placing a large travel mug on

the bottom shelf of a preparation table after sipping from the straw inserted in the mug. During the meal tray service in the kitchen on 9/8/25 at 12:00 p.m., a small 3-shelf cart was observed next to the trayline service with plate covers stacked on the top shelf, large blue travel mug on the second shelf, one large pink travel mug, one large can of kidney beans, and one bushel of plastic flowers were on the bottom shelf of the cart.

1. 3. During the tour of the kitchen on 9/8/25 at 11:42 a.m., there was a thick, black grease build-up covering

the stove top and dried dark stains on the front and sides of the stove. The interior of the double convection ovens also contained thick, dark grease buildup. The interior of the double-sided plate warmer had dried brown/yellow stains. There were clean plates observed in the warmer. On 9/12/25 at 2:31 p.m., the Dietary Manager stated Sundays were scheduled as the deep cleaning day in the kitchen, including equipment. He revealed he last cleaned the ovens on 8/30/25. 4. During an observation of the meal service trayline in the kitchen on 9/10/25 at 12:08 p.m., there were seven wet and dirty (dried food particles) divided plates stacked on the meal service trayline. During an interview on 9/12/25 at 2:31 p.m. the Dietary Manager stated the Registered Dietitian conducted audits of the kitchen every Monday on sanitation, safety, dating and labelling of foods.

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

09/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Blumenthal Health and Rehabilitation Center

3724 Wireless Drive Greensboro, NC 27455

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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

order to receive meropenem (an antibiotic used to treat severe bacterial infections) intravenous (IV) solution reconstituted 1 gram intravenously every 8 hours.

The August 2025 Medication Administration Record (MAR) for Resident #101 was reviewed and revealed 2 occurrences indicating the meropenem antibiotic was not administered for the following dates: 08/17/25 at 4:00 PM and 08/22/25 at 12:00 AM.

An interview was conducted on 09/13/25 at 2:00 PM with Nurse #1. She verified she worked on 08/17/25.

She stated she did administer Resident #101's IV medication on 08/17/25 at 4:00 PM. She explained she forgot to sign the MAR.

A phone interview was conducted on 09/11/25 at 10:52 AM with the Wound Nurse. She verified she worked

on 08/22/25 at 12:00 AM. She stated she knew she administered the IV antibiotic for Resident #101 but that

she could not remember why she didn't sign the MAR. She indicated it was an oversight.

The Physician's Assistant was interviewed on 9/12/25 at 12:50 PM he stated he was aware the MAR was not signed as being administered. He explained medications should have been accurately documented.

The Director of Nursing was interviewed on 9/12/25 at 2:42 PM and stated nurses were supposed to document on the MAR after administering IV antibiotics. The DON verified he was aware of the missed signatures on the MAR.

1. 3. Resident #82 was admitted on [DATE REDACTED] with diagnoses that included type II diabetes and cognitive

communication deficit.

An active physician's order dated 5/28/25 and renewed on 8/5/25 revealed Resident #82 had an order to receive 8 units of Novolin R (insulin regular human); inject 8 units subcutaneously two times a day related to type II diabetes with hyperglycemia. Hold if not eating meal; hold for blood glucose less than 150.

The August 2025 Medication Administration Record (MAR) for Resident #82 was reviewed and revealed 5 occurrences indicating Resident #82's blood sugar was not assessed, and the Novolin R insulin was not administered for the following dates: 8/2/25 at 11:30 AM, 8/28/25 at 4:00 PM, and 8/30/25 at 4:00 PM.

On 9/12/25 at 12:00 PM Nurse #1 was interviewed and verified she had worked the dates of 8/2/25, 8/28/25, and 8/30/25. She stated she did not recall having missed checking Resident #82's blood sugars or giving him insulin on the missing dates, and she was uncertain why her initials were not recorded on the MAR.

The Physician's Assistant was interviewed on 9/12/25 at 12:50 PM and stated medications should have been administered and accurately documented as ordered.

The Director of Nursing was interviewed on 9/12/25 at 2:42 PM and stated nurses were supposed to document on the MAR after checking a resident's blood sugar and administering insulin.

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

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

09/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Blumenthal Health and Rehabilitation Center

3724 Wireless Drive Greensboro, NC 27455

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)

Federal health inspectors cited Blumenthal Health and Rehabilitation Center in Greensboro, NC for a deficiency under regulatory tag F-F0850 during a standard health inspection conducted on 2025-09-13.

Category: Administration Deficiencies

The facility was found deficient in the following area: Hire a qualified full-time social worker in a facility with more than 120 beds.

Scope/Severity Level C: pattern, no actual harm with potential for minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 28 deficiencies cited during this inspection of Blumenthal Health and Rehabilitation Center.

Correction Status: No revisit needed.

The facility reported correction as of 2025-10-20.

Federal health inspectors cited Blumenthal Health and Rehabilitation Center in Greensboro, NC for a deficiency under regulatory tag F-F0880 during a complaint investigation conducted on 2025-09-13.

Category: Infection Control Deficiencies

The facility was found deficient in the following area: Provide and implement an infection prevention and control program.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 28 deficiencies cited during this inspection of Blumenthal Health and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-12-09.

Federal health inspectors cited Blumenthal Health and Rehabilitation Center in Greensboro, NC for a deficiency under regulatory tag F-F0883 during a standard health inspection conducted on 2025-09-13.

Category: Infection Control Deficiencies

The facility was found deficient in the following area: Develop and implement policies and procedures for flu and pneumonia vaccinations.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 28 deficiencies cited during this inspection of Blumenthal Health and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-12-09.

Federal health inspectors cited Blumenthal Health and Rehabilitation Center in Greensboro, NC for a deficiency under regulatory tag F-F0887 during a standard health inspection conducted on 2025-09-13.

Category: Infection Control Deficiencies

The facility was found deficient in the following area: Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.

Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 28 deficiencies cited during this inspection of Blumenthal Health and Rehabilitation Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-12-09.