Lexington Health Care Center

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

stay/live in Resident #1's personal house because employees cannot access goods or property from residents. The DON stated NA #1 was suspended during the investigation and then terminated for attendance issues. She stated NA #1 did not work after the facility was aware of the allegation.A phone

interview on [DATE REDACTED] at 9:38am with the local law enforcement officer whose name was listed on the initial allegation report dated [DATE REDACTED]. He stated he was unable to recall responding to the call or any circumstances regarding the allegation. He stated he did not complete a report, and he was unable to

review notes that may have been written on the call sheet (the call sheet is documentation recorded by the local 911 call center that is provided to local law enforcement to respond to a 911 call).A request was made

during the survey for a copy of the law enforcement call sheet related to the [DATE REDACTED] allegation involving Resident #1 and NA #1. This was not received. In a phone interview with the former Administrator on [DATE REDACTED] at 4:44pm, she explained she was not aware of conversations between Resident #1 and NA #1 until Resident #1's family member and neighbor came to the facility on [DATE REDACTED] and reported NA #1 had attempted to obtain a key to enter Resident #1's personal house. She explained Resident #1's wife had recently died, and she learned from Resident #1 that he felt sorry for NA #1 when he (the resident) learned from NA #1 that she would have nowhere to live at the first of the month. She stated the resident admitted giving NA #1 permission to stay at his personal house and when he learned about NA #1's boyfriend, Resident #1 was concerned and changed his mind. She stated the facility identified NA #1 through matching the phone number on the text messages observed on Resident #1's cellular phone after learning NA #1 had attempted to obtain a key to Resident's #1 personal house from Resident #1's neighbor. She stated the allegation for misappropriation of property and resident abuse was not substantiated because Resident #1 was not harmed and NA #1 did not access Resident #1's personal house or obtain any of Resident #1's property. The former Administrator stated she had not thought about exploitation for Resident #1 because NA #1 had not benefited from the situation. She indicated looking back, she should have substantiated the allegation for exploitation because after NA #1 discussed staying/ living at Resident #1's personal house with Resident #1, she attempted to enter Resident #1's personal house without the resident being present.In an interview with the Administrator, Regional Clinical Consultant and Director of Nursing present on [DATE REDACTED] at 5:30 pm, they stated the facility had not completed a plan of correction for misappropriation of property/exploitation.

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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

09/02/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Lexington Health Care Center

17 Cornelia Drive Lexington, NC 27292

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review and staff interviews, the facility failed to report an allegation misappropriation of property/exploitation to Adult Protective Services (APS) for 1 of 3 residents reviewed for abuse, misappropriation of property and/or exploitation (Resident #1).Findings included:The Facility's Reporting Requirements/Investigations policy statement dated effective 2/5/2023 indicated the Administrator will immediately notify the adult protective services agency for any incident of patient abuse, mistreatment, neglect or misappropriation of personal property or other reasonable suspicion of a crime. Resident #1 was admitted to the facility on [DATE REDACTED].An initial allegation report dated 7/10/2025 at 2:13 pm was completed by

the former Administrator and faxed to the State Agency alleging misappropriation of Resident #1's property

on 7/9/2025. The initial report recorded the facility became aware of the incident on 7/10/2025 at 10:45am.

Details of the allegation stated NA #1 convinced Resident #1 to allow her to stay/live in his personal house while he was at the nursing facility. NA #1 went to Resident #1's neighbor's home to obtain a key to Resident #1's personal house who refused to give NA #1 a key to Resident #1's personal house. On 7/10/2025, Resident #1's neighbor and family member reported NA #1 attempted to exploit Resident #1 to become a squatter in Resident #1's personal house. Resident #1's family member, who was financial proxy and health power of attorney for Resident #1, stated Resident #1 was easily manipulated and coerced into agreements of helping others. NA #1 was suspended pending investigation of the allegation on 7/10/2025.

The facility report indicated notification of the allegation was made to local law enforcement on 7/10/2025 at 12:41 pm. There was no documentation that APS was notified of the allegation of misappropriation of property and/or exploitation.The facility's investigation report signed by the former Administrator on 7/16/2025 was faxed to the State Agency on 7/17/2025. There was no documentation that APS was notified of the allegation of misappropriation of property and/or exploitation.In a phone interview with the former Administrator on 8/27/2025 at 4:44pm, she stated she could not recall if APS was notified of the allegation related to misappropriation of property/exploitation for Resident #1. She explained that usually the Social Worker electronically notified APS of abuse, misappropriation or property and/or exploitation allegations.In

an interview with the Social Worker on 8/28/2025 at 5:47 pm, she explained since starting at the facility in May 2025, she was responsible for notifying APS for incidents of residents leaving against medical advice and exploitation of funds. She stated the former Administrator would have to let her know when there were allegations of misappropriation of property and/or exploitation to report to APS. She stated she was not informed by the former Administrator of the allegation of misappropriation of property and/or exploitation for Resident #1 and therefore, she had not notified APS of the allegation.In a follow up phone interview with

the former Administrator on 9/4/2025 at 12:00 pm, she stated per the facility's policy, the local adult protective agency should be notified of allegations of misappropriation of property and/or exploitation. She explained she had no recall of informing the Social Worker of the allegation of misappropriation of property and/or exploitation for Resident #1 and the local adult protective agency was not notified. In an interview with the Administrator, Regional Clinical Consultant and Director of Nursing on 8/28/2025 at 5:50 pm, they stated the facility did not have a plan of correction that was completed for reporting an allegation of misappropriation of property and/or exploitation for Resident #1.

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