Nhc Healthcare, Hendersonville

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

staff were observed entering or exiting the room. CNA I was asked about Resident #5's functional status.

CNA I stated, .[Resident #5].can roll in the bed with help, but she can't stand up. She's a Hoyer lift . When asked who transferred Resident #5 from the bed to the wheelchair this morning, CNA I stated, .I did her myself with the Hoyer, it just takes 1 person with her, she grabs onto the bars, there's no issues, like no one needs to hold her legs up or anything . 6. Review of the medical record revealed Resident #6 was admitted to the facility on [DATE REDACTED] with diagnoses including Heart Disease, Kidney Disease, and History of Falling.

Review of the facility Can-Do Information Sheet for Resident #6 dated 1/8/2025, revealed .Transfer Assist: 2 person for safety due to bad left knee/use walker .or sliding board [with 1 person assistance] .Fall Precautions: inconsistent transfers/use walker or use 2x staff . Review of a Functional Abilities Assessment by Physical Therapy for Resident #6 dated 10/13/2025, revealed .mobility devices: walker, wheelchair .chair/bed to chair transfers: substantial/maximal assistance . Review of the annual MDS assessment dated [DATE REDACTED], revealed Resident #6 scored an 8 on the BIMS assessment which indicated the resident had moderate cognitive impairment. Resident #6 required Substantial/Maximal Assistance for sit-to-stand transfers, chair/bed-to-chair transfers, and used a walker and wheelchair for mobility. Review of the Care Plan dated 10/20/2025, revealed .Resident is at risk for falls.requires staff assist .hx of falling .minimum to moderate assistance with transfers and self-care .Activities of daily living .minimum to moderate assistance.assist.with.bed mobility . The facility failed to ensure the Care Plan was revised and included an intervention for method of transfer, including using a 2 person assist and walker, as was documented on the Can-Do Information Sheet. During an interview on 10/21/2025 at 11:19 AM, CNA G stated, .[Resident #6] needs 1 person for transfer, sometimes we will use 2, it depends.she is terrified of falling . 7. During an

interview on 10/22/2025 at 3:30 PM, the Director of Nursing (DON) confirmed the care plans for Residents #3, #4, #5, and #6 had not been revised to include the residents' transfer methods, and confirmed the care plans did not match the Can-Do information sheets.

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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

11/04/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Nhc Healthcare, Hendersonville

370 Old Shackle Island Rd Hendersonville, TN 37075

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

to the floor, her R leg was under her left leg . Further documentation revealed, .conscious decision at the time of the fall was based on safety and comfort, The hoyer was not an option in the moment d/t pt slipping and the CNA's inability to safely utilize the hoyer lift. It was a controlled lowered to the floor vs [versus] a fall . The documentation revealed the QAPI committee identified that another shower device could have been used instead of the chair, interventions included: Anyone using a hoyer lift would be care planned to use a shower bed, in-serviced /educated on hoyer sling placement was initiated, competencies with all new hires and transfer training with therapy, and current employees will need to complete annual competency checks and return demonstration. In-services were initiated 12/17/2024 for transfers per care plan, hoyer sling/sitting, hoyer sling/lying position, timely assessment after lowering a patient to the floor, reduce injury with a fall, timely communication after a fall, and gait belt transfers. The facility's corrective actions for the removal plan were issued to the state surveyors on 10/29/2025. The corrective action plan included the following: 1. Resident #1 returned to the facility on [DATE REDACTED]. Resident #1's care plan was updated on the use of a shower bed (instead of a shower chair). 2. The facility identified residents who require a Hoyer lift, and care planned these residents to use the shower bed (instead of a shower chair) on shower days, completed

on 12/17/2024. 3. Staff in-services and education - initiated 12/17/2024. a. How to safely place Hoyer slings from various positions, sitting and lying. b. How to reduce injury with an interrupted fall. c. How to lower a patient to the floor and body positioning. d. Timely assessments at time of fall. e. Timely notifications with family communication. 4. New Hire orientation to include fall safety and transfer training. Initiated 12/17/2024 and ongoing. 5. Complete competencies with all new hires and transfer training with therapy ongoing. 6. Current employees will complete annual competency checks with return demonstration, and is ongoing. The Removal Plan was validated onsite by the surveyors on 10/29/2025 which included review of

the facility education to show each step was completed, staff interviews to confirm completion, review of care plans, review of new hire orientation training, review of new hire competencies and transfer training, and review of current employee annual competency checks.

Event ID:

Facility ID:

If continuation sheet