Nhc Healthcare, Bristol

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

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

Administrator for a copy of the Facility Reported Incident (FRI) or evidence the abuse allegation was reported to the State Agency, and they stated, We didn't do a FRI. When it was reported to us, we immediately started an investigation and there were so many inconsistencies, we concluded they had a confrontation between the two of them, not in front of the patient and that the accusation was made in retaliation, so we thought it wasn't credible, so in my mind, it wasn't reportable.On 8/20/25 at 1:25 PM this surveyor met with the Administrator and the Director of Social Work (DSW) who was also involved in the investigation. The DSW stated that they had spoken with the resident representative (RR)during the course of the investigation to inform them of the allegation and the RR stated, I'm surprised (the resident) didn't say worse. They indicated the RR was not upset and stated, I don't recall if I told her exactly what was supposedly said or not, I may have just said it was inappropriate or unprofessional. Knowing the patient and knowing her use of foul language and there was no negative outcome we didn't think it rose to the level of being reportable. The Administrator added, We don't feel it was reportable secondary to there was no negative outcome and language is somewhat cultural. Some people use foul language on a regular basis, it's just how they talk. It was minor and goes back to how the resident responds, was it abuse to her? She can't tell us, and I don't think so. This surveyor explained the Reasonable Person Concept and stated, As a reasonable person, how would the CNA speaking to you like that make you feel? The Administrator provided a copy of the policy entitled, Patient Protection and Response Policy for Allegations/Incidents of Abuse, Neglect, Misappropriation of Property and Exploitation with a revised date of 2/1/23. The document defined verbal abuse as, The use of oral, written or gestured language that willfully includes disparaging remarks to residents or their families, or within hearing distance regardless of their age, ability to comprehend, or disability. On page 6 the document read in part, Any patient event that is reported to any partner by patient, family, other partner, or any other person will be considered an allegation of either abuse, neglect, misappropriation of patient property or exploitation if it meets any of the following criteria: 5.

Any complaint of the use of oral, written, or gestured language that willfully includes disparaging and derogatory terms to patients or families or within their hearing distance. On pages 7-8, the document read

in part, It is the policy of this facility that abuse allegations (abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property are reported per Federal and State Law. The facility will ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but no later than two (2) hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause

the allegation do not involve abuse and do not result in serious bodily injury, to the Administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities), in accordance with state law and through established procedures. On the bottom of page 8, b. The results of all investigations will be completed within five working days of the incident. Depending on the result of the investigation, all necessary corrective actions will be taken.The investigation was thorough, and it was determined that there was not enough evidence to support that Resident R1 had been verbally abused. During the investigation, both CNAs quit and there was no further danger to Resident R1.On 8/20/25 at 4:30 PM this concern was discussed with the Administrator and the DON. No further information was provided prior to the exit conference.

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

08/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Nhc Healthcare, Bristol

245 North Street Bristol, VA 24201

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

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

Levothyroxine 150 mcg once a day at 6:00 AM.On 8/20/25 at 2:00 PM, surveyor spoke with the DON who stated LPN #5 reported administering Levothyroxine at bedtime because the resident did not want to be awakened at 6:00 AM and the LPN thought the medication could be given on an empty stomach, so they went ahead and gave it. The DON stated LPN #5 should have waited until the ordered administration time and they were educated that should a resident want to change their medication administration time; they should reach out to the provider for a time change. No further information regarding this concern was presented to the survey team prior to the exit conference on 8/20/25. 6. For Resident #15, the facility staff administered Omeprazole at 9:00 PM instead of 6:00 AM as ordered by the medical provider. Omeprazole is a medication used to treat excess stomach acid. Resident #15's diagnosis list indicated diagnoses, which included, but not limited to Charcot-Marie-Tooth and Achalasia of Cardia. The most recent minimum data set (MDS) with an assessment reference date (ARD) of 6/03/25 assigned the resident a brief interview for mental status (BIMS) summary score of 12 out of 15 indicating the resident was moderately cognitively impaired. On 8/19/25 at 3:35 PM, surveyor spoke with Registered Nurse (RN) #1 who stated a night shift nurse administered 6:00 AM medications with residents' bedtime medications. The Director of Nursing (DON) identified Resident #15 as having received medication at the incorrect time and provided an Event Report dated 6/06/25 indicating Licensed Practical Nurse (LPN) #5 administered Omeprazole on 6/05/25 at 9:00 PM instead of waiting until 6/06/25 at 6:00 AM as ordered. Resident #15's clinical record included an active order for Omeprazole 40 mg once a day at 6:00 AM.On 8/20/25 at 2:00 PM, surveyor spoke with the DON who stated LPN #5 reported administering Omeprazole at bedtime because the resident did not want to be awakened at 6:00 AM and the LPN thought the medication could be given on an empty stomach, so

they went ahead and gave it. The DON stated LPN #5 should have waited until the ordered administration time and they were educated that should a resident want to change their medication administration time,

they should reach out to the provider for a time change. No further information regarding this concern was presented to the survey team prior to the exit conference on 8/20/25.

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

08/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Nhc Healthcare, Bristol

245 North Street Bristol, VA 24201

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 - Actual harm Residents Affected - Few

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

transfer but after several days it was discovered the shower chair breaks were not locked during the transfer. DON stated CNA #4 and nursing staff were re-educated following the fall and stated the re-education included the locking of breaks prior to a resident transfer. The DON provided a copy of CNA #4's annual competency checklist dated 3/03/25 indicating the CNA demonstrated understanding of falls prevention. The DON stated falls prevention included locking breaks prior to transfer. On 8/20/25 at 4:09 PM, surveyor met with the Administrator and DON and discussed the concern of CNA #4 failing to lock the shower chair breaks prior to transferring Resident #7 which resulted in a fall with a fracture. No further information regarding this concern was presented to the survey team prior to the exit conference on 8/20/25.

Event ID:

Facility ID:

If continuation sheet