Oakhurst Health & Rehabilitation

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

investigated by facility management. [Sic] Findings of abuse investigations will also be reported .The individual[s] conducting the investigation may, at a minimum .Review the resident's medical record to determine events leading up to the incident .Interview any witnesses to the incident .Interview the resident (as medically appropriate) .Interview the staff members (on all shifts) who have had contact with the resident during the period of the alleged incident .Interview the resident's roommate, family members, visitors .Review all events leading up to the alleged incident .This finding was reviewed with the administrator and regional nurse consultant on 9/9/25 at 3:50 p.m. with no further information provided prior to the end of the survey.

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

09/10/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Oakhurst Health & Rehabilitation

4238 James Madson Highway Fork Union, VA 23055

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

working in the facility at the time of the incident and that the former administrator conducted the investigation. The administrator stated he thought the incident had not been reported to the state agency or APS because the verbal threats were directed toward staff members and not residents. The facility's policy titled Abuse (revised 10/20/22) documented, .The organization will maintain systems to 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 not later than 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 .to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) .

This finding was reviewed with the administrator and regional nurse consultant on 9/9/25 at 3:50 p.m. with no further information provided prior to the end of the survey.

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

09/10/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Oakhurst Health & Rehabilitation

4238 James Madson Highway Fork Union, VA 23055

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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

verbal threats of physical violence toward him and the nursing staff. The maintenance director stated Resident R201 directed aggressive comments toward the staff members but that there were several residents in the area when the incident took place. On 9/9/25 at 12:00 p.m., the current administrator and regional nurse consultant (administration #3) were interviewed about the reporting/investigating of the 7/30/25 incident of verbal aggression. The administrator stated he was not working in the facility at the time of the incident and that the former administrator conducted the investigation. The administrator stated the investigation included statements from staff about Resident R201's aggressive behaviors and described events surrounding Resident R201's behaviors. The administrator presented no documentation the investigation addressed Resident R201's report that assistance was not provided by staff. On 9/9/25 at 3:18 p.m., CNA #2 that cared for Resident R201 at the time of the incident on 7/30/25 was interviewed. CNA #2 stated, prior to today, she had not been interviewed or asked to provide a statement about the events on 7/30/25.The facility's policy titled Abuse Investigation and Reporting (10/01/21) documented, .All reports of resident abuse, neglect, exploitation, misappropriation of resident property, mistreatment and/or injuries of unknown and [are] thoroughly investigated by facility management .The individual[s] conducting the investigation may, at a minimum .Review the resident's medical record to determine events leading up to the incident .Interview any witnesses to the incident .Interview the resident (as medically appropriate) .Interview the staff members (on all shifts) who have had contact with the resident during the period of the alleged incident .Interview the resident's roommate, family members, visitors .Review all events leading up to the alleged incident .This finding was reviewed with the administrator and regional nurse consultant on 9/9/25 at 3:50 p.m. with no further information provided prior to the end of the survey.

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

09/10/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Oakhurst Health & Rehabilitation

4238 James Madson Highway Fork Union, VA 23055

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

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

work as a team to provide timely assistance for residents. The DON stated that CNAs could ask for help from other aides and that nurses were also able to provide care if needed. The regional nurse consultant stated assistance could have been provided for the early appointment resident so that CNA #2 could help Resident R201 more timely. The administrator stated again that staff members needed to work together to meet resident needs and requests.Resident R201's plan of care (revised 6/2/25) documented the resident required assistance with activities of daily living (ADL) due to chronic health conditions, muscle weakness, bladder incontinence and used a urinal at times. Interventions to provide incontinence care and maintain ADLs included, Physical assist as needed with ADL care .resident uses disposable briefs. Change q [every] 2 hr [hours] and prn [as needed] .Provide supervision and cuing [cueing] as needed with ADL care .The facility's policy titled Answering the Call Light (undated) documented, The facility will maintain a functional call light system and will make all reasonable efforts to ensure timely responses to the resident's requests and needs .'Timely Response': is not defined by a 'pre-set' measure of minutes but rather is defined that the response time was appropriate to situation and/or need. Response time varies based on each situation and is impacted from the resident's need and perception/understanding of the urgency and time lapse .If the resident needs assistance, indicate the approximate time it will take for you to respond .If you are uncertain as to whether or not a request can be fulfilled or if you cannot fulfill the resident's request, ask an appropriate staff member for assistance .This finding was reviewed with the administrator, DON and regional nurse consultant on 9/10/25 at 11:50 a.m. with no further information presented prior to the end of

the survey.

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

09/10/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Oakhurst Health & Rehabilitation

4238 James Madson Highway Fork Union, VA 23055

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

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview and clinical record review, the facility staff failed to obtain a physician ordered urinalysis with culture for one of seven residents in the survey sample (Resident #201).The findings include:Resident #201 (Resident R201) was admitted to the facility with diagnoses that included cerebral infarction, diabetes, hypertension, peripheral vascular disease, history of myocardial infarction with defibrillator/pacemaker, dysarthria, anxiety, depression, chronic pain syndrome, heart failure, adult failure to thrive, history of prostate cancer, and congestive heart failure. The minimum data set (MDS) dated [DATE REDACTED] assessed Resident R201 as cognitively intact. Resident R201's clinical record documented on 7/1/25 that the resident reported burning with urination and discolored urine. The provider was notified, and a physician's order was entered dated 7/1/25 for a urinalysis with culture and sensitivity. A nursing note dated 7/5/25 documented, urine sample being sent to lab. Resident R201's clinical record documented no results of the urinalysis with culture ordered on 7/1/25.On 9/9/25 at 3:50 p.m., the regional nurse consultant (administration #3) was interviewed about results of the urinalysis ordered on 7/1/25. The nurse consultant reviewed the clinical record and stated she did not find results of the urinalysis with culture.On 9/10/25 at 10:55 a.m., the regional nurse consultant stated she contacted the lab. The regional nurse consultant stated the lab picked up samples from the facility on 7/5/25, but there was no record that Resident R201's urine sample was picked up or processed by lab personnel. A lab listing for Resident R201 was presented with no urine sample sent or picked up by the lab in response to the 7/1/25 order. The regional nurse consultant was not sure why the sample was not provided to the lab.This finding was reviewed with the administrator and regional nurse consultant on 9/10/25 at 11:30 a.m. with no further information presented prior to the end of the survey.

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet