Elizabeth Adam Crump Health And Rehab

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

available at each resident's bedside to summon staff assistance. Room environment checks: During regular patient rounding, nursing staff should ensure that the call light, along with other personal items like tissues and the phone, is within the resident's reach. This is part of a broader falls-prevention strategy. These guidelines align with federal regulations for long-term care facilities, which also mandate that a functioning call system be available at a resident's bedside and in their bathing areas.10/30/25 during the end of day exit, the Administrator, Director of Nursing and Regional Nurse Consultant were made aware of the concerns, and no further information was provided.

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

10/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Elizabeth Adam Crump Health and Rehab

3600 Mountain Road Glen Allen, VA 23060

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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

repairs and maintenance for 2 large buildings. The nursing facility had 160 beds. It is unknown how many individual apartments were contained in the larger assisted living building. The maintenance Director stated

they were starting to get some priorities taken care of in the facility now as staffing had improved just recently. On 10-29-25, and 10-30-25 during a meeting with the Administrator, Director of Nursing, and Corporate clinical support consultant, the facility staff were made aware of the above concerns and that the living units were not safe, clean and comfortable. At the time of the survey exit the facility Administrator, and Director of Nursing stated they had nothing further to provide.

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

10/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Elizabeth Adam Crump Health and Rehab

3600 Mountain Road Glen Allen, VA 23060

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

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

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on Resident interview, staff interview, clinical record review, and facility document review, the facility staff failed to maintain an abuse/neglect free environment for 1 Resident (Resident #3) in a survey sample of 13 Residents.The findings included.Resident #3 Was admitted to the facility on [DATE REDACTED] with diagnoses including stroke, anemia, gout, heart attack, diabetes, asthma, atrial fibrillation, and vertigo. The Resident required extensive assistance or was fully dependent on 1 to 2 staff members for all activities of daily living such as hygiene, and bed mobility. The Resident was her own responsible party and found to be alert and oriented to person, place, time, and situation. The Resident had no observable cognitive impairment. The Resident was conversational and appropriate in response to questioning and was a good historian. On 10/28/25 at 12:15 p.m. Resident #3 was interviewed in the Resident's Room. The Resident was sitting in bed dressed in hospital gown. CNA #6 (Certified Nursing Assistant #6) entered the room and Resident #3 asked is there any milk today? CNA #6 stated, I've told you, no milk at lunch (Resident's name). In a frustrated angry elevated voice, (the CNA had said this before to the Resident). The CNA was loud, curt, and dismissive. This caused the Resident to then whisper while talking to the surveyor out of fear of being overheard by the CNA, stating they have said before that we can't have milk at lunch. The Surveyor then asked the CNA, No milk at lunch is that a rule? CNA #6 replied they have tea and coffee at lunch, in a curt response. The Surveyor then asked, Even if she requested it? CNA #6 responded, Well, I guess if she asked dietary, they might get it. The CNA immediately exited the room and did not retrieve the milk for the Resident. Resident #3 then whispered, asking the surveyor I'm not going to get kicked out am I? The surveyor replied no, and asked does she always speak that way to you? The Resident replied, they all talk like that to us.On 10/28/25 at 12:30 p.m. an interview was conducted with the Dietary manager, who stated residents can request milk at lunch, but it is not routinely given out at lunch, however, it is with breakfast and dinner. She further stated that the Residents could have milk, and it was in the refrigerator on all of the units at the nursing station at all times, but the CNA's had to go and get it. The Refrigerator on the unit was examined and found to contain at least 12 cartons of 2% and whole milk options.CNA #6 willing (repeatedly) withheld readily available goods and services (neglect) from a Resident who requested them from her in the presence of a representative of the State Agency. This was done in an angry manner that resulted in the Resident experiencing fear of retaliation or reproach for asking for those goods and services (abuse). This action had been repeated by this CNA, and others.On 10-29-25 at 11:30 a.m. The Administrator, Corporate Registered Nurse (RN), and Director of Nursing (DON), were made aware of the incident, and stated that it had been reported to them. They had begun an investigation of abuse and notified the State Agency of such. CNA #6 was suspended (thus protecting the Resident) pending the result of their investigation.The facility policy on Abuse was reviewed and revealed their definitions of abuse supported this situation as being identified as an allegation of abuse. The policy steps were followed after

the allegation of abuse was made.On 10-30-29 at the end of day debriefing the facility Administrator, DON, and Corporate RN were made aware of the deficient practice and they stated they had no further information to provide.

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

10/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Elizabeth Adam Crump Health and Rehab

3600 Mountain Road Glen Allen, VA 23060

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 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

the person who administers the dose.8. Check expiration date on package/container. No expired medication will be administered to a resident.15. Residents are allowed to self-administer medications when specifically authorized by the prescriber, the nursing care center's Interdisciplinary Team (IDT). And in accordance with procedures for self-administration of medications and state regulations.20. The resident is always observed after administration to ensure that the dose was completely ingested.Documentation1.

The individual who administers the medication dose records the administration on the resident's MAR (Medication Administration Record) immediately following the medication being given.Section 7.3 Self-Administration by Resident1. 1. If the resident desires to self-administer medications, an assessment is conducted by the interdisciplinary team of the resident's cognitive, physical, and visual ability to carry out

this responsibility, during the care planning process.2. 2. The interdisciplinary team determines the resident's ability to self-administer medications by means of a skill assessment conducted as part of the care plan process.4. If the resident demonstrates the ability to safely self-administer medications, a further assessment of safety of bedside medication storage is conducted.7.5 OralsProcedures10. Administer medication and remain with the resident while medication is swallowed. Do not leave a medication in a resident's room without orders to do so along with documentation of self-administration. Use caution with residents who have difficulty with swallowing.14. Chart medication administration on the Medication Administration Record immediately following each resident's medication administration.On 10/28/25 a

review of clinical records for Residents #4, #5 and #6 was completed with no evidence that the residents had been assessed or care planned to self-administer medications.On 10/29/25 during the end of day meeting, the Administrator, Director of Nursing and Regional Nurse Consultant were made aware of concerns, and no further information was provided.

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

10/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Elizabeth Adam Crump Health and Rehab

3600 Mountain Road Glen Allen, VA 23060

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 0686

Consultant were made aware of concerns, and no further information was provided.

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

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

10/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Elizabeth Adam Crump Health and Rehab

3600 Mountain Road Glen Allen, VA 23060

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 0757

Ensure each resident’s drug regimen must be free from unnecessary drugs.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, clinical record review and facility documentation, the facility staff failed to ensure that residents were free from unnecessary medications for 1 Resident (#2) in a survey sample of 13 residents.For Resident #2 the faciltiy staff failed to ensure that the resident was free from unnecessary drugs related to duplicate drug therapy.Resident #2 was admitted to the facility on [DATE REDACTED] with diagnoses that include but were not limited to fracture of left femur, COPD (Chronic Obstructive Pulmonary Disease), asthma, chronic respiratory failure, abscess of lung, major depressive disorder, generalized anxiety disorder, acute hepatitis C, and insomnia. Resident #2 had a BIMS (Brief Interview of Mental Status) Score of 11 out of a possible 15 indicating moderate cognitive impairment. Resident #2 was admitted to the facility on [DATE REDACTED] with orders that included the following:Escitalopram 20 mg daily was DISONTINUED Continue Fluoxetine 25 mg daily Continue Seroquel low dose to assist with sleep. A review of the clinical record revealed that on admission to the facility the order for Escitalopram 20 mg was ordered by attending physician. The discharge order on page 5 of the discharge summary read: Start taking these medications:Melatonin 3 mg at night for insomniaQuetiapine Fumarate 25 mg. [an anti-psychotic] in the evening for mood take 0.5 tab. [1/2 of a tablet or 12.5 mg] On 9/5/25 during the admission process the order was written as follows: Quetiapine fumarate oral tablet 25 mg give 1 tablet by mouth in the evening for mood. 9/5/25 The resident received the incorrect dosage twice (9/6/25 and 9/7/25) before the correction was made to read 0.5 of a 25 mg tablet to equal 12.5 mg, thus causing the resident to be given twice the amount of medication on 2 separate occasions.The Psych Nurse Practitioner ordered the Buspar on 9/15/25 and the following warning was flagged by the pharmacy system The system raised the alert again on 9/15/25 when the physician ordered buspirone HCL 7.5 mg by mouth 2 times a day for major depressive disorderHas triggered the following drug protocol alerts / warningsDrug to Drug interactionInteraction: Additive serotonergic effects may occur

during coadministration of buspirone and escitalopram oxalate 20 mg tramadol HCl and trazadone and the risk of developing serotonin syndrome may be increased.No documentation was present that the MD had been notified, or the pharmacy had been consulted regarding these alerts of drug-to-drug interactions. On 10/30/25 at approximately 11:30 am an interview was conducted with the Psych NP who stated that he did not order the admission medications they were done by the hospital and the attending physician at the facility. He stated that he ordered the Buspar on 9/15/25 for depression. When asked if he was made aware of the warnings of concomitant use of several of the medications, he stated that the facility staff did not contact him regarding pharmacy warnings of drug-to-drug interactions. He stated that he did not order the other medications, so he was not aware of any issues with them. On 10/30/25 an interview was conducted with LPN B who stated that pharmacy alerts will appear when orders are entered into the system that are conflicting or have drug to drug interactions or if a patient has an allergy. LPN B stated that the nurses are supposed to notify the physician to see if the physician wants to keep the medicine or change it to something else. She further stated that they also should consult with the pharmacist as well. On the afternoon of 10/30/25 an interview was conducted with the DON who stated that it is her expectation that nurses are to contact physicians when they have pharmacy alerts for drug to drug interactions and or allergy alerts. The DON also stated that notifying the physicians allows the physician to decide whether the benefit of taking the drug outweighs the risks. When asked if the physicians have access to the progress notes where the pharmacy alerts are written she stated that they did.On 10 /30/25 during the end of day meeting the Administrator was made aware of the finding and no further information was provided.

Residents Affected - Some

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

10/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Elizabeth Adam Crump Health and Rehab

3600 Mountain Road Glen Allen, VA 23060

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 0760

Administrator was made aware of the finding and no further information was provided.

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

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

10/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Elizabeth Adam Crump Health and Rehab

3600 Mountain Road Glen Allen, VA 23060

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 0880

Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, interview, and facility documentation the facility staff failed to ensure safe practice for infection prevention for one 5 staff memebers in the kitchen.For the facility, the facility staff failed to ensure that hair covering was worn by all staff entering the kitchen area.On 10/29/25 at approximately 12:15 PM LPN #1 was observed as she walked from hall past surveyor and went into the kitchen. There were no hairnets at this entrance. Surveyor was standing in doorway entrance awaiting staff to get hairnets. LPN #1 was observed going into the kitchen and walking out of the surveyors view to the other side of the kitchen.

Surveyor spoke to dietary staff who alerted the dietary manager.LPN #1 walked to the other kitchen entrance where the hairnets are located exited to the hallway and then came to the surveyor and stated Oh! I had the hairnet in my hand and forgot to put it on.On 10/29/25 at approximately 12:25 p.m. an interview was conducted with the dietary Manager who stated anyone in the kitchen must have hair net.On 10/30/25

during the end of day meeting the Administrator was made aware of the concern and no further information was provided.

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet