Portsmouth Health And Rehab

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

interview and record review, the facility failed to provide one of four residents (Resident (R) 106) reviewed for activities out of a total sample of 47 with the opportunity to be offered diversional activities or to be moved to another room when his roommate (Resident R119) passed away. This had the potential for a resident to be traumatized due to being a vulnerable resident.Findings include:Review of Resident R106's admission Record, located under the Profile tab of the electronic medical record (EMR), indicated the resident was admitted to

the facility on [DATE REDACTED].Review of Resident R106's admission Minimum Data Set (MDS), located under the MDS tab of

the EMR and with an Assessment Reference Date (ARD) of 09/10/24, indicated the resident had a Brief

Interview for Mental Status (BIMS) score of 15 out of 15, which indicated the resident was cognitively intact.

The assessment indicated the resident was able to ambulate on his own.Review of Resident R106's Progress Note, located under the Prog (Progress) Note tab of the EMR and dated 12/17/24, failed to indicate the resident was offered a room change on 12/17/24 when Resident R106's roommate passed away.2. Review of R119s admission Record located under the Profile tab of the EMR, indicated the resident was admitted to the facility on [DATE REDACTED].Review of Resident R119's death in the facility MDS, located under the MDS tab of the EMR and with an ARD of 12/17/24, revealed the resident passed away on this date.Review of a document for Resident R119 titled Record of Death, located under the Misc (Miscellaneous) tab of the EMR and dated 12/17/24, indicated the resident passed away at 5:20 PM and his body was released to the funeral home at 10:11 PM.During an interview on 09/17/2025 at 2:48 PM, the Central Supply Manager (CSM) stated she was assigned to Resident R106's room to ensure everything was in place. CSM stated she did not remember if the body of Resident R119 was left in his room but stated it was the facility policy to offer the living resident another room.During an interview on 09/17/25 at 5:53 PM, the Administrator stated the process for a resident who has passed away was to offer the roommate outside diversional activities or to offer another room.During

an interview on 09/18/25 at 8:37 AM, Licensed Practical Nurse (LPN) 9 who was an agency staff member stated when a resident has passed away, staff were to pull the curtain and offer any roommate another room.During an interview on 09/18/2025 at 3:58 PM, the MDS Coordinator (MDSC) stated she was the staff member who pronounced the death of Resident R119 only and was not the staff member who spoke with Resident R106 about moving to another room. The MDSC stated it was the facility's policy to offer the resident another room after a death of their roommate.During an interview on 09/18/2025 at 4:02 PM Resident R106 stated he was not offered another room after Resident R119 passed away.During an interview on 09/18/25 at 5:15 PM, the Administrator stated, We do not have a specific policy for dignity.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

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

Facility ID:

If continuation sheet

Event ID:

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

09/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Portsmouth Health and Rehab

900 London Boulevard Portsmouth, VA 23704

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

Resident R53 screaming at LPN14 in the hallway so she escorted him to his room and provided emotional support.

LPN14 left the building after the incident and was terminated from employment. Abuse in-services were completed with all staff during the investigation from 03/25/25 and 03/26/25. Additional interventions included Resident R53 receiving a visit from the psychologist for emotional well-being, receiving psychosocial follow-up from the Social Services Director (SSD), and the Director of Nursing (DON) and nurse management ensuring his safety and that his needs were met.During an interview on 09/15/25 at 4:05 PM, Resident R53 stated that on 03/23/25 LPN14 entered his room to give him medications, woke him up by knocking on

the door, he told her to come closer to him so he could get the medication cup from her, she shoved the medications in his face and he thought he heard her say something about him under her breath as she was exiting his room. Resident R53 confirmed he got mad, so he got in his wheelchair, went to the hallway, yelled at her at the medication cart, picked up a wet floor sign off the floor, and then LPN14 picked up the water pitcher off the medication cart and threatened to crack him over the head with it. Resident R53 also stated that LPN1 took him to his room, he reported it to her, and he did not see LPN14 for the remainder of the evening and hasn't since then. Resident R53 indicated he felt safe in the facility, and the staff checked on him for weeks after the incident.During an interview on 09/17/25 at 5:22 PM, the Administrator confirmed LPN14 admitted that she threatened to hit Resident R53 with the water pitcher when he threatened to hit her with the wet floor sign. The Administrator stated she suspended the nurse during the investigation and terminated her on 03/25/25.During an interview on 09/18/25 at 5:33 PM, LPN14 stated Resident R53 tried to attack her in the hallway with a wet floor sign and cursed her at the medication cart after she administered his medications to him on 03/23/25. LPN14 confirmed she picked up the water pitcher off the medication cart and said she would crack him in the head if he didn't get away from her. LPN14 also stated she wrote her statement at the request of LPN1 and left for the evening, verbally quit, and has not returned to the facility. During an

interview on 09/19/25 at 9:03 AM, LPN1 stated she saw LPN14 with a water pitcher in her hand at the medication cart in the hallway and Resident R53 was screaming in front of her in his wheelchair screaming at her with a wet floor sign in his hand. LPN1 also stated she went to Resident R53's room with him, he told her about the incident, and she stayed with him until he didn't want to be disturbed. LPN1 indicated LPN14 wrote a statement and then left the facility and has not returned to the facility.

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

09/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Portsmouth Health and Rehab

900 London Boulevard Portsmouth, VA 23704

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

During an interview on 09/17/25 at 5:22 PM, the Administrator confirmed she was not notified of the verbal abuse to Resident R53 when it was observed by LPN1 and reported to the on-call manager on 03/23/25 around 11:00 PM. The Administrator confirmed she did not report it within two hours to the state survey agency (SSA), and did not submit the initial and 5-day follow-up report to the SSA within the required timeframes.

The Administrator stated LPN1 left a concern note on 03/25/25 regarding the incident so she submitted the initial report to the SSA on 03/25/25, initiated the investigation, asked LPN14 to write a statement, substantiated abuse in the 5-day report on 04/03/25, and then training was conducted with all the staff on abuse, neglect, and reporting abuse. The Administrator also indicated LPN14 was suspended during the investigation and terminated on 03/25/25.

During an interview on 09/18/25 at 5:33 PM, LPN14 stated Resident R53 tried to attack her in the hallway with a wet floor sign and cursed at her at the medication cart after she administered his medications to him on 03/23/25. LPN14 confirmed she picked up the water pitcher off the medication cart and said she would crack him in the head if he didn't get away from her. LPN14 also stated she wrote a statement at the request of LPN1 and left for the evening, verbally quit, and only returned to the facility to provide another statement to the Administrator on 03/25/25. During an interview on 09/19/25 at 9:03 AM, LPN1 stated she saw LPN14 with a water pitcher in her hand at the medication cart in the hallway and Resident R53 was screaming in front of her in his wheelchair with a wet floor sign in his hand. LPN1 indicated she reported abuse to the on-call manager but could not remember the name of the manager after Resident R53 explained what occurred around 11:00 PM on 03/23/25. LPN1 also indicated the on-call manager instructed her to write a statement and to get one from LPN14. LPN1 also stated she thought she reported timely.

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

09/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Portsmouth Health and Rehab

900 London Boulevard Portsmouth, VA 23704

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

obtain an order from her before giving it regardless of emergency situation or not, then on call nurse was notified as well. The family member was notified @ [at] 9:39 PM. The night nurse was as well notified of the situation.Review of Resident R13's Alert Note, dated 04/25/25, located in the EMR under the Prog Notes tab, revealed This nurse called to pt's [patient's] bedside for c/o [complaints of] distress by CNA. Pt. was found in bed, actively seizing. Pt's head was turned to left side. Pt. was spitting, and having pink tinged secretions from mouth. Pt. did not respond, to name calling. Pt continued to have rapid eye movement. Warm to touch.

Nurse remained with patient, until 911 called by this nurse. Nurse was advised to maintained a safe environment for patient. Pt. seized for 4 minutes then stopped for 10 sec [seconds] and seized again for 5 minutes. 0.5 cc [cubic centimeters] IM [intramuscular] Ativan given in right deltoid. Pt. continued to seize

after medication given. EMS [emergency medical services] arrived and toke [sic] over pt.'s care .Review of

the facility's internal investigation, dated 04/29/25, revealed Resident R13 exhibited seizure like activity on 04/25/25 and Licensed Practical Nurse (LPN) 5 provided supportive care for safety and contacted the on-call practitioner and left a message to return the call regarding the resident's change of condition. Before the on-call practitioner returned the call, Resident R13 experienced another episode of seizure like activity. LPN5 provided supportive care and called for assistance from Registered Nurse (RN) 2. LPN5 contacted 911, and RN2 noted Resident R13 had Ativan IM in the narcotic drawer, however, the medication had been discontinued and there was not an active order. LPN5 brought the medication to Resident R13's room and RN2 administered the IM Ativan to stop the seizure. EMS arrived and transported Resident R13 to the hospital in which Resident R13 was admitted for seizures. Actions taken included suspending LPN5 during the investigation on 04/25/25 then firing him

on 05/02/25. RN2 was removed from the schedule and agency was informed that she was a do not return to the facility on [DATE REDACTED]. All nursing staff were re-educated on following physician's orders, medication administration, and the narcotic destruction process for discontinued medications on 04/26/25 by Director of Nursing (DON) 2. DON2 audited the medication cart narcotic boxes and facilitated the destruction of the discontinued narcotics. During an interview on 09/18/25 at 11:22 AM, the Director of Nursing (DON) 1 stated discontinued narcotic medications should be pulled from the medication carts along with a completed narcotic sheet and then given to her to destroy with another nurse. DON1 also stated it was not

in nursing scope of practice to administer medications without an order, and nurses should verify or obtain

an order prior to administering any medications to residents. During an interview on 09/18/25 at 1:59 PM,

the Administrator stated DON2 initiated the investigation of the incident and facilitated the destruction of the discontinued narcotic medications. During an interview on 09/18/25 at 11:31 AM, the Physician Assistant (PA) stated she was not on call on 04/25/25 but expected the nurses to obtain an order from the on-call providers prior to administering any medications. The PA stated Resident R13 had received lorazepam in the past for agitation and there were no negative outcomes because of receiving the medication. During an interview on 09/18/25 at 11:50 AM, DON2 confirmed her investigation was substantiated when RN2 was practicing out of scope when she administered the discontinued lorazepam to Resident R13 without a new order while he experienced a seizure on 04/25/25. DON2 stated she terminated LPN5 on 05/01/25 and RN2 admitted she administered the medication without an order because it was an emergency. During an interview on 09/18/25 at 1:11 PM, the Medical Director stated he expected the nurses to obtain an order for medications and not administer discontinued medications for it was in their scope of their practice.

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

09/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Portsmouth Health and Rehab

900 London Boulevard Portsmouth, VA 23704

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 0678 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

interview on [DATE REDACTED] at 9:51 AM, LPN7 stated she did not know where to find the code status of the residents when the power went out and could not access the EMR. During an interview on [DATE REDACTED] at 10:26 AM, Physician Assistant (PA) stated she was at the facility on [DATE REDACTED] when Resident R109 was found unresponsive

in her room by CNA1 and LPN1. The PA stated she expected staff to initiate CPR until they determine their code status if found unresponsive. PA confirmed the staff did not honor Resident R109's wishes of DNR when they began chest compressions on the resident. PA indicated she was concerned that the facility did not have

the code status of the residents when the power went out in the building and the EMR could not be accessed.During an interview on [DATE REDACTED] at 4:57 PM, the SSD confirmed when she began employment in [DATE REDACTED], she performed an audit of the resident's code status, created a code status binder which included a copy of the resident's DNR order, CPR and Advance Directive policy and procedure, daily census for each unit, and then placed the binder at the two nurses' stations in the building for staff to use during a power outage. During an interview on [DATE REDACTED] at 1:01 PM, the Medical Director stated he expected the nursing staff to follow the resident's code status orders and a DNR means no CPR was provided and the code status should be verified in the computer first. The Medical Director also stated Resident R109 was sent to the hospital and returned unharmed.

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

09/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Portsmouth Health and Rehab

900 London Boulevard Portsmouth, VA 23704

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 0697

Provide safe, appropriate pain management for a resident who requires such services.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and facility policy review, the facility failed to ensure narcotic pain medications were administered to one of three residents (Resident (R) 106) reviewed for pain management out of a total sample of 47. This resulted in the resident missing multiple doses of pain medication and potentially reducing his quality of life.Findings include:Review of a facility policy titled, Pain Management, dated 01/2020, indicated . Residents will be assessed for pain upon admission, readmission, quarterly, annually, upon significant change, when a resident experiences a new onset of pain or experiencing uncontrolled pain .Review of Resident R106's admission Record, located under the Profile tab of the electronic medical record (EMR), indicated the resident was admitted to the facility on [DATE REDACTED].Review of Resident R106's admission Minimum Data Set (MDS), located under the MDS tab of the EMR and with an Assessment Reference Date (ARD) of 09/10/24, indicated the resident had a Brief Interview for Mental Status (BIMS) score of 15 out of 15, which indicated the resident was cognitively intact. The assessment indicated the resident was able to ambulate

on his own. The assessment indicated at the time of the assessment, the resident had no pain.Review of Resident R106's Care Plan, located under the Care Plan tab of the EMR and dated 11/04/24, indicated the resident had intermittent pain post motor vehicle accident. The intervention was to medicate for pain as ordered by physician and follow up for effectiveness.Review of Resident R106's Order, located under the Orders tab of the EMR and dated 12/09/24, indicated the resident was ordered by Oxycodone HCI (a narcotic analgesic) tablet 5 milligrams (mg) to be administered every six hours for chronic pain.Review of Resident R106's Medication Administration Record (MAR) for the month of 12/2024, located under the Orders tab of the EMR, indicated

the facility failed to assess the resident's pain and administer Oxycodone 5 mg on the following dates: 12/10/24 at 6:00 AM; 12/15/24 at 6:00 AM; 12/23/24 at 12:00 AM; 12/26/24 at 12:00 AM and 6:00 AM; and

on 12/28/24 at 6:00 AM.Review of Resident R106's Progress Notes, located under the Prog (Progress) Note tab of

the EMR and dated for the month of 12/2024, failed to contain evidence of why the resident was not assessed or administered his physician ordered pain medication.Review of Resident R106's MAR, for the month of 01/2025 and located under the Orders tab of the EMR, indicated the facility failed to assess and administer Oxycodone 5mg on the following dates: 01/04/35 at 6:00 PM; on 01/05/25 at 6:00 AM and 6:00 PM; and on 01/06/25 at 12:00 AM.Review of Resident R106's Progress Notes, located under the Prog Note tab of the EMR and dated for the month of 01/2025, failed to contain evidence of why the resident was not assessed or administered his physician ordered pain medication. During an interview on 09/18/25 at 10:36 AM, the Director of Nursing (DON) stated her expectation was if a resident was on routine pain medication and it was not administered, the nurse should have then documented the reason in the EMR.

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

09/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Portsmouth Health and Rehab

900 London Boulevard Portsmouth, VA 23704

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)

Federal health inspectors cited PORTSMOUTH HEALTH AND REHAB in PORTSMOUTH, VA for a deficiency under regulatory tag F-F0755 during a complaint investigation conducted on 2025-09-19.

Category: Pharmacy Service Deficiencies

The facility was found deficient in the following area: Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 7 deficiencies cited during this inspection of PORTSMOUTH HEALTH AND REHAB.

Correction Status: Deficient, Provider has no plan of correction.