Parham Health Care & Rehab Center

During an initial interview on 8-29-25, at 10:00 A.M., and again at 1:40 PM, Resident #123 was found to be alert and oriented to person, place, time, and situation.

During the 1:40 PM interview, Resident #123 verbalized that she was uncomfortable and need to have her brief changed as she was Wet head to toe.

The Resident was noted to have her body and bed smell strongly of urine, and in fact the entire room had a pervasive odor of urine, feces, and body odor.

The Resident wore socks which were meant to be white, however, had brown stains on them which were dried on.

The Resident stated that there just were not enough staff to take care of Residents, and this situation happened to her often.

The Resident's bed had a brown halo of partially dried strong-smelling urine around her body from her knees to her mid back.

Her mattress was soaked as well with a permanent divot in the area directly under her bottom that did not spring back into place when she rolled off of it onto her side. A pervasive smell of urine and feces permeated the room and the entire unit. ADL care records were reviewed for Resident #123 and revealed that the Resident was totally dependent on one staff member.

The document indicated that a bath was given every morning, however, the Resident was observed on 8-29-25 during survey and found to be soiled from 10:00 A.M. until 1:40 PM. in a soiled bed with soiled linens.

The Resident was never seen out of bed during daytime hours for the entire survey. On 8-29-25 during an end of day meeting with the Administrator, Director of Nursing, and Corporate clinical support consultant, the facility staff were made aware of the above concerns.

Furthermore they were made aware that Residents were not being bathed and given hygiene timely, nor as often as needed, as this was the observation on days during the survey with Residents being soiled with dirty linens and clothing. On 9-3-25, prior to the survey exit the Director of Nursing informed surveyors that Resident #123 was now receiving needed care every 2 hours, and stated they had nothing further to provide.

495097 09/03/2025

Parham Health Care & Rehab Center 2400 E Parham Road Richmond, VA 23228

During an initial interview on 8-29-25, at 10:00 A.M., and again at 1:40 PM, Resident #123 was found to be alert and oriented to person, place, time, and situation.

During the 1:40 PM interview, Resident #123 verbalized that she received her medications late on occasion, and sometimes hours later than they were scheduled to be given.

The Resident was laying in bed and noted to have her body and bed smell strongly of urine, and in fact the entire room had a pervasive odor of urine, feces, and body odor.

The Resident wore socks which were meant to be white, however, had brown stains on them which were dried on.

The Resident stated that there just were not enough staff to take care of Residents, and this situation happened to her often.

ADL care records were reviewed for Resident #123 and revealed that the Resident was totally dependent on one staff member.

The document indicated that a bath was given every morning, however, the Resident was observed on 8-29-25 during survey and found to be soiled from 10:00 A.M. until 1:40 PM. in a soiled bed with soiled linens.

The Resident was never seen out of bed during daytime hours for the entire survey.

The Resident's Medication administration record was reviewed with time stamps for the time medications were administered for 3 months, in March.

April, and May of 2025.

The records revealed that medications were being administered later than they were ordered to be administered.

The examples follow below.

March 2025 - 3-25-25, Carbidopa/levodopa ordered for 1:00 P.m., given at 2:31 P.m.

April 2025 - 4-25-25, Carboxymethylcellulose-glycerin eye drops, multivitamin, docusate sodium, Carbidopa/levodopa, Meloxicam, amlodipine, Sitagliptin phosphate, house supplement drink, ordered for 9:00 A.m., given at 11:00 A.m.

May 2025 - 5-25-25, Carbidopa/levodopa ordered for 5:00P.m., given at 7:42 P.m., Ascorbic acid, ferrous sulfate, Carboxymethylcellulose-glycerin eye drops, melatonin, tizanidine, Carbidopa/levodopa, doxepin, atorvastatin, oxycodone, mirtazapine, and gabapentin all ordered for 9:00 P.m., and not given until the next morning on 5-26-25 at 8:15 A.m., (11 hours late).

Review of the Facility Medication Administration policy indicated medication administration would be completed according to the doctor's orders.

The Resident's care plan was reviewed and indicated medications would be administered according to the doctor's orders. On 8-29-25 during an end of day meeting with the Administrator, Director of Nursing, and Corporate clinical support consultant, the facility staff were made aware of the above concerns. On 9-3-25, prior to the survey exit, the Director of Nursing informed surveyors that Resident #123 was now receiving needed care every 2 hours, and medications timely.

They further stated they had nothing further to provide.

495097 09/03/2025

Parham Health Care & Rehab Center 2400 E Parham Road Richmond, VA 23228

could fall for immediate repair or removal.

The housekeeping and maintenance directors notified the

notified of the above findings.

They stated there was no further evidence to present.

495097 09/03/2025

Parham Health Care & Rehab Center 2400 E Parham Road Richmond, VA 23228

Summary with a Brief Interview of Mental Status score of 11 out of 15 which means the resident has moderate cognitive impairment in daily decision making.On 8/28/25 at approximately 10:15 AM, an interview was conducted with Resident 109 who stated it belonged to his roommate.

The roommate's bed was observed without a footboard attached. Resident #128 could not recall how long it had been there.On 8/29/25 at 12:28 PM during end of day debriefing these findings were reviewed with the Administrator, Director of Nursing, Regional Director Clinical Services and Divisional Regional Director of Clinical Services. No further information was provided.