Charleston Healthcare Center
Inspection Findings
F-Tag F0656
F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Based on record review and staff interview, the facility failed to implement the care plan regarding the amount of feeding assistance needed as well as develop and implement impaired skin integrity interventions for Resident #153. This was true for one (1) of 18 residents reviewed during the survey process. Facility Census: 143.Findings Include:a1) Resident #153On 10/14/25 at 1:30 AM, a record review was completeid for Resident #153. The review found the care plan had not been implemented regarding feeding assistance. The resident was noted as totally dependent of staff x 1 (one) for eating. The documentation of assistance given during meals from 07/2025 through 09/2025 was reviewed. The following meals were not documented as dependent:--07/15/25 at breakfast, lunch--07/16/25 at dinner--0717/25 all meals--07/18/25 all meals--07/19/25 all meals--07/21/25 all meals--07/22/25 breakfast, lunch--07/23/25 all meals--07/24/25 all meals--07/25/25 all meals--07/27/25 all meals--07/28/25 all meals--07/29/25 all meals--07/30/25 all meals--07/31/25 all meals--08/01/25 all meals--08/02/25 all meals--08/03/25 all meals--08/04/25 breakfast, dinner--08/05/25 all meals--08/06/25 all meals--08/07/25 all meals--08/08/25 all meals--08/09/25 breakfast, lunch--08/10/25 all meals--08/11/25 all meals--08/12/25 all meals--08/13/25 all meals--08/14/25 all meals--08/15/25 all meals--08/16/25 all meals--08/17/25 all meals--08/18/25 all meals--08/19/25 all meals--08/20/25 all meals--08/22/25 all meals--08/23/25 all meals--08/24/25 breakfast, lunch--08/25/25 all meals--08/26/25 all meals--08/27/25 all meals--08/30/25 breakfast--09/01/25 all meals--09/04/25 dinnerOn 10/15/25 at approximately 1:30 PM, the Director of Nursing (DON) confirmed the meals were not documented as dependent and the care plan was not implemented.a2) Resident #153On 10/15/25 at approximately 1:40 PM, a review was completed regarding
the skin integrity interventions in place for Resident #153. The resident was noted with a deep tissure injury (DTI) to the right heel on 08/18/25. The skin integrity interventions were not put in place until 08/18/25 after
the DTI was found. The following interventions were added:--Heels floated as resident allows--Turn and reposition scheduleOn 10/15/25 at approximately 3:00 PM, the DON confirmed the interventions were not added to the care plan until 08/18/25. The DON confirmed the care plan had not been developed and implemented regarding the skin integrity interventions.
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
10/16/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Charleston Healthcare Center
3819 Chesterfield Avenue Charleston, WV 25304
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-Tag F0677
F 0677
Provide care and assistance to perform activities of daily living for any resident who is unable.
Level of Harm - Minimal harm or potential for actual harm
Based on record review and staff interview, the facility failed to provide activities of daily living (ADLs) for a dependent resident, #153. The ADLs included feeding assistance as well as showers or baths. This was true for one (1) of 18 residents reviewed during the survey process. Resident Identifier: #153. Facility Census: 143. Findings Include:a1) Resident #153On 10/14/25 at 1:30 PM, a record review was completed for Resident #153. The review found the resident had not been provided feeding assistance as a dependent resident for meals. The documentation of assistance given during meals from 07/2025 through 09/2025 was reviewed. The following meals were not documented as dependent:--07/15/25 at breakfast, lunch--07/16/25 at dinner--0717/25 all meals--07/18/25 all meals--07/19/25 all meals--07/21/25 all meals--07/22/25 breakfast, lunch--07/23/25 all meals--07/24/25 all meals--07/25/25 all meals--07/27/25 all meals--07/28/25 all meals--07/29/25 all meals--07/30/25 all meals--07/31/25 all meals--08/01/25 all meals--08/02/25 all meals--08/03/25 all meals--08/04/25 breakfast, dinner--08/05/25 all meals--08/06/25 all meals--08/07/25 all meals--08/08/25 all meals--08/09/25 breakfast, lunch--08/10/25 all meals--08/11/25 all meals--08/12/25 all meals--08/13/25 all meals--08/14/25 all meals--08/15/25 all meals--08/16/25 all meals--08/17/25 all meals--08/18/25 all meals--08/19/25 all meals--08/20/25 all meals--08/22/25 all meals--08/23/25 all meals--08/24/25 breakfast, lunch--08/25/25 all meals--08/26/25 all meals--08/27/25 all meals--08/30/25 breakfast--09/01/25 all meals--09/04/25 dinnerThe resident was noted with weight loss from the admission date of 07/14/25 through 09/05/25. The weight loss was noted as 26.2 pounds.On 10/15/25 at approximately 1:30 PM, the Director of Nursing (DON) confirmed the meals were not documented as dependent; and, the resident was noted as dependent for meals.a2) Resident #153On 10/15/25 at approximately 2:15 PM, a record review was completed for Resident #153. The resident was noted as totally dependent for showers and baths. The review found the resident did not receive a shower or a bed bath between the dates of 07/26/25 through 08/06/25. This is ten days. Also, the resident did not receive a shower or a bed bath between the dates of 08/13/25 through 08/20/25. This is seven (7) days.On 10/15/25 at 3:00 PM, the DON confirmed the resident was dependent for showers and baths; and, on two (2) different occasions the resident did not receive a shower or bath.
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
10/16/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Charleston Healthcare Center
3819 Chesterfield Avenue Charleston, WV 25304
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-Tag F0684
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
record review and staff interview the facility failed to ensure Resident #152's recommendations from a hospital stay were followed up on with the attending physician. The discharge summary indicated the resident should have a BMP (Basic Metabolic Panel) and CBC (complete blood count) in one week from
the date of discharge. This labs were not obtained nor was there evidence this was addressed with the attending physician to see if they wanted the lab work to be obtained or not. This was true for one (1) of residents reviewed during the complaint survey. Resident Identifier: #152. Facility Census: 143. Findings Included: a) Resident #152 A review of Resident #152's medical record found the resident was readmitted from the hospital on [DATE REDACTED]. A review of the hospital discharge summary associated with this readmission found the following, Pending Labs and studies: BMP CBC in one (1) week. In the afternoon on 10/15/25 the Interim Director of Nursing (DON) was asked to provide the results of the BMP and CBC the hospital recommended be obtained in one (1) week. After reviewing the electronic medical record (EMR) she stated, I know why we did not get that. It was on the discharge summary and not the discharged instructions. She further stated, the nurses are trained to look at the discharge instructions and not the summary. The DON was then asked if the physician had addressed the recommendation for a BMP and CBC, she confirmed
they had not.
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
10/16/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Charleston Healthcare Center
3819 Chesterfield Avenue Charleston, WV 25304
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-Tag F0686
F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some
LPNs do not stage pressure ulcers so this should be performed by a Registered Nurse shortly after admission.
C) Resident #153
On 10/15/25 at approximately 1:40 PM, a review was completed regarding the skin integrity interventions in place for Resident #153. The resident was noted with a deep tissure injury (DTI) to the right heel on 08/18/25. The skin integrity interventions were not put in place until 08/18/25 after the DTI was found. The following interventions were added: --Heels floated as resident allows --Turn and reposition schedule
On 10/15/25 at approximately 3:00 PM, the DON confirmed the interventions were not added to the care plan until 08/18/25. The DON confirmed the DTI to the right heel was in-house acquired.
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
10/16/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Charleston Healthcare Center
3819 Chesterfield Avenue Charleston, WV 25304
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-Tag F0689
F 0689
On 10/16/25 at 9:42, the Director of Nursing (DON) stated there was no written documentation the resident's family had been notified of products that could not be brought into the facility.
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
10/16/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Charleston Healthcare Center
3819 Chesterfield Avenue Charleston, WV 25304
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-Tag F0692
F 0692
--08/23/25 all meals
Level of Harm - Minimal harm or potential for actual harm
--08/24/25 breakfast, lunch --08/25/25 all meals
Residents Affected - Some --08/26/25 all meals --08/27/25 all meals --08/30/25 breakfast --09/01/25 all meals --09/04/25 dinner
The resident was noted with weight loss from the admission date of 07/14/25 through discharge on [DATE REDACTED].
The weight loss was noted as 26.2 pounds. This is -15.78% of weight loss in 53 days.
On 10/15/25 at approximately 1:30 PM, the Director of Nursing (DON) confirmed the meals were not documented as dependent; and, the resident was noted as dependent for meals.
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
10/16/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Charleston Healthcare Center
3819 Chesterfield Avenue Charleston, WV 25304
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-Tag F0842
F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Based on record review and staff interview, the facility failed to ensure complete and accurate medical records. For one (1) of three (3) residents reviewed for the care area of pressure ulcers, the wound nurse practitioner's note documented the wrong treatment being used. Resident Identifier: #152. Facility census: 143.Findings included:a) Resident #152Review of Resident #152's physician's orders showed an order written on 01/20/25 for skin prep to left great toe pressure injury. The order continued through the resident's discharge from the facility.The resident's medical records documented an allergy to betadine. Wound Nurse Practitioner (NP) #173 assessed the wound weekly and made treatment recommendations. On 01/23/25, 02/04/25, and 02/10/25, NP #173 indicated the resident's left great toe pressure ulcer was being treated with betadine. Beginning 02/19/25, NP #173 correctly indicated the pressure ulcer was being treated with skin prep. On 10/16/25 at 9:45 AM, the Director of Nursing (DON) confirmed NP #173's weekly treatment recommendations on 01/23/25, 02/04/25, and 02/10/25 incorrectly indicated Resident #152's pressure ulcers were being treated with betadine, to which the resident had an allergy.
Event ID:
Facility ID:
If continuation sheet
CHARLESTON HEALTHCARE CENTER in CHARLESTON, WV inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in CHARLESTON, WV, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from CHARLESTON HEALTHCARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.