Trinity Health Care Of Logan

F 0600 Level of Harm - Actual harm Residents Affected - Few

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

that he would let us know what he would be able to do. 6/17/2025 10:00Received call from Officer stating

he would be in facility to arrest resident. 6/17/2025 10:50Corporal and Deputy Sheriff arrived with active arrest warrant signed by Magistrate listing two counts of felony malicious assault. Resident handcuffed, read [NAME] rights, cooperative, and escorted from facility at 1103 without incident.Review of facility's internal timeline (12/01/24-6/17/25) showed:Resident #12;12/05/24 Resident struck staff member.12/06/24 Psychiatric visit with [NAME], FNP including medication review and Pavilion referral.12/10/24-12/26/24 admission to psychiatric hospitalization at Behavioral Health Pavilion. (medications adjusted and group counselling attended by Resident #12)12/26/25 All staff in-service held by [NAME], FNP addressing topics including abuse, resident redirection.3/30/25 After referral to Behavioral Health Pavilion denied.4/15/25

After a resident-to-resident event involving room mate being punched in the chest, Resident #12 was placed in a room on the opposite side of the building; referral repeated and denied.4/18/25 Psychiatric follow-up addressing room mate altercation; medication regimen reviewed by [NAME], FNP.4/30/25 Resident#12 pushed another resident in a wheelchair; nurse educated Resident #12 to notify nursing staff when other residents needed assistance. Verbalized understanding.5/01/25 Psychiatric follow-up with FNP with another medication review.5/19/25a€ 6/11/25 All staff in-service held addressing Resident #12 resident-to-resident aggression; 1:1 initiated.6/14/25 Resident #12resident-to-resident aggression towards KD; 1:1 initiated.6/16/25 @ 08:30AMLogan County Sheriff Office contacted; voicemail left regarding resident's abusive behavior.6/16/25 @ 10:45AM [NAME] County Sheriff Office contacted; stated that an officer would return a call.6/16/25 @ 10:48 AM Resident interviewed about the 6/14 event; stated, (I beat his ass.)6/16/25 @ 03:12PM Facility contacted the Sheriff's office again; spoke with Officer stated he would come to the facility to get a statement.6/16/25Officer arrived at the facility and spoke to nurse and PD POA ; Officer given details of incident and stated he would be in contact with facility regarding next steps.6/16/25 Mental hygiene field.6/17/25 @ 10:00 AM Received call from Officer informing intent to arrest Resident #12; informed that arrest would be done privately to avoid distressing residents.6/17/25 @ 10:50 AM Resident #12 arrested by Officer and Deputy ; all parties notified (Administrator, CFO, Attending Physician, NP, Ombudsman, WVDHHR, and responsible party Actual HarmHospital reports confirmed orbital fractures, hematoma, and suspected brain bleed sustained by Resident KD as a result of the 6/14/25 assault.Evidence of Past Noncompliance Correction:Prior to survey, the facility:Coordinated with law enforcement and removed the aggressive resident on 6/17/25.Completed staff retraining on abuse prevention, escalation response, and reporting by 6/20/25.Revised all behavioral care plans to include enhanced supervision and environmental modifications.Implemented 1:1 observation for residents with escalating aggression.QAPI committee reviewed incidents and began monthly audits on behavioral interventions.No further resident-to-resident altercations with harm were reported after corrective actions were implemented

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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

10/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Trinity Health Care of Logan

135 Bills Branch Road Logan, WV 25601

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

Based on observation and staff interviews, the facility failed to ensure that residents were free from skin irritation and rashes associated with the use of a laundry detergent known to cause skin irritation. This deficient practice has the potential to affect all residents within the nursing home and was substantiated for 3 of 3 residents reviewed during the long-term care survey process. Findings include: On 10/20/25 record

review of complaint filed with the State Agency (SA) reviled residents that the laundry detergent that the facility was using was causing outbreaks for half of residents from neck to feet. No rashes on hands and face. On 10/21/25 at 1:45 PM this surveyor observed blue detergent stored in the laundry area. Hooked up to the laundry machine was a clear detergent. During an interview competed on 10/21/25 at approximately 1:50 PM with Laundry Aide #93 , who stated the facility has been using a hypoallergenic detergent for approximately two years. The laundry aide # 93 explained that the blue detergent is used when the hypoallergenic detergent is out of stock or unavailable. Laundry aide #93 further reported that when the blue detergent was used, some residents would experience itchiness or develop rashes. Laundry aide #93 also stated the detergent change was implemented after residents complained of itchiness and the development of rashes. This confirming the facility still had access to the Blue Laundry detergent that causes irritations and rashes to residents residing in the long term care facility. On 10/21/25 around 2:00 PM The administrator was informed of Laundry aide#93's statement/interview and of this surveyors

observations of the Blue laundry detergent. The Administrator stated he was unaware that the blue detergent was still being stored and used and stated we will get that out of there now. This confirming the facility had previously been aware of skin-related concerns among residents.

Residents Affected - Some

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

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If continuation sheet