Abingdon Care & Rehabilitation Center

In the surveyor’s words

From the most serious findings on record at Abingdon Care & Rehabilitation Center, in the surveyor’s own words.

• Actual harm, isolatedF684Oct 31, 2023

  Based on observation, interview, record review, and review of facility documents, it was determined that the facility failed to ensure: a) a resident assessment was completed to rule out injury, and the physician was immediately notified when staff witnessed a resident who banged finger hard on a door frame and yelled ouch. This resulted in a delay in treatment for one and a half hours, and the resident experienced pain and was subsequently diagnosed with a fracture of the third finger left hand, and b) appropriate incontinence care and related services were provided for two residents dependent on staff for care. […]

• No harm, potential for more than minimal, widespreadF850Feb 12, 2026

  Complaints: 2706516, 2743086 Based on interview and review of facility documentation, it was determined that the facility failed to employ a full-time Social Worker (SW) from August 2024 until 02/12/2026. This deficient practice had the potential to affect all residents and was evidenced by the following:On 02/11/2026 at 10:05 AM, a survey entrance conference was conducted with the Licensed Nursing Home Administrator (LNHA) who stated that the facility did not have a full-time Social Worker (SW) and the facility's part-time SW left approximately two weeks prior. On 02/12/2026 at 9:34 AM, an interview was conducted with the Human Resources Director (HRD) who stated the facility had no full-time SW for the last five months. […]

• No harm, potential for more than minimal, widespreadF803Apr 23, 2025

  Based on observations, interviews, and review of pertinent facility documents, it was determined that the facility failed to ensure a.) the facility's Registered Dietitian (RD) reviewed and approved the four week cycle menus for nutritional adequacy in accordance with nationally accredited standards and the facility provided Diet Manual, b.) residents consistently received the standard serving of the main entree/protein (16 out of 56 lunch and dinner meals were inadequate) or an alternate item (2 out of 9 were inadequate) for high biological value protein (proteins of high biological value, also known as complete proteins, are those that contain all the essential amino acids in the appropriate proportions that the body needs to carry out its functions optimally), c.) alternate menu items… […]

• No harm, potential for more than minimal, widespreadF809Apr 23, 2025

  Based on interviews, and review of pertinent facility documents, it was determined that the facility failed to serve and document residents received a nourishing snack in the evening when there was more than a 14-hour span between dinner and breakfast mealtimes. This deficient practice was identified for 6 of 7 alert and oriented residents (Resident's #4, #22, #53, #58, #70, and #81) during the resident council meeting and was evidenced by the following: On 4/14/25 at 10:05 AM, the surveyor conducted a kitchen tour with the Food Service Director (FSD). At the end of the initial tour, the surveyor requested a copy of residents who received labeled snacks, as well as a list of snacks that were sent to the units in the evening to be distributed after dinner. […]

• No harm, potential for more than minimal, widespreadF812Apr 23, 2025

  Based on observations, interview, and review of pertinent facility documents, it was determined that the facility failed to a.) store potentially hazardous foods in a manner to prevent food borne illness, and b.) failed to maintain the kitchen equipment in a sanitary manner to prevent contamination from foreign substances and potential for the development a food borne illness. This deficient practice was evidenced by the following: On 4/14/25 at 10:05 AM, the surveyor toured the kitchen with the Food Service Director (FSD). The following was observed: 1. Inside the ice machine there was a reddish like substance on the bottom of the white baffle (a flow-directing panel that restrained ice), as well as both sides of the interior walls of the ice machine near screws. […]