Asbury Place Kingsport

In the surveyor’s words

From the most serious findings on record at Asbury Place Kingsport, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Aug 12, 2022

  Based on review of facility policy, medical record review, review of a facility investigation, observations, and interviews, the facility failed to prevent elopement for 1 resident (Resident #1) of 4 residents reviewed. The facility's failure to ensure adequate supervision after being assessed on admission as a risk for elopement with exhibited aimless, wandering behaviors throughout the night requiring redirection, placed Resident #1 in Immediate Jeopardy (IJ) (a situation in which a provider's non-compliance with one or more requirements of participation has caused, or is likely to cause serious injury, harm, impairment, or death to a resident) when Resident #1 eloped from the facility on 6/18/2022 and was located 75 feet in the parking lot of the independent living side of the building. […]

• No harm, potential for more than minimal, widespreadF812May 24, 2023

  Based on facility policy review, observation, and interview, the facility failed to ensure expired food items were discarded and failed to ensure food was properly stored in a walk-in freezer in 1 of 2 kitchens which had the potential to affect 29 residents. The findings include: Review of the facility policy titled, Sanitation & [and] Infection Control Receiving & Storage, dated ,d+[DATE], showed .Proper storage procedures will be utilized for all dry and refrigerated food storage .All items are dated when received to ensure correct product rotation .Items are stored a minimum of 18 inches from the ceiling . […]

• No harm, potential for more than minimal, isolatedF582Apr 1, 2026

  Based on facility policy review, medical record review, and interview, the facility failed to obtain a timely signature on the required Notice of Medicare Non-Coverage (NOMNC) for 1 resident (Resident #56) of 3 residents reviewed for beneficiary notification. The findings include:Review of the facility's undated policy titled, Form Instructions for the Notice of Medicare Non-Coverage (NOMNC) CMS [Centers for Medicaid and Medicare Services]-10123, revealed .The NOMNC must be delivered at least two calendar days before Medicare covered services end .The provider must ensure that the beneficiary or representative signs and dates the NOMNC to demonstrate that the beneficiary or representative received the notice and understands that the termination decision can be disputed .Review of the… […]

• No harm, potential for more than minimal, isolatedF658Apr 1, 2026

  Based on facility policy review, medical record review, pharmacy record review, observation, and interview, the facility failed to administer a prophylactic antibiotic [medication used to treat a bacterial infection, in prophylactic use it is used to help decrease the risk for a recurring bacterial infection] as ordered by the Physician for 1 resident (Resident #8) of 15 residents reviewed for medications.The findings include: Review of the facility's undated policy titled, Medication Administration Guidelines, revealed .Verify that the name & [and] dose of the medication are correct .Verify each medication against the MAR [Medication Administration Record] .Sign MAR immediately after administering the medications . […]

• No harm, potential for more than minimal, isolatedF761Apr 1, 2026

  Based on facility policy review, observation, and interview, the facility failed to ensure expired over-the-counter medications, intravenous (IV) catheters, syringes, blood collection tubes (vacuum-sealed tubes used for collecting, transporting, and processing blood samples for laboratory analysis), and sterile water vials were discarded and not available for resident use, failed to ensure an insulin pen was labeled with the resident's name, and failed to ensure wound care supplies were stored unopened in 1 medication cart of 2 medication carts and 1 medication room of 2 medication rooms observed for medication storage. […]