Every finding on record at NHC Healthcare, Kingsport

Based on facility policy review, medical record review, observation, and interviews, the facility failed to revise the comprehensive care plan to include alterations in skin integrity for 2 residents (Resident #40 and #64) of 19 residents reviewed. The Findings include: Review of the facility's policy titled, Patient Care Policies dated 3/2026, revealed .incorporating the physicians plan of care (orders) into the care plan . Review of the medical record revealed Resident #40 was admitted to the facility on [DATE] with diagnoses including Fracture of Left Femur, Pressure Ulcer of Right Buttocks Stage 2, and Anxiety. Review of a 5-day Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #40 scored a 15 on the Brief Interview for Mental Status (BIMS) assessment which indicated the resident had intact cognition and a stage 2 pressure ulcer. Review of a comprehensive care plan dated 5/4/2026, revealed Resident #40 had a .skin/wound . Review of a Physicians Order dated 4/28/2026 for Resident #40, revealed .apply zinc oxide [skin ointment] to open wound .5/19/2026 .float heels . During an interview on 5/28/2026 at 2:30, PM Registered Nurse (RN) MDS Coordinator confirmed Resident #40's comprehensive care plan had not been revised to include stage 2 wound, treatment for zinc oxide and float heels. Review of the medical record revealed Resident #64 was admitted to the facility on [DATE] with diagnoses including Chronic Kidney Disease with Heart failure, Type II Diabetes Mellitus with Polyneuropathy, and Excoriation (skin picking) Disorder. Review of the facility document titled, admission Observation, for Resident #64 dated 8/15/2025, revealed .scabbed areas to both arms and legs .numerous scratches to bilateral upper extremities .blanchable redness to buttocks . Review of a comprehensive care plan dated 8/15/2025 with a revision date of 5/13/2026, for Resident #64 revealed .Skin/Wound .will have no skin breakdown . Further review revealed there were no specific skin related problems identified. Review of a Physician's Order dated 9/16/2025 for Resident #64 revealed .[NAME] Calm-Cool .lotion .Apply to upper extremities BID [twice a day] . Review of a Physician's Order dated 4/7/2026 for Resident #64 revealed .encourage patient to wear protective sleeves on BUE [bilateral upper extremities] to prevent picking of areas . Review of a quarterly MDS assessment dated [DATE], revealed Resident #64 scored an 11 on the BIMS assessment which indicated the resident had moderate cognitive impairment. Review of the facility document titled, Weekly Skin Observation, for Resident #64 dated 5/25/2026, revealed .shearing to bilateral buttocks and open abrasions to bilateral arms (self-inflicted) . Review of a Physician's Order dated 5/28/2026 for Resident #64 revealed .apply barrier cream to bilat [bilateral] buttocks and surrounding area twice daily . During an observation and interview on 5/28/2026 at 3:45 PM, the RN MDS Coordinator reviewed the comprehensive care plan for Resident #64. She stated she was responsible for the development and revision of the comprehensive care plans. The RN MDS Coordinator confirmed Resident #64's care plan had not been revised to include the self-inflicted abrasions on both arms and shearing to bilateral buttocks.

Based on medical record review, observations, and interviews, the facility failed to obtain a physician's order for the administration of supplemental oxygen for 1 resident (Resident #11) of 22 residents observed for oxygen use. The findings include: Review of the medical record revealed Resident #11 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including Hypertensive Heart and Chronic Kidney Disease with Heart Failure, Chronic Systolic Congestive Heart Failure, Chronic Kidney Disease Stage 3A, and Cardiomyopathy. Review of a 5-day Minimum Data Set assessment dated [DATE], revealed Resident #11 scored a 00 on the Brief Interview for Mental Status (BIMS) assessment, which indicated the resident had severe cognitive impairment.During an observation on 5/26/2026 at 11:38 AM, revealed Resident #11 was lying in bed with supplemental oxygen at 3 liters (L) per minute by nasal cannula (a thin, flexible plastic device used to deliver oxygen directly into the nostrils) in use. During an observation on 5/27/2026 at 2:53 PM, revealed Resident #11 was lying in bed with supplemental oxygen at 3L per minute by nasal cannula in use. Review of the current physician's orders report dated 4/28/2026 - 5/27/2026, for Resident #11 revealed there was no order for the use of supplemental oxygen. During an observation and interview on 5/27/2026 with Licensed Practical Nurse (LPN) A at 4:32 PM, in Resident #11's room revealed Resident #11 was receiving supplemental oxygen at 3L per minute. LPN A confirmed Resident #11 did not have a physician's order for the oxygen.Review of a physician's order for Resident #11 dated 5/27/2026, revealed an order was obtained for the use of supplemental oxygen at 3L per minute by nasal cannula after the State Survey Agency Surveyor interview with LPN A.During an interview on 5/28/2026 at 4:08 PM, the Director of Nursing confirmed an order should have been obtained to administer oxygen for Resident #11.

Based on facility policy review, observations and interview, the facility failed to maintain a sanitary kitchen environment by storing expired food items and failing to safely store 1 bag of food with the potential to affect all 69 residents. The findings include: Review of the facility's policy titled, Safety & Sanitation Best Practice Guidelines, dated ,d+[DATE], showed .Refrigerated Food Storage Guide .Food .Commercially prepared .egg .covered securely; date when opened and with use by date .Food .Cheese .Milk .Storage Time .Manufacturer's expiration date . During an observation on [DATE] at 11:20 AM, with the Dietary Manager, the following items were found in the main walk-in refrigerator: 1 box containing 116 fluid ounces of individual creamers, approximately ,d+[DATE] full, expired on [DATE]. 2- 5 pound (lb) packages of pasteurized processed Swiss cheese (unopened), expired on [DATE]. 1- 1 gallon container of Vitamin D milk, approximately ,d+[DATE] full, expired on [DATE]. During an observation on [DATE] at 11:30 AM, with the Dietary Manager, the following item was found in the main walk-in freezer: 1 opened, unsealed, unlabeled bag of commercially prepared eggs containing 19 servings. During an interview on [DATE] at 11:35 AM, the Dietary Manager stated food items should be sealed and labeled with opened date or discarded if expired, and he confirmed the expired and unsealed food items were available for resident use. During an observation and interview on [DATE] at 8:27 AM, the Regional Dietician in the dry storage room, the following items were found: 3- 1.5 lb unopened bags of the facility's supplier's brand of Fried Crispy Onions, expired on [DATE]. The Regional Dietician confirmed the crispy onions were expired and available for resident consumption.

Based on facility policy review, observation and interview the facility failed to ensure staff wore protective beard covering while preparing food for 1 of 2 staff observed; failed to wear appropriate hair covering during meal service for 1 of 2 staff observed and failed to ensure staff disinfected hands after glove removal during meal service for 1 of 2 staff observed. The findings include: Review of the facility policy, Hygiene & Safety Practices, revised 11/2017 revealed .partners shall wear hair restraints such as hats, hair coverings, or nets, beard restraints .that are designed and worn to effectively keep their hair from contacting exposed food; clean equipment, utensils, and linens; and unwrapped single-service and single-use articles . Review of the facility policy Safety & Sanitation Best Practice Guidelines .Glove Use, revised 11/2017 revealed .Always wash hands using correct hand washing procedures before putting on gloves. Putting on gloves with contaminated hands will contaminate the outside of the glove .Remove used gloves by pulling downward from wrist covering soiled portion of gloves, discard, and wash hands . Observation in the kitchen on 12/16/18 at 9:42 AM, revealed Cook #1 preparing cheese cake. Continued observation revealed Cook #1had a beard and was not wearing a protective covering over his beard. Interview with Cook #1 and the Chef on 12/16/18 at 10:00 AM, in the kitchen, confirmed they did not usually wear protective coverings over beards. Observation in the kitchen on 12/16/18 at 11:40 AM, revealed Cook #1 assisting the Chef to check food temperatures in the food prep area. Continued observation revealed Cook #1 did not have a protective covering over his beard. Observation of the lunch meal in the East Bistro on 12/16/18 from 12:05 PM - 1:15 PM revealed the Chef served a hot plate of food; donned a glove on the left hand; retrieved a container from the cooler without removing the glove or sanitizing the hands and prepared a sandwich. Continued observation revealed after preparing the sandwich the Chef removed and discarded the glove and continued to serve hot foods without disinfecting the hands. Further observation revealed the Chef donned a glove on the left hand, retrieved a container from the cooler without removing the glove and sanitizing the hands and prepared another sandwich. Continued observation revealed the Chef removed and discarded the glove, without disinfecting the hands, and proceeded to serve hot foods. Observation of the lunch meal on 12/17/18 at 12:20 PM, at the West Bistro revealed Cook #2 was wearing a baseball type cap with a long pony tail hanging out the back of the cap while preparing/plating food. Interview with the Dietary Manager on 12/17/18 at 2:30 PM, in the conference room, confirmed staff are expected to follow the facility policy and wear protective covering over beards and disinfect their hands after glove removal.

Based on observation and interview, the facility failed to post staffing in a public area. The findings included: Observation on 12/7/15 at 10:30 AM revealed the staffing schedule was located at the North hall Nurse's station turned upside down not visible to the public. Interview with the Director of Nursing on 12/7/15 at 10:30 AM, at the North hall Nurse's station confirmed the staffing was not posted in a place visible to the public.

Based on review of facility policy, review of facility admission forms, and interview, the facility failed to give a 30 day notice of discharge to one Resident (#1) of 5 residents reviewed. The findings included: Review of facility policy, Admission/Transfers/Discharge, last revised on 3/4/15 revealed .Admission is accomplished with the mutual agreement of the patient and the center .the Preadmission and Admission and Financial Agreement .details the terms of the contract between the center and the patient and signed by both parties, must be completed prior to the arrival/admission of the patient . Review of facility document, Admission Documents .Preadmission Agreement, last revised 10/2014 revealed .this agreement can be terminated by Patient upon the giving of notice to the Center and this agreement can be terminated by Center upon the giving of 30 days written notice to Patient . Review of facility document, Admission and Financial Agreement, last revised 7/2015 revealed .Agreement Termination: This agreement can be terminated by Patient upon the giving of notice to the Center and this agreement can be terminated by Center upon the giving of 30 days written notice to Patient .Acknowledgement: Patient and other parties signing this agreement have reviewed this ADMISSION AND FINANCIAL AGREEMENT, have had opportunity to ask questions of Center personnel about the agreement and understand that admission to this Center constitutes agreement to be bound by said ADMISSION AND FINANCIAL AGREEMENT . Interview with the Facility Administrator on 12/8/15 at 12:57 PM, in the conference room revealed .we started the financial process .we hadn't even seen her (resident) .we learned our lesson .everyone we admit from (named rehabilitation hospital) we do an onsite visit with now .going on what (rehabilitation hospital) told us we were going to admit her . Continued interview revealed the facility .shredded the admission paperwork .when he (resident's husband) came in to do the paperwork is when we found out about her medications .we sent a list to the pharmacy and found out her MS ([MEDICAL CONDITION]) medication was $8000.00 per month .he offered to provide her medication but we would have to provide .with skilled care the meds would be my cost .we couldn't admit her because we couldn't meet her needs .it wasn't because of her meds . Interview with the Senior Regional Vice-President on 12/8/15 at 12:35 PM, in the Administrator's office revealed .she (resident) had fractured her ankle in October .in March or April she still wasn't able to walk .we couldn't meet her needs .they have to be able to do therapy and she couldn't .she wasn't going to get better . Telephone interview with the resident's husband on 12/9/15 at 8:43 AM, revealed .I filled out the (admission) paperwork and had signed it .they had assigned her a room .I told them about her medications .they told me they had checked on the cost already and it was $500.00 .I told them that must be per shot and she (admission coordinator) said 'what' .I said it costs more than that .she checked again and came back in the room and said you are right it's $8000.00 a month .she told me that she talked to the administrator and corporate and they said they couldn't take her because of her medications being too expensive .don't remember what the girls (admission coordinator) name is .I actually went back and saw the room .they gave me the room number .I did the paperwork there and signed it .they took the paperwork and didn't give it back to me . Interview with the Administrator on 12/9/15 at 9:53 AM, in the conference room confirmed .husband came in to sign paperwork to admit .he signed the contracts .first one is giving us permission for admission, treat, and bill insurance .second one is financial . Further interview confirmed the admission paperwork does not contain a disclosure statement advising the resident the admission could be denied after the paperwork is complete.