Stokes County Nursing Home

In the surveyor’s words

From the most serious findings on record at Stokes County Nursing Home, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF838Nov 21, 2025

  Based on record review and staff interview, the facility failed to ensure the facility assessment included a contingency plan that was informed by the facility assessment to address the availability of staff and other resources for events that did not require activation of the facility's emergency plan but had the potential to affect resident care. This had the potential to affect 38 of 38 facility residents. The findings included:The review of the facility assessment dated 2025 did not identify a written contingency plan that was informed by the facility assessment to address the availability of nursing staff and other resources for events that did not require activation of the facility's emergency plan but had the potential to affect resident care. […]

• No harm, potential for more than minimal, widespreadF851Aug 12, 2024

  Based on staff interview and record review, the facility failed to electronically submit direct care staffing information based on payroll data to the Centers for Medicare and Medicaid Services (CMS) as required for quarter three of fiscal year (FY) 2023 (April 1- June 30, 2023). This failure occurred for 1 of 4 quarters reviewed. The findings included: A review of the Payroll Based Journal (PBJ) Staffing Data report from the Certification and Survey Provider Enhanced Reports (CASPER) database revealed the facility failed to submit the required PBJ Staffing Data for quarter three of FY 2023. […]

• No harm, potential for more than minimal, widespreadF880Aug 12, 2024

  Based on record review and staff interviews, the facility failed to have a documented water management program for Legionella. Failure to have a water management program had the potential to affect 34 of 34 residents in the facility. The findings included: Review of the facility's Emergency Preparedness Plan last reviewed by the facility on 2/17/2024 and Infection Control policies revealed no evidence of a water management program for Legionella. Interview with the Infection Preventionist (IP) on 8/12/24 at 1:13 PM revealed the IP was unsure about any written water management program for Legionella. Interview with the Administrator on 8/12/24 at 1:24 PM revealed it was the IP that oversaw water management. […]

• No harm, potential for more than minimal, widespreadF812Mar 9, 2023

  Based on observations and staff interviews, the facility failed to dispose of expired nutritional supplements and failed to dispose of expired individually packaged cartons of juice from 1 of 1 nourishment room. The findings included: Observations of the nourishment room on [DATE] at 11:42 AM and on [DATE] at 10:40 AM revealed the following: a. Nine (2.5 ounce) bottles of a protein supplement on the dry storage rack with a use by date of [DATE]. b. Six (2.5 ounce) bottles of a protein supplement in the refrigerator with a use by date of [DATE]. c. Ten (4 ounce) containers of prune juice in the freezer with a best by date of [DATE]. Dietary Aide #1 was interviewed on [DATE] at 10:43 AM, while she stocked the nourishment room. […]

• No harm, potential for more than minimal, patternF638Mar 9, 2023

  Based on staff interviews and medical record review, the facility failed to complete a quarterly Minimum Data Set (MDS) assessment within 92 days of the Assessment Reference Date (ARD) of the previous MDS assessment for 4 of 10 residents (Residents #9, #37, #14 and #2) reviewed for timely completion of MDS assessments. Findings included: 1. Resident #9 was admitted to the facility on [DATE]. A review of the Minimum Data Set (MDS) assessments for Resident #9 revealed the last assessment completed was a quarterly assessment completed on 10/12/22. No other MDS assessments had been completed since 10/12/22. 2. Resident #37 was admitted to the facility on [DATE]. […]