Tug Valley ARH Skilled Nursing Facility

In the surveyor’s words

From the most serious findings on record at Tug Valley ARH Skilled Nursing Facility, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF727Mar 3, 2023

  Based on interview, and document review, it was determined the facility failed to ensure a Registered Nurse (RN) was designated to serve as the Director of Nursing (DON) on a full-time basis, which had the potential to affect all eighteen (18) residents currently residing in the facility. Per interview, the Administrator was also the facility's Director of Nursing (DON) and the facility had no Assistant Director of Nursing (ADON) in order to devote full time supervision of nursing services. The findings include: Review of the Facility Assessment Tool updated 10/23/2022, revealed the Administrator and the DON were noted as the same person. […]

• No harm, potential for more than minimal, patternF656Mar 3, 2023

  Based on observation, interview, record review, and facility policy review, it was determined the facility failed to ensure the Comprehensive Care Plan interventions related to side rail use were consistently implemented to maintain safety for eight (8) out of nine (9) sampled residents reviewed for use of side rails, Residents #1, #2, #3, #4, #5, #7, #8, and #15. Observations conducted throughout the survey revealed the side rails for the residents in question were raised while the residents were in bed. Use of the side rails was not reflected in the respective residents' care plans to direct staff regarding the type of side rails to be utilized or their expected and safe deployment. […]

• No harm, potential for more than minimal, patternF700Mar 3, 2023

  Based on observation, interview, record review, and review of the facility's policies and documents, it was determined the facility failed to ensure: (a) resident-appropriate alternatives were attempted prior to installing side rails on residents' beds: side rail assessments were consistently conducted and documented; (b) resident-specific risks and benefits of side rail use were evaluated and discussed with the residents and/or their responsible parties; (c) and informed consents were obtained for nine (9) of nine (9) sampled residents (Residents #1, #2, #3, #4, #5, #7, #8, #14, and #15) reviewed for the use of side rails. […]

• No harm, potential for more than minimal, isolatedF568Jun 27, 2025

  Based on interview, record review, and review of the facility's policy, the facility failed to have a system in place to account for residents' funds or provide residents with a monthly statement of their funds for one of five sampled residents (R1). Based on interview, record review, and review of the facility's policy, the facility failed to have a system in place to account for residents' funds or provide residents with a monthly statement of their funds for one of five sampled residents (Resident 1 (R1).The findings include: Interview on 06/04/2025 at 10:36 AM, with the Interim Administrator, revealed the facility did not have a policy related to staff acting as a resident's payee. […]

• No harm, potential for more than minimal, isolatedF602Jun 27, 2025

  Based on interview, record review, and review of the facility's policy, the facility failed to ensure residents were free from misappropriation of resident's property for one of five sampled residents (Resident (R)1), who were investigated for misappropriation. As the representative payee for the resident, the facility failed to properly manage the resident's account. It was determined through a Kentucky State Police (KPS) and Adult Protective Services (APS) investigations that the former Administrator had stolen more than $8,300.00 from Resident (R) 1's personal funds. […]