Wolfe County Health & Rehabilitation Center

In the surveyor’s words

From the most serious findings on record at Wolfe County Health & Rehabilitation Center, in the surveyor’s own words.

• No harm, potential for more than minimal, isolatedF655Apr 2, 2026

  Based on observation, interview, record review, and facility policy review, the facility failed to ensure the baseline care plan was developed and implemented with current instructions necessary to provide effective, person-centered care for one of 31 sampled residents Resident(R) 88. Record review revealed a physician order dated 03/24/2026 for a secure care bracelet. However, this intervention was not added to the care plan or Kardex until 04/01/2026. The failure to maintain an accurate and timely baseline care plan had the potential to affect staff awareness of the residents' current risks and needed safety interventions.Review of facility policy dated September 2024 titled, Baseline Care Policy and Protocol, revealed that a baseline care plan would be developed and implemented to… […]

• No harm, potential for more than minimal, isolatedF812Apr 2, 2026

  Based on observation, interview and facility policy review, the facility failed to prepare, distribute, and serve food in accordance with professional standards for food service safety. Observations of dietary staff during a meal service on 03/31/2026 revealed staff failed to perform hand hygiene and wear hair nets. Review of facility policy Dietary infection control, undated, revealed all staff members were to wear hair nets or caps in the food service areas.Review of facility policy Hand Washing' undated, revealed all staff were to wash their hands During food preparations, as often as necessary to remove soil or contamination and to prevent cross contamination when changing tasks, after engaging in other activities that contaminate the hands.Observation on 03/31/2026 at 12:25 PM,… […]

• No harm, potential for more than minimal, isolatedF609May 27, 2021

  Based on interview, facility policy review, facility investigation review, it was determined the facility failed to ensure an allegation involving misappropriation of resident property was reported to the state survey agency and other officials in accordance with State Law. Review of a facility investigation revealed on 03/03/2021, at 9:45 PM, the Staff Development Coordinator (SDC) received an anonymous phone call stating Registered Nurse (RN) #1 was stealing narcotics and pain patches from the facility. The SDC notified the Director of Nursing (DON) and the Administrator. […]

• No harm, potential for more than minimal, isolatedF610May 27, 2021

  Based on observation, interview, record review, and facility policy review, it was determined that the facility failed to ensure an allegation of misappropriation of resident property was thoroughly investigated per the facility's policy for one (1) of five (5) sampled residents (Resident #1). The facility received an allegation of misappropriation of resident property on 04/23/2021, which alleged Registered Nurse (RN) #1 and the Infection Control Nurse (ICN) Assistant had received narcotics from Resident #1. According to the allegation, Resident #1 was holding the medication in his/her cheek, and staff was buying the narcotics from the resident. The facility failed to thoroughly investigate Resident #1's allegation in accordance with facility policy/procedure. […]