Federal Nursing-Home Survey Record
OLD SOUTHWEST HEALTH AND REHABILITATION
Does OLD SOUTHWEST HEALTH AND REHABILITATION have a federal violation or abuse history?
According to the public federal record on file with the Centers for Medicare & Medicaid Services (CMS), OLD SOUTHWEST HEALTH AND REHABILITATION (CCN 495156), in ROANOKE, VA, has federal inspection findings on its record.
In its current inspection cycle, CMS cited the facility for 46 deficiencies; the most serious carries scope/severity G on CMS's A–L scale, a level CMS classifies as actual harm. Citations from earlier inspection cycles appear in the dated timeline below as historical findings, not current ones. CMS has $143,823 in civil money penalties on file against the facility. This page restates the federal record as published by CMS and draws no conclusion of its own. Federal nursing-home surveys are conducted on a recurring cycle by state survey agencies acting on CMS's behalf, and the figures on this page are compiled from CMS's published provider data, as on file with CMS; the federal record may understate what actually occurred, and inspection findings are point-in-time survey results, not a determination that any specific resident was harmed.
The Federal Record
At its most recent federal inspection, CMS cited this facility for 2 actual-harm deficiencies.
Below is this facility's federal survey record as on file with CMS.
Scope & Severity — current cycle
Civil money penalties on file
$143,823
CMS has $143,823 in civil money penalties on file against this facility. CMS also records 61 day(s) of payment denial.
Overall CMS star rating: this facility vs the CMS-published state average
This facility: 1 · CMS state average: 3.0
Deficiency timeline — full federal history
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Ensure that residents are free from significant medication errors.
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Provide and implement an infection prevention and control program.
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
Provide care and assistance to perform activities of daily living for any resident who is unable.
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.
Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents.
Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members.
Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
Observe each nurse aide's job performance and give regular training.
Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
Reasonably accommodate the needs and preferences of each resident.
Develop, implement, and/or maintain an effective training program for all new and existing staff members.
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Provide behavior health training consistent with the requirements and as determined by a facility assessment.
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Ensure each resident receives an accurate assessment.
Have a plan that describes the process for conducting QAPI and QAA activities.
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Provide safe, appropriate pain management for a resident who requires such services.
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Provide activities to meet all resident's needs.
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
25 citations from earlier inspection cycles — historical, not current (expand)
Have a plan that describes the process for conducting QAPI and QAA activities.
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Provide care and assistance to perform activities of daily living for any resident who is unable.
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
Develop, implement, and/or maintain an effective training program for all new and existing staff members.
Provide and implement an infection prevention and control program.
Ensure that residents are free from significant medication errors.
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Keep complete, dated laboratory records in the resident's record.
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Ensure services provided by the nursing facility meet professional standards of quality.
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Provide timely, quality laboratory services/tests to meet the needs of residents.
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results.
Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Document what happened
Have a concern about care at OLD SOUTHWEST HEALTH AND REHABILITATION?
Share a few details to put your inquiry on file. CareSentinel is an independent service that compiles the public CMS record and does not provide legal advice. As qualified attorneys join our network in your area, one may reach out — we can’t guarantee contact yet, so we encourage you to consult a qualified attorney promptly on your own as well. There is no cost, and your information is handled with care.
Strict time limits can apply to taking legal action — consider consulting a qualified attorney promptly.