Inspection Reports for
Hardinsburg Nursing and Rehabilitation Center
101 FAIRGROUNDS ROAD, HARDINSBURG, KY, 40143
Back to Facility ProfileDeficiencies (last 3 years)
Deficiencies (over 3 years)
5.7 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
21% worse than Kentucky average
Kentucky average: 4.7 deficiencies/yearDeficiencies per year
8
6
4
2
0
Inspection Report
Routine
Deficiencies: 2
Date: Jul 10, 2025
Visit Reason
The inspection was conducted to assess compliance with nursing home regulations, focusing on medication safety and respiratory care for residents.
Findings
The facility failed to ensure medications were safely stored and monitored at a resident's bedside, and failed to follow physician orders for supplemental oxygen administration for another resident. Both issues posed minimal harm or potential for actual harm to residents.
Deficiencies (2)
F 0689: The facility failed to ensure the environment was free of accident hazards by allowing medications, including Tylenol and ointment, to be kept at Resident 39's bedside without a doctor's order or staff monitoring.
F 0695: The facility failed to follow physician orders for supplemental oxygen administration by setting Resident 9's oxygen concentrator flow rate at 3 LPM instead of the ordered 2 LPM.
Report Facts
Medication dosage: 325
Oxygen flow rate ordered: 2
Oxygen flow rate observed: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Director of Nursing | Stated expectations for medication monitoring and oxygen administration |
| Registered Nurse 1 | Registered Nurse | Stated medications should not be left at bedside without doctor's order |
| Licensed Practical Nurse 2 | Licensed Practical Nurse | Reported oxygen concentrator was set incorrectly and explained risks |
| Staff Development Coordinator | Staff Development Coordinator | Described nurse competencies related to oxygen administration |
| Medical Director | Medical Director | Expected nurses to monitor oxygen flow rates and follow orders |
| Administrator | Administrator | Expected nurses to follow physician orders for oxygen and medication monitoring |
Inspection Report
Complaint Investigation
Census: 56
Deficiencies: 5
Date: Jul 10, 2025
Visit Reason
A Recertification Survey, Abbreviated Survey investigating Complaints #KY00043756 and #KY00044771 and a COVID-19 Focused Infection Control Survey was initiated on 07/07/2025 and concluded on 07/10/2025.
Complaint Details
Complaint #KY00044771 was unsubstantiated but related deficiencies were cited. Complaint #KY00043756 was unsubstantiated with no deficiencies cited.
Findings
The facility was found not to be in substantial compliance with 42 CFR 483 subpart B. Deficiencies were cited at the highest Scope and Severity of a "D". Complaint #KY00044771 was unsubstantiated but related deficiencies were cited. Complaint #KY00043756 was unsubstantiated with no deficiencies cited. The facility was found in compliance with infection control regulations and CMS/CDC recommended COVID-19 practices.
Deficiencies (5)
Failure to report an allegation of sexual abuse to the State Survey Agency within 2 hours for 1 of 1 sampled resident reviewed for abuse.
Failure to ensure the resident environment remains as free of accident hazards as possible for 1 of 2 sampled residents reviewed for accidents.
Failure to ensure adequate supervision and assistance devices to prevent accidents for 1 of 2 sampled residents reviewed for accidents.
Failure to ensure proper medication administration and monitoring related to Tylenol and bacitracin zinc ointment at resident bedside.
Failure to follow physician's orders for administration of supplemental oxygen for 1 of 3 sampled residents reviewed for respiratory care.
Report Facts
Survey Census: 56
Sample Size: 16
Supplemental Residents: 16
Deficiencies cited: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Debra Williams | Completed findings writing related to accident hazards deficiency | |
| FM1 | Family member who reported sexual abuse allegation | |
| Certified Nursing Assistant (CNA)4 | Reported in interview regarding sexual abuse allegation | |
| Kentucky Medication Aide (KMA)5 | Reported sexual abuse allegation in interview | |
| Licensed Practical Nurse (LPN)6 | Reported sexual abuse allegation and shift change information | |
| Director of Nursing (DON) | Director of Nursing | Interviewed regarding sexual abuse allegation reporting and medication reporting |
| RN Charge Nurse | Registered Nurse | Involved in medication and ointment deficiency follow-up and education |
| Wound Care Nurse | Involved in medication and oxygen care deficiencies and education | |
| Staff Development Coordinator | Initiated abuse education and medication education for staff | |
| Administrator | Interviewed regarding abuse allegation reporting and medication reporting | |
| Licensed Practical Nurse (LPN)2 | Interviewed regarding oxygen administration and resident care | |
| Medical Director | Interviewed regarding oxygen administration and resident care |
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Jul 10, 2025
Visit Reason
The inspection was conducted due to a complaint investigation regarding the facility's failure to timely report an allegation of sexual abuse involving a resident.
Complaint Details
The complaint involved an allegation that two males entered Resident 36's room and touched the resident inappropriately on 01/10/2025. The facility was notified on 01/11/2025 but reported the allegation to the State Survey Agency approximately four hours late. The facility staff and administration had differing understandings of the reporting time requirements.
Findings
The facility failed to report an allegation of sexual abuse to the State Survey Agency within the required 2-hour timeframe. The report was submitted approximately four hours late after the facility was notified of the allegation.
Deficiencies (1)
F 0609: The facility failed to timely report suspected abuse, neglect, or theft and did not report the results of the investigation to proper authorities within the required timeframe.
Report Facts
Residents Affected: 1
Time delay in reporting: 4
Inspection Report
Routine
Deficiencies: 2
Date: Jun 14, 2024
Visit Reason
The inspection was conducted to assess compliance with medication labeling and storage standards, as well as food service sanitation and safety in the nursing home facility.
Findings
The facility failed to ensure all medications were properly labeled with open/use dates and resident names, and failed to store, prepare, and serve food in a sanitary manner. Observations included unlabeled and expired medications, dirty kitchen equipment, unsealed and expired food items, and inadequate staff training on sanitation and labeling.
Deficiencies (2)
F 0761: The facility failed to ensure all drugs and biologicals were labeled according to professional standards, including open/use dates and resident identification. Multiple medications on medication carts lacked proper labeling or were expired.
F 0812: The facility failed to procure food from approved sources and store, prepare, distribute, and serve food in a sanitary manner. Observations included dirty handwashing and prep sinks, dirty scoops, unclean cooking equipment, and food stored open, unlabeled, undated, or past expiration.
Report Facts
Residents whose medications were observed: 43
Residents affected by medication labeling deficiency: 7
Residents affected by food service deficiency: 59
Cleaning checklist missing initials: 3
Expired seasoning containers: 5
Yogurt cups undated: 7
Bags of cooked boiled eggs: 10
Cartons of liquid egg whites: 15
Employees mentioned
| Name | Title | Context |
|---|---|---|
| DA1 | Dietary Aide | Interviewed regarding sanitation training and kitchen cleaning practices |
| DA2 | Dietary Aide | Interviewed regarding sanitation training and kitchen cleaning practices |
| DM | Dietary Manager | Interviewed regarding kitchen cleaning schedules, food storage policies, and staff training |
| LPN1 | Licensed Practical Nurse | Interviewed regarding medication labeling and disposal practices |
| LPN2 | Licensed Practical Nurse | Interviewed regarding inhaler disposal and medication labeling |
| DON | Director of Nursing | Interviewed regarding medication cart audits and labeling expectations |
| RD | Regional Dietician | Interviewed regarding expectations for food storage, sanitation, and labeling |
| Administrator | Interviewed regarding expectations for medication labeling and kitchen sanitation |
Inspection Report
Annual Inspection
Deficiencies: 7
Date: Mar 29, 2019
Visit Reason
Annual recertification survey to assess compliance with regulatory requirements for nursing home operations and resident care.
Findings
The facility was found deficient in multiple areas including failure to notify physician and responsible party of resident condition changes, improper use of restraints without care plans, delayed treatment of urinary tract infection leading to resident harm, unsecured controlled medications, unlocked medication carts, and unsanitary food preparation practices.
Deficiencies (7)
F 0580: The facility failed to notify the physician and responsible party of Resident #47's change in condition including fever, pain, and fall leading to delayed treatment and harm.
F 0604: The facility failed to ensure Resident #5 was free from unnecessary physical restraints by using a full lap tray that restricted movement without proper assessment or care plan.
F 0656: The facility failed to develop and implement a care plan for Resident #5's restraint and Resident #47's urinary tract infection, resulting in inadequate care and monitoring.
F 0690: The facility failed to provide timely and appropriate care for Resident #47's urinary tract infection, resulting in worsening condition, fall, fractures, and increased dependency.
F 0761: The facility failed to store controlled medications in a permanently affixed locked compartment in the medication room refrigerator and had unlocked medication carts unattended by staff.
F 0812: The facility failed to ensure food was prepared in a safe and sanitary manner, including dirty kitchen surfaces, unlabeled and outdated foods, improper hand hygiene, and failure to calibrate food thermometers.
F 0865: The facility failed to maintain an effective Quality Assurance Performance Improvement (QAPI) program to ensure medication cart security, as unlocked medication carts were observed after the survey.
Report Facts
Marinol tablets: 23
Ativan 2 gm vials: 2
Ativan 2 mg vials: 8
Medication carts observed unlocked: 2
Medication carts total: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN #4 | Licensed Practical Nurse | Named in failure to notify physician and responsible party of Resident #47's condition |
| LPN #7 | Licensed Practical Nurse | Named in failure to notify responsible party of Resident #47's fall and transfer to ER |
| RN #3 | Registered Nurse | Named in restraint assessment and failure to develop care plan for Resident #5 |
| OT #1 | Occupational Therapist | Named in restraint assessment for Resident #5 |
| Director of Nursing | Director of Nursing | Named in restraint and medication cart security findings |
| Unit Manager | Unit Manager | Named in medication cart security and notification process |
| Assistant Director of Nursing | Assistant Director of Nursing | Named in medication cart security and notification process |
| Dietary Manager | Dietary Manager | Named in food safety and hand hygiene deficiencies |
| LPN #3 | Licensed Practical Nurse | Named in medication cart security observation |
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