Inspection Reports for Highlands Nursing and Rehabilitation

1705 STEVENS AVENUE, KY, 40205

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Deficiencies per Year

8 6 4 2 0
2025
Severe High Moderate Low Unclassified
Inspection Report Abbreviated Survey Census: 143 Deficiencies: 7 Feb 28, 2025
Visit Reason
A Recertification and Abbreviated Survey was conducted to investigate multiple facility IDs from 02/24/2025 to 02/28/2025.
Findings
The facility was found not to be in substantial compliance with 42 CFR 483 Subpart B, with deficiencies cited at the highest Scope and Severity of an 'E'. Issues included failure to provide a safe, clean, comfortable, and homelike environment, failure to ensure employment of staff without adverse actions, failure to provide notice requirements before transfer or discharge, failure to develop and implement comprehensive care plans, failure to provide routine dental services, and failure to maintain infection prevention and control.
Severity Breakdown
E: 1 D: 6
Deficiencies (7)
DescriptionSeverity
Failure to provide a safe, clean, comfortable, and homelike environment including maintenance and housekeeping issues such as foul odors, peeling paint, missing toilet seats, mold, and damaged baseboards.E
Failure to ensure employment of individuals with adverse actions or disqualifying criminal convictions.D
Failure to provide proper notice requirements before transfer or discharge of residents.D
Failure to develop and implement comprehensive, person-centered care plans for residents.D
Failure to provide routine and emergency dental services to residents.D
Failure to establish and maintain an infection prevention and control program.D
Failure to ensure free of accident hazards and adequate supervision and assistive devices to prevent accidents.D
Report Facts
Survey Census: 143 Sample Size: 29 Supplemental Resident: 65 Employees with disqualifying background: 3 Residents reviewed for falls: 29 Residents reviewed for accident hazards: 29 Residents reviewed for dental care: 7 Residents reviewed for comprehensive care plan: 29
Employees Mentioned
NameTitleContext
Licensed Practical Nurse (LPN)4Stated maintenance issues and care plan importance during interviews
State Registered Nurse Aide (SRNA)16Reported missing baseboard and maintenance issues during interview
Maintenance DirectorAddressed maintenance issues and participated in corrective actions
Housekeeping SupervisorInvolved in cleaning and sanitizing deficient areas and education
Admissions CoordinatorReported daily rounds and maintenance observations
IC Unit ManagerReported on maintenance and environmental issues
Director of Nursing (DON)Director of NursingProvided interviews on rounds, maintenance, and education
Executive Director (ED)Reported on management rounds and maintenance follow-up
CookFound to have disqualifying felony conviction and no abuse registry checks
Human Resource DirectorHandled abuse registry checks and employee audits
Medical Records NurseNotified State Long-Term Care Ombudsman of transfers
Social Services DirectorResponsible for notifying Ombudsman of resident transfers
Regional Nurse ConsultantReported lack of notification to Ombudsman
Director of Nursing ServicesProvided education and audits related to care plans and dental services
Licensed Practical Nurse (LPN)1Observed infection control deficiencies
Infection Preventionist (IP)Provided education and oversight of infection prevention program
Social Services Director (SSD)Responsible for dental care orders and consents
Executive Director (ED)Reported on dental care referrals and audits

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