Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record

NANS POINTE REHABILITATION AND NURSING

SUFFOLK, VA · 148 certified beds · Last Life Safety survey July 12, 2022

CMS Certification Number 495247 · first certified June 1991

Also on this campus

The same campus holds a state-licensed assisted living facility, with its own state record on the Assisted Living Index: Nans Pointe Rehabilitation and Nursing LLC (200 West Constance Road). Matched by the street address the two records share. The records are separate and are never added together.

Ownership

Operated by EASTERN HEALTHCARE GROUP · For profit - Limited Liability company

Ownership changed March 1, 2022 (change of ownership)from ACCORDIUS HEALTH AT NANSEMOND POINTE LLC

Citations on file

Rolling three-year window

Life Safety surveys

In the same window

Tags cited more than once

Across separate surveys

Inspection & testing records

Of the citations on file

Position within VA

23 citations — more than 88% of the 289 certified nursing homes in VA. Compared within VA rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated

Improvingfewer citations at the latest survey than at its earlier surveys in the window.

The latest survey found 6 citations; the earlier surveys in the window averaged 8.5. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

Well past the typical window (February 2025 to February 2026), and past the point by which nine in ten VA facilities have been surveyed. This facility’s last Life Safety survey was July 2022. Facilities in VA are typically surveyed 31–43 months after the last one (median 37), measured over 125 consecutive surveys in the last two years of CMS records.

A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured

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2 inspection-and-testing tags have been cited here at more than one survey. Nationally, that pattern is common: about three quarters of cited facilities have at least one repeated tag, and half of the facilities ever cited for sprinkler inspection and testing are cited for it again. A repeat is usually a recordkeeping gap rather than a new hazard.

Emergency preparedness

7 of the 23 citations on file are Emergency Preparedness E-tags. E-tags are cited under 42 CFR §483.73 and concern the emergency plan, training, drills, communications and supplies. Nationally about half of certified facilities have at least one. The Emergency Preparedness Index

Physical environment (health survey)

5 physical-environment citations on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 23 Life Safety citations above. The Physical Environment Index

F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
F-0880 Provide and implement an infection prevention and control program.
F-0584 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.
F-0908 Keep all essential equipment working safely.
F-0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

How that compares

Citations on file over three years

Compared with the median facility in VA, and nationally. Surveyors differ markedly between states, so the VA figure is the meaningful one.

Citations on file over three years, compared
Measure	Citations
This facility	23
Median facility in VA	10
Median facility nationally	11

Survey history

Citations at each Life Safety survey

Citations at each Life Safety survey
Survey date	Citations
August 10, 2017	7
May 16, 2019	10
July 12, 2022	6

Most-cited tags

Most-cited tags at this facility

Most-cited tags at this facility
Tag	What the surveyor checks	Times cited	Last cited
K-0521	Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.	2	2019-05-16
K-0353	Inspect, test, and maintain automatic sprinkler systems.	2	2019-05-16
K-0741	Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.	2	2019-05-16
E-0007	Address patient/client population and determine types of services needed.	2	2022-07-12
K-0919	Meet requirements for the use of electrical equipment.	2	2019-05-16
E-0037	Establish staff and initial training requirements.	1	2022-07-12
E-0013	Develop Emergency Preparedness policies and procedures.	1	2022-07-12
K-0223	Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.	1	2019-05-16

What the citations cover

Citations by CMS category

Emergency Preparedness Deficiencies 7
Smoke Deficiencies 6
Gas, Vacuum, and Electrical Systems Deficiencies 4
Services Deficiencies 2
Other 4

Citations by CMS category
Category	Citations
Emergency Preparedness Deficiencies	7
Smoke Deficiencies	6
Gas, Vacuum, and Electrical Systems Deficiencies	4
Services Deficiencies	2
Egress Deficiencies	2
Miscellaneous Deficiencies	2

Every citation on file

As published by CMS, newest survey first. Descriptions are CMS’s own wording.

July 12, 2022 — 6 citations

Citations issued on July 12, 2022
Tag	What the surveyor checks	Status
E-0006	Conduct risk assessment and an All-Hazards approach.	Deficient, Provider has date of correction (August 19, 2022)
E-0007	Address patient/client population and determine types of services needed.	Deficient, Provider has date of correction (August 19, 2022)
E-0013	Develop Emergency Preparedness policies and procedures.	Deficient, Provider has date of correction (August 19, 2022)
E-0037	Establish staff and initial training requirements.	Deficient, Provider has date of correction (August 19, 2022)
K-0200	Meet other general requirements.	Deficient, Provider has date of correction (August 12, 2022)
K-0915	Have proper power supply for life support equipment.	Deficient, Provider has date of correction (August 12, 2022)

May 16, 2019 — 10 citations

Citations issued on May 16, 2019
Tag	What the surveyor checks	Status
E-0007	Address patient/client population and determine types of services needed.	Deficient, Provider has date of correction (June 20, 2019)
E-0015	Address subsistence needs for staff and patients.	Deficient, Provider has date of correction (June 20, 2019)
E-0023	Establish policies and procedures for medical documentation.	Deficient, Provider has date of correction (June 20, 2019)
K-0223	Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.	Deficient, Provider has date of correction (July 10, 2019)
K-0353	Inspect, test, and maintain automatic sprinkler systems.	Deficient, Provider has date of correction (July 10, 2019)
K-0355	Properly select, install, inspect, or maintain portable fire extinguishes.	Deficient, Provider has date of correction (July 10, 2019)
K-0521	Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.	Deficient, Provider has date of correction (July 10, 2019)
K-0741	Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.	Deficient, Provider has date of correction (July 10, 2019)
K-0919	Meet requirements for the use of electrical equipment.	Deficient, Provider has date of correction (July 10, 2019)
K-0920	Ensure proper usage of power strips and extension cords.	Deficient, Provider has date of correction (July 10, 2019)

August 10, 2017 — 7 citations

Citations issued on August 10, 2017
Tag	What the surveyor checks	Status
K-0353	Inspect, test, and maintain automatic sprinkler systems.	Deficient, Provider has date of correction (November 2, 2017)
K-0363	Install corridor and hallway doors that block smoke.	Deficient, Provider has date of correction (November 2, 2017)
K-0372	Ensure smoke barriers are constructed to a 1 hour fire resistance rating.	Deficient, Provider has date of correction (November 2, 2017)
K-0374	Install smoke barrier doors that can resist smoke for at least 20 minutes.	Deficient, Provider has date of correction (November 2, 2017)
K-0521	Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.	Deficient, Provider has date of correction (November 2, 2017)
K-0741	Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.	Deficient, Provider has date of correction (November 2, 2017)
K-0919	Meet requirements for the use of electrical equipment.	Deficient, Provider has date of correction (November 2, 2017)

Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.