Newport News, VA

James River Nursing And Rehabilitation Center

3-star overall rating with 2-star inspections with 16 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle

540 Aberthaw Avenue, Newport News, VA

(757) 595-2273

Compare this facility

Overall

3 / 5

CMS overall stars

Health inspections

2 / 5

Survey and complaint cycles

Staffing

3 / 5

RN + nurse staffing

Quality measures

5 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

154

Certified beds

Average residents

136

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

Virginia Health Services

Operator or chain grouping

Approved since

1994-01-01

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Chain footprint

7 facilities

Chain averages 4 overall / 3 health / 3 staffing / 4 quality stars

Changed ownership

Within the last 12 months

Family council

Yes

Resident and family council reported

Sprinklers

Yes

Automatic sprinklers in all required areas

Staffing

Hours and turnover

RN hours / resident day

0.66

Registered nurse staffing · state 0.69 · national 0.68

LPN hours / resident day

0.88

Licensed practical nurse staffing · state 1.00 · national 0.87

Aide hours / resident day

2.36

Nurse aide staffing · state 2.12 · national 2.35

Total nurse hours

3.89

All reported nurse hours · state 3.81 · national 3.89

Licensed hours

1.53

RN + LPN hours · state 1.68 · national 1.54

Weekend hours

3.36

Weekend nurse staffing · state 3.31 · national 3.43

Weekend RN hours

0.59

Weekend registered nurse coverage · state 0.46 · national 0.47

Physical therapist

0.01

Reported PT staffing · state 0.09 · national 0.07

Adjusted RN hours

0.57

CMS adjusted RN staffing hours

Adjusted total hours

3.38

CMS adjusted total nurse staffing hours

Case-mix index

1.57

Higher values indicate more complex resident acuity

RN turnover

20%

Annual RN turnover · state 49% · national 45%

Total nurse turnover

37%

Annual nurse turnover · state 48% · national 46%

SNF VBP

Value-based purchasing

Program rank

7,751

Lower is better among SNFs in the FY 2026 VBP program.

Performance score

28.89

Composite VBP score used to determine payment impact.

Payment multiplier

0.9852

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

Not reported

This facility did not meet this measure's case minimum policy requirement and therefore no measure data is publicly reported.

Healthcare-associated infections

1.03

Baseline 6.74% · Performance 7.53% · Measure score 1.03 · Achievement 1.03 · Improvement 0

Total nurse turnover

7.64

Baseline 52.63% · Performance 32.46% · Measure score 7.64 · Achievement 7.64 · Improvement 6.76

Adjusted total nurse staffing

Baseline 3.02 hours · Performance 3.02 hours · Measure score 0 · Achievement 0 · Improvement 0

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	10.34%	10.72% 0.4 pts better	No Different than the National Rate · Eligible stays 91 · Observed rate 8.79% · Lower 95% interval 6.91%
Discharge to community	50.3%	50.57% 0.3 pts worse	No Different than the National Rate · Eligible stays 99 · Observed rate 45.45% · Lower 95% interval 39.34%
Medicare spending per beneficiary	1.18	1.02 0.2 pts worse
Drug regimen review with follow-up	96.43%	95.27% 1.2 pts better	Numerator 27 · Denominator 28
Falls with major injury	0%	0.77% 0.8 pts better	Numerator 0 · Denominator 28
Discharge self-care score	Not Available	53.69%	Numerator Not Available · Denominator 8 · Too few residents or stays to report publicly.
Discharge mobility score	Not Available	50.94%	Numerator Not Available · Denominator 8 · Too few residents or stays to report publicly.
Pressure ulcers or injuries, new or worsened	0%	2.29% 2.3 pts better	Numerator 0 · Denominator 28 · Adjusted rate 0%
Healthcare-associated infections requiring hospitalization	7.53%	7.12% 0.4 pts worse	No Different than the National Rate · Eligible stays 30 · Observed rate 10% · Lower 95% interval 4.11%
Staff COVID-19 vaccination coverage	0%	8.2% 8.2 pts worse	Numerator 0 · Denominator 151
Staff flu vaccination coverage	1.56%	42% 40.4 pts worse	Numerator 3 · Denominator 192
Discharge function score	Not Available	56.45%	Numerator Not Available · Denominator 8 · Too few residents or stays to report publicly.
Transfer of health information to provider	100%	95.95% 4 pts better	Numerator 20 · Denominator 20
Transfer of health information to patient	Not Available	96.28%	Numerator Not Available · Denominator 4 · Too few residents or stays to report publicly.
Resident COVID-19 vaccinations up to date	Not Available	25.2%	Numerator Not Available · Denominator 15 · Too few residents or stays to report publicly.

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Number of hospitalizations per 1000 long-stay resident days	0.9	1.5 0.6 pts better	1.9 1 pts better	Long Stay · 20240701-20250630 · Adjusted 0.9 · Observed 1.3 · Expected 2.7 · Used in QM five-star
Number of outpatient emergency department visits per 1000 long-stay resident days	0.4	1.4 1 pts better	1.8 1.4 pts better	Long Stay · 20240701-20250630 · Adjusted 0.4 · Observed 0.4 · Expected 1.8 · Used in QM five-star
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine	98.8%	91.2% 7.6 pts better	93.4% 5.4 pts better	Long Stay · 2024Q4-2025Q3 · Q1 99.2% · Q2 96.8% · Q3 100.0% · Q4 99.1% · 4Q avg 98.8%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine	99.3%	94.0% 5.3 pts better	95.5% 3.8 pts better	Long Stay · 2024Q3-2025Q2 · 4Q avg 99.3%
Percentage of long-stay residents experiencing one or more falls with major injury	3.5%	3.6% 0.1 pts better	3.3% 0.2 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 6.6% · Q2 3.2% · Q3 1.7% · Q4 2.6% · 4Q avg 3.5% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms	0.5%	15.7% 15.2 pts better	11.4% 10.9 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.9% · Q2 0.9% · Q3 0.0% · Q4 0.0% · 4Q avg 0.5%
Percentage of long-stay residents who lose too much weight	6.6%	5.7% 0.9 pts worse	5.4% 1.2 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 4.4% · Q2 7.8% · Q3 8.8% · Q4 5.3% · 4Q avg 6.6%
Percentage of long-stay residents who received an antianxiety or hypnotic medication	22.2%	20.2% 2 pts worse	19.6% 2.6 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 24.8% · Q2 19.8% · Q3 23.0% · Q4 21.2% · 4Q avg 22.2%
Percentage of long-stay residents who received an antipsychotic medication	13.9%	15.0% 1.1 pts better	16.7% 2.8 pts better	Long Stay · 2024Q4-2025Q3 · Q1 15.9% · Q2 13.6% · Q3 14.8% · Q4 11.1% · 4Q avg 13.9% · Used in QM five-star
Percentage of long-stay residents who were physically restrained	0.0%	0.2% 0.2 pts better	0.1% 0.1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0%
Percentage of long-stay residents whose ability to walk independently worsened	8.4%	17.5% 9.1 pts better	16.3% 7.9 pts better	Long Stay · 2024Q4-2025Q3 · Q1 2.8% · Q2 14.7% · Q3 4.2% · Q4 11.4% · 4Q avg 8.4% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	8.8%	15.7% 6.9 pts better	14.9% 6.1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 12.1% · Q2 12.8% · Q3 5.6% · Q4 4.6% · 4Q avg 8.8% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder	0.0%	0.5% 0.5 pts better	1.0% 1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection	0.2%	1.6% 1.4 pts better	1.7% 1.5 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.8% · Q4 0.0% · 4Q avg 0.2% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	22.0%	22.2% 0.2 pts better	19.8% 2.2 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 30.4% · Q2 26.4% · Q3 15.1% · Q4 15.8% · 4Q avg 22.0%
Percentage of long-stay residents with pressure ulcers	5.7%	5.2% 0.5 pts worse	5.1% 0.6 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 6.4% · Q2 5.6% · Q3 4.8% · Q4 6.2% · 4Q avg 5.7% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	90.7%	74.6% 16.1 pts better	81.7% 9 pts better	Short Stay · 2024Q4-2025Q3 · Q1 97.0% · Q2 89.6% · Q3 87.2% · Q4 91.2% · 4Q avg 90.7%
Percentage of short-stay residents who had an outpatient emergency department visit	10.9%	11.7% 0.8 pts better	12.0% 1.1 pts better	Short Stay · 20240701-20250630 · Adjusted 10.9% · Observed 10.7% · Expected 11.0% · Used in QM five-star
Percentage of short-stay residents who newly received an antipsychotic medication	1.1%	1.2% 0.1 pts better	1.6% 0.5 pts better	Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 2.6% · Q3 1.6% · Q4 0.0% · 4Q avg 1.1% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	88.5%	73.6% 14.9 pts better	79.7% 8.8 pts better	Short Stay · 2024Q3-2025Q2 · 4Q avg 88.5%
Percentage of short-stay residents who were rehospitalized after a nursing home admission	25.5%	22.0% 3.5 pts worse	23.9% 1.6 pts worse	Short Stay · 20240701-20250630 · Adjusted 25.5% · Observed 25.0% · Expected 23.3% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2022-12-01 · Fire 2022-12-01

16 health deficiencies

Top issue: Nutrition and Dietary (5 deficiencies)

3 fire-safety deficiencies

Top issue: Smoke (2 deficiencies)

Cycle 2 Health 2019-04-18 · Fire 2019-04-18

10 health deficiencies

Top issue: Pharmacy Service (2 deficiencies)

6 fire-safety deficiencies

Top issue: Egress (2 deficiencies)

Cycle 3 Health 2017-09-14 · Fire 2017-09-14

2 health deficiencies

Top issue: Environmental (1 deficiency)

0 fire-safety deficiencies

No concentrated fire-safety issue counts in this cycle.

Fire safety

Fire-safety citations

D · Potential for more than minimal harm 2022-12-01

E15 · Emergency Preparedness Deficiencies

Fire Safety

Address subsistence needs for staff and patients.

Corrected 2023-01-16

D · Potential for more than minimal harm 2022-12-01

K324 · Smoke Deficiencies

Fire Safety

Provide properly protected cooking facilities.

Corrected 2023-01-21

D · Potential for more than minimal harm 2022-12-01

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2023-01-21

F · Potential for more than minimal harm 2019-04-18

K211 · Egress Deficiencies

Fire Safety

Keep aisles, corridors, and exits free of obstruction in case of emergency.

Corrected 2019-07-31

E · Potential for more than minimal harm 2019-04-18

K100 · Construction Deficiencies

Fire Safety

Meet other general requirements.

Corrected 2019-09-18

E · Potential for more than minimal harm 2019-04-18

K223 · Egress Deficiencies

Fire Safety

Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.

Corrected 2019-09-18

E · Potential for more than minimal harm 2019-04-18

K345 · Smoke Deficiencies

Fire Safety

Have approved installation, maintenance and testing program for fire alarm systems.

Corrected 2019-07-31

E · Potential for more than minimal harm 2019-04-18

K921 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure that testing and maintenance of electrical equipment is performed.

Corrected 2019-07-31

D · Potential for more than minimal harm 2019-04-18

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2019-07-31

Inspection history

Recent health citations

D · Potential for more than minimal harm 2023-06-14

F689 · Quality of Life and Care Deficiencies

Health

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Corrected 2023-07-31

G · Actual harm 2022-12-01

F686 · Quality of Life and Care Deficiencies

Health

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Corrected 2023-01-16

F · Potential for more than minimal harm 2022-12-01

F802 · Nutrition and Dietary Deficiencies

Health

Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.

Corrected 2023-01-16

F · Potential for more than minimal harm 2022-12-01

F803 · Nutrition and Dietary Deficiencies

Health

Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

Corrected 2023-01-16

F · Potential for more than minimal harm 2022-12-01

F804 · Nutrition and Dietary Deficiencies

Health

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Corrected 2023-01-16

F · Potential for more than minimal harm 2022-12-01

F812 · Nutrition and Dietary Deficiencies

Health

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Corrected 2023-01-16

F · Potential for more than minimal harm 2022-12-01

F814 · Nutrition and Dietary Deficiencies

Health

Dispose of garbage and refuse properly.

Corrected 2023-01-16

F · Potential for more than minimal harm 2022-12-01

F886 · Infection Control Deficiencies

Health

Perform COVID19 testing on residents and staff.

Corrected 2023-01-16

E · Potential for more than minimal harm 2022-12-01

F867 · Administration Deficiencies

Health

Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.

Corrected 2023-01-16

E · Potential for more than minimal harm 2022-12-01

F925 · Environmental Deficiencies

Health

Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

Corrected 2023-01-16

D · Potential for more than minimal harm 2022-12-01

F600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Corrected 2023-01-16

D · Potential for more than minimal harm 2022-12-01

F607 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

Corrected 2023-01-16

D · Potential for more than minimal harm 2022-12-01

F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Corrected 2023-01-16

D · Potential for more than minimal harm 2022-12-01

F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Respond appropriately to all alleged violations.

Corrected 2023-01-16

D · Potential for more than minimal harm 2022-12-01

F641 · Resident Assessment and Care Planning Deficiencies

Health

Ensure each resident receives an accurate assessment.

Corrected 2023-01-16

D · Potential for more than minimal harm 2022-12-01

F791 · Quality of Life and Care Deficiencies

Health

Provide or obtain dental services for each resident.

Corrected 2023-01-16

D · Potential for more than minimal harm 2022-12-01

F919 · Environmental Deficiencies

Health

Make sure that a working call system is available in each resident's bathroom and bathing area.

Corrected 2023-01-16

E · Potential for more than minimal harm 2019-04-18

F622 · Resident Rights Deficiencies

Health

Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.

Corrected 2019-05-17

E · Potential for more than minimal harm 2019-04-18

F625 · Resident Rights Deficiencies

Health

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.

Corrected 2019-05-17

E · Potential for more than minimal harm 2019-04-18

F925 · Environmental Deficiencies

Health

Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

Corrected 2019-05-17

D · Potential for more than minimal harm 2019-04-18

F641 · Resident Assessment and Care Planning Deficiencies

Health

Ensure each resident receives an accurate assessment.

Corrected 2019-05-17

D · Potential for more than minimal harm 2019-04-18

F655 · Resident Assessment and Care Planning Deficiencies

Health

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

Corrected 2019-05-17

D · Potential for more than minimal harm 2019-04-18

F675 · Quality of Life and Care Deficiencies

Health

Honor each resident's preferences, choices, values and beliefs.

Corrected 2019-05-17

D · Potential for more than minimal harm 2019-04-18

F758 · Pharmacy Service Deficiencies

Health

Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

Corrected 2019-05-17

D · Potential for more than minimal harm 2019-04-18

F761 · Pharmacy Service Deficiencies

Health

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Corrected 2019-05-17

D · Potential for more than minimal harm 2019-04-18