Inspection Report
Follow-Up
Deficiencies: 0
Feb 25, 2025
Visit Reason
The State Agency conducted a follow-up revisit at the facility from 2/24/25 through 2/25/25 related to an annual recertification survey conducted from 1/14/25 through 1/16/25.
Findings
The State Agency determined the facility was in compliance with the Minimum Standards for Institutions for the Aged or Infirm, state licensure requirements, and recommends the facility be placed back in compliance effective 2/14/25.
Inspection Report
Follow-Up
Census: 59
Capacity: 60
Deficiencies: 0
Feb 25, 2025
Visit Reason
The State Agency conducted a follow-up revisit at the facility from 2/24/25 through 2/25/25 related to the annual certification survey conducted from 1/14/25 through 1/16/25.
Findings
The State Agency found the facility to be in compliance with the requirements of participation in Medicare and Medicaid and recommends the facility be placed back in compliance effective 2/14/25.
Inspection Report
Complaint Investigation
Deficiencies: 5
Jan 16, 2025
Visit Reason
The surveyor conducted a Complaint Investigation (CI) MS #27395 regarding call light not answered, resident left wet, and nursing services, along with a recertification survey to assess compliance with Minimum Standards for Institutions for the Aged or Infirm and state licensure requirements.
Findings
The facility was found not in compliance with residents' rights, activities of daily living, urinary incontinence management, special needs care, and infection control. Specific deficiencies included lack of privacy cover for a urinary catheter bag, failure to accommodate shower needs, incomplete advance directives documentation, improper use of physical restraints, inadequate nail care for a diabetic resident, improper catheter care, improper storage of CPAP masks, and failure to follow proper hand hygiene during PEG care.
Complaint Details
Complaint Investigation MS #27395 was conducted for call light not answered, resident left wet, and nursing services. No citations were related to the complaint itself.
Severity Breakdown
Level II: 5
Deficiencies (5)
| Description | Severity |
|---|---|
| Failure to ensure a resident's right to a dignified existence related to a urinary catheter drainage bag without a privacy cover, failure to accommodate shower needs, incomplete advance directives, and improper use of physical restraints. | Level II |
| Failure to provide nail care to a diabetic resident requiring nail care by a Registered Nurse. | Level II |
| Failure to prevent complications related to urinary incontinence and catheter care, including catheter drainage bag touching the floor. | Level II |
| Failure to prevent complications related to storage of CPAP mask not being stored in a designated bag. | Level II |
| Failure to ensure proper hand hygiene and glove changes during Percutaneous Endoscopic Gastrostomy (PEG) care. | Level II |
Report Facts
Number of sampled residents: 23
Number of residents with deficiencies: 9
BIMS score: 15
BIMS score: 15
BIMS score: 4
BIMS score: 11
BIMS score: 14
BIMS score: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nursing Assistant #1 | CNA | Responsible for Resident #16's care and confirmed lack of privacy cover on catheter bag |
| Licensed Practical Nurse #1 | LPN | Confirmed catheter bag should have privacy cover |
| Assistant Director of Nursing | ADON | Provided expectations on catheter care, restraint use, CPAP mask storage, and infection control |
| Certified Nursing Assistant #3 | Lead CNA | Described use of lap tray restraint for Resident #52 |
| Certified Nursing Assistant #4 | CNA | Provided care for Resident #52 and described lap tray use |
| Licensed Practical Nurse #3 | LPN | Described lap tray use and supervision for Resident #52 |
| Assistant Director of Nursing | ADON | Confirmed lap tray use and fall history for Resident #52 |
| Assistant Director of Nursing | ADON | Discussed shower chair evaluation and advance directives |
| Director of Rehabilitation | Director of Rehabilitation | Evaluated Resident #1 for shower safety |
| Admissions Director | Admissions Director | Discussed advance directives documentation |
| Administrator | Administrator | Confirmed advance directives issues and shower chair availability |
| Licensed Practical Nurse #2 | LPN | Observed not changing gloves during PEG care |
| Registered Nurse #1 | RN Infection Preventionist | Explained proper glove use during PEG care |
Inspection Report
Annual Inspection
Census: 60
Capacity: 60
Deficiencies: 10
Jan 16, 2025
Visit Reason
The State Agency conducted an annual recertification survey and complaint investigations at the facility from 01/14/2025 through 01/16/2025 to assess compliance with Medicare and Medicaid participation requirements.
Findings
The facility was found not in compliance with multiple regulatory requirements including resident rights, reasonable accommodations, advance directives, physical restraints, ADL care, catheter care, respiratory care, medication storage, facility assessment, and infection control. Several deficiencies were cited with corrective actions planned.
Complaint Details
The complaint investigation MS #27395 was conducted for quality of care/treatment and nursing services. There were no citations related to the complaint investigation.
Severity Breakdown
SS=D: 9
SS=E: 1
Deficiencies (10)
| Description | Severity |
|---|---|
| Failure to ensure a resident's right to a dignified existence related to a urinary catheter drainage bag that did not have a privacy covering. | SS=D |
| Failure to accommodate the needs and preferences of residents requiring adaptive equipment for showering. | SS=D |
| Failure to ensure advance directives were completed and readily available on the charts for seven residents. | SS=E |
| Failure to ensure a resident was free from a physical restraint imposed for staff convenience related to fall prevention. | SS=D |
| Failure to provide nail care to a diabetic resident requiring nail care by a Registered Nurse. | SS=D |
| Failure to prevent possible complications related to a resident with an indwelling suprapubic catheter, as evidenced by the catheter drainage bag coming into direct contact with the floor. | SS=D |
| Failure to prevent possible complications related to the storage of a CPAP mask, which was left out of a designated bag. | SS=D |
| Failure to ensure medications and a medication cart were locked and secured. | SS=D |
| Failure to include all required elements in the Facility Assessment, including specific staffing needs by shift, recruitment and retention plans, and contingency planning. | SS=D |
| Failure to ensure proper hand hygiene when a Licensed Practical Nurse did not wash hands or change gloves during PEG care. | SS=D |
Report Facts
Deficiencies cited: 10
Census: 60
Total licensed capacity: 60
BIMS score: 15
BIMS score: 15
BIMS score: 4
BIMS score: 14
BIMS score: 10
Physician order date: Sep 3, 2024
Physician order date: May 20, 2024
Physician order date: Dec 4, 2024
Physician order date: Jan 15, 2025
Physician order date: Jun 26, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Assistant Director of Nursing | Assistant Director of Nursing | Provided expectations and education on catheter care, lap tray use, catheter bag placement, and infection control. |
| Certified Nursing Assistant #1 | Certified Nursing Assistant | Responsible for Resident #16's care and retrieved privacy cover for catheter bag. |
| Licensed Practical Nurse #1 | Licensed Practical Nurse | Confirmed catheter bag should have privacy cover and not touch floor. |
| Certified Nurse Aide #3 | Lead CNA | Explained lap tray use for Resident #52 and fall prevention. |
| Licensed Practical Nurse #3 | Licensed Practical Nurse | Explained lap tray use and supervision for Resident #52. |
| Director of Nursing | Director of Nursing | Educated staff on catheter bag dignity, nail care, medication cart locking, and CPAP mask storage. |
| Staff Development Nurse | Staff Development Nurse | Conducted in-service trainings on catheter bag dignity, shower chair use, advance directives, medication cart locking, CPAP mask storage, and PEG care. |
| Licensed Practical Nurse #2 | Licensed Practical Nurse | Observed not changing gloves during PEG care. |
| Registered Nurse #1 | Infection Preventionist | Confirmed proper glove use during PEG care and CPAP mask storage. |
| Administrator | Administrator | Confirmed advance directives availability issue and facility assessment gaps. |
Inspection Report
Deficiencies: 0
Jan 15, 2025
Visit Reason
The survey was conducted to assess the facility's compliance with emergency preparedness requirements and the Life Safety Code provisions.
Findings
The facility met all applicable Federal, State, and local emergency preparedness requirements with no deficiencies cited. Additionally, there were no Life Safety Code deficiencies found during the survey.
Inspection Report
Complaint Investigation
Deficiencies: 0
May 13, 2024
Visit Reason
The State Agency conducted a Complaint Investigation (CI), MS #24812 at the facility related to Residents Rights and Quality of Care/Treatment concerning resident repositioning, grooming, call bell accessibility, and medication administration.
Findings
During the survey, the State Agency determined the facility was in compliance with the Minimum Standards for Institutions for the Aged or Infirm and state licensure requirements. No deficiencies were cited.
Complaint Details
Complaint Investigation MS #24812 was related to Residents Rights and Quality of Care/Treatment issues including resident not turned/repositioned appropriately, resident not groomed adequately, call bells not accessible, and resident medications not administered properly. The complaint was not substantiated as no deficiencies were cited.
Inspection Report
Complaint Investigation
Census: 54
Capacity: 60
Deficiencies: 0
May 13, 2024
Visit Reason
The State Agency conducted a complaint investigation related to Residents Rights and Quality of Care/Treatment concerning resident repositioning, grooming, call bell accessibility, and medication administration.
Findings
The survey determined the facility was in compliance with Medicare and Medicaid requirements and no deficiencies were cited.
Complaint Details
Complaint Investigation (CI MS #24812) was related to resident not turned/repositioned appropriately, resident not groomed adequately, call bells not accessible, and resident medications not administered properly. The complaint was not substantiated as no deficiencies were cited.
Report Facts
Licensed beds: 60
Census: 54
Inspection Report
Complaint Investigation
Census: 54
Capacity: 60
Deficiencies: 0
May 13, 2024
Visit Reason
The State Agency conducted a complaint investigation related to Residents Rights and Quality of Care/Treatment concerning resident repositioning, grooming, call bell accessibility, and medication administration.
Findings
The facility was found to be in compliance with Medicare and Medicaid requirements, and no deficiencies were cited during the complaint investigation.
Complaint Details
Complaint Investigation (CI MS #24812) was related to residents not being turned/repositioned appropriately, not groomed adequately, call bells not accessible, and resident medications not administered properly. The complaint was not substantiated as no deficiencies were cited.
Report Facts
Licensed beds: 60
Census: 54
Inspection Report
Complaint Investigation
Deficiencies: 0
May 13, 2024
Visit Reason
The State Agency conducted a Complaint Investigation (CI), MS #24812, related to Residents Rights and Quality of Care/Treatment concerning resident repositioning, grooming, call bell accessibility, and medication administration.
Findings
The facility was found to be in compliance with the Minimum Standards for Institutions for the Aged or Infirm and state licensure requirements. No deficiencies were cited.
Complaint Details
Complaint Investigation MS #24812 was substantiated with no deficiencies cited.
Inspection Report
Plan of Correction
Deficiencies: 0
Oct 10, 2023
Visit Reason
The State Agency conducted a desk review of information related to the annual survey completed on 2023-08-17 to confirm compliance with Minimum Standards of Operation for Institutions for the Aged or Infirm.
Findings
The facility was found to be in compliance based on the information provided, and the State Agency recommended the facility be placed back in compliance effective 2023-10-02.
Report Facts
Annual survey date: Aug 17, 2023
Inspection Report
Annual Inspection
Deficiencies: 0
Aug 17, 2023
Visit Reason
The State Agency conducted a desk review of information related to the annual survey completed on 08/17/23 to verify corrective measures and compliance with Medicare and Medicaid requirements.
Findings
The facility provided information confirming corrective actions were implemented to address deficient practices, and the State Agency recommended the facility be placed back in compliance effective 10/02/23.
Inspection Report
Annual Inspection
Deficiencies: 2
Aug 17, 2023
Visit Reason
The State Agency conducted an annual recertification survey at the facility from 08/14/2023 through 08/17/2023 to determine compliance with Minimum Standards for Institutions for the Aged or Infirm and state licensure requirements.
Findings
The facility was found not in compliance with residents' rights related to respecting dietary preferences for one resident and with gastric feeding procedures for one resident with a PEG tube. Deficiencies included failure to honor a resident's food dislikes and allowing a CNA to operate an enteral feeding pump outside their scope of practice.
Severity Breakdown
Level II: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility failed to support the nutritional well-being for a resident by not respecting the resident's dietary preferences, resulting in the resident receiving disliked food. | Level II |
| Facility failed to ensure an enteral feeding pump was operated only by licensed staff for a resident with a PEG tube, with a CNA observed pausing and restarting the pump. | Level II |
Report Facts
Residents sampled: 19
Residents observed with PEG tube feeding: 2
Weight loss threshold: 5
Feeding pump rate: 65
Feeding pump duration: 22
Monitoring frequency: 5
Monitoring duration: 6
Monitoring frequency: 3
Monitoring duration: 6
Nursing monitoring frequency: 3
Nursing monitoring duration: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nurse Aide #3 | Certified Nurse Aide | Interviewed regarding Resident #12's dietary preferences and food handling |
| Dietary #1 | Dietary Staff | Interviewed about Resident #12's food requests and meal tray card |
| Dietary #2 | Dietary Staff | Interviewed about dietary likes and dislikes assessments and Resident #12's meal tray card |
| Administrator | Facility Administrator | Interviewed about expectations for honoring resident food preferences |
| Director of Nursing | Director of Nursing | Interviewed about staff responsibilities for honoring resident food preferences and feeding pump operation; signed facility statement |
| Certified Nursing Assistant #1 | Certified Nursing Assistant | Observed and interviewed regarding operation of Resident #43's feeding pump outside scope of practice |
| Licensed Practical Nurse #2 | Licensed Practical Nurse | Interviewed about scope of practice for feeding pump operation |
Inspection Report
Annual Inspection
Census: 58
Capacity: 60
Deficiencies: 3
Aug 17, 2023
Visit Reason
The State Agency conducted an annual recertification survey at the facility from 08/14/2023 through 08/17/2023 to determine compliance with Medicare and Medicaid participation requirements.
Findings
The facility was found not in compliance with requirements related to comprehensive care plans, professional standards for services provided, and dietary services meeting residents' needs. Specific deficiencies included failure to implement care plans respecting resident food preferences, improper operation of enteral feeding pumps by unlicensed staff, and failure to honor resident dietary preferences.
Severity Breakdown
SS=D: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Failed to implement the comprehensive care plan related to a resident's food preferences for one of 19 sampled residents (Resident #12). | SS=D |
| Failed to ensure an enteral feeding pump was operated by licensed staff for one of two residents observed with PEG tube feedings (Resident #43). | SS=D |
| Failed to provide a nourishing, palatable, well-balanced diet that meets each resident's nutritional and special dietary needs, respecting individual preferences for one of 19 residents sampled (Resident #12). | SS=D |
Report Facts
Census: 58
Total Capacity: 60
Weight loss: 5
Monitoring frequency: 5
Monitoring frequency: 3
Monitoring frequency: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Director of Nursing | Conducted in-services and confirmed expectations regarding care plan adherence and feeding pump operation |
| Administrator | Administrator | Explained expectations for staff to follow residents' care plans and dietary preferences |
| Certified Nursing Assistant #1 | Certified Nursing Assistant | Observed operating feeding pump outside scope of practice and received in-service training |
| Certified Nursing Assistant #3 | Certified Nursing Assistant | Interviewed regarding resident food preferences and tray handling |
| Dietary Manager | Dietary Manager | Conducted resident interviews and dietary tray monitoring |
| Licensed Practical Nurse #2 | Licensed Practical Nurse | Confirmed scope of practice regarding feeding pump operation |
| Registered Nurse #2 | Registered Nurse | Explained expectations for staff to follow care plans |
| Dietary #1 | Dietary Staff | Interviewed about resident food requests and tray cards |
| Dietary #2 | Dietary Staff | Interviewed about admission dietary assessments and resident preferences |
Inspection Report
Life Safety
Deficiencies: 0
Aug 14, 2023
Visit Reason
The survey was conducted to assess compliance with the 2012 Edition of the Life Safety Code (LSC) of the National Fire Protection Association (NFPA).
Findings
The facility met the applicable provisions of the 2012 Edition of the Life Safety Code, and no LSC deficiencies were cited during this survey.
Inspection Report
Life Safety
Deficiencies: 0
Aug 14, 2023
Visit Reason
The inspection was conducted to assess compliance with the 2012 Edition of the Life Safety Code (LSC) of the National Fire Protection Association (NFPA).
Findings
The facility met the applicable provisions of the 2012 Edition of the Life Safety Code, and no LSC deficiencies were cited during this survey.
Inspection Report
Deficiencies: 0
Aug 14, 2023
Visit Reason
The survey was conducted to assess the facility's compliance with Federal, State, and local emergency preparedness requirements.
Findings
The facility met all applicable Federal, State, and local emergency preparedness requirements with no deficiencies noted.
Inspection Report
Complaint Investigation
Deficiencies: 0
Jun 21, 2023
Visit Reason
The State Agency conducted a Complaint Investigation at the facility for one complaint, MS #21399, on 6/21/23.
Findings
The facility was found to be in compliance with the Mississippi Regulations for Minimum Standards for Institutions for the Aged or Infirm. No deficiencies were cited related to the complaint of Resident Abuse.
Complaint Details
Complaint MS #21399 for Resident Abuse was investigated and found to have no deficiencies.
Report Facts
Complaint number: 21399
Inspection Report
Complaint Investigation
Census: 58
Capacity: 60
Deficiencies: 0
Jun 21, 2023
Visit Reason
The State Agency conducted a complaint investigation at the facility for one complaint (MS #21399) regarding resident abuse on 6/21/23.
Findings
The facility was found to be in compliance with Medicare and Medicaid requirements, and no deficiencies were cited related to the complaint investigation.
Complaint Details
The complaint investigation was for resident abuse (MS #21399) and was not substantiated as no deficiencies were cited.
Report Facts
Licensed beds: 60
Census: 58
Inspection Report
Complaint Investigation
Deficiencies: 0
Aug 2, 2022
Visit Reason
The State Agency conducted a Complaint Investigation (CI), MS #19420 at the facility from 7/29/22 through 8/02/22.
Findings
The facility was found in compliance with Mississippi Regulations for Minimum Standards for Institutions for the Aged or Infirm and state licensure requirements. No deficiencies were cited and the complaint was not substantiated for abuse, neglect, dignity and respect issues, nursing services, pharmacy services, dietary, infection control, falsification of records, medication administration, or care plan adherence.
Complaint Details
Complaint Investigation MS #19420 was not substantiated for abuse, neglect, residents not treated with dignity and respect, nursing services, pharmacy services, dietary, infection control, falsification of records, medications not given according to physician instructions, and care not given per the plan of care.
Inspection Report
Complaint Investigation
Census: 57
Capacity: 60
Deficiencies: 0
Aug 2, 2022
Visit Reason
The State Agency conducted a Complaint Investigation (CI), MS #19420, and a Focused Infection Control survey at the facility from 7/29/22 through 8/02/22.
Findings
The facility was found to be in compliance with Medicare and Medicaid participation requirements. The complaint was not substantiated for abuse, neglect, dignity and respect issues, nursing services, pharmacy services, dietary, infection control, falsification of records, medication administration, or care plan adherence. No deficiencies were cited.
Complaint Details
Complaint MS #19420 was investigated and not substantiated for abuse, neglect, residents not treated with dignity and respect, nursing services, pharmacy services, dietary, infection control, falsification of records, medications not given according to physician instructions, and care not given per the plan of care.
Report Facts
Licensed beds: 60
Census: 57
Inspection Report
Routine
Deficiencies: 0
Aug 2, 2022
Visit Reason
A COVID-19 Focused Emergency Preparedness Survey was conducted by the Centers for Medicare & Medicaid Services (CMS) from 7/29/22 through 8/2/22.
Findings
The facility was found to be in compliance with 42 CFR §483.73 related to E-0024 (b)(6).
Inspection Report
Complaint Investigation
Deficiencies: 0
Aug 2, 2022
Visit Reason
The State Agency conducted a Complaint Investigation (CI), MS #19420 at the facility from 7/29/22 through 8/02/22.
Findings
The facility was found to be in compliance with Mississippi Regulations for Minimum Standards for Institutions for the Aged or Infirm and state licensure requirements. No deficiencies were cited and the complaint was not substantiated.
Complaint Details
Complaint MS #19420 was investigated and not substantiated for abuse, neglect, residents not treated with dignity and respect, nursing services, pharmacy services, dietary, infection control, falsification of records, medications not given according to physician instructions, and care not given per the plan of care.
Inspection Report
Complaint Investigation
Census: 57
Capacity: 60
Deficiencies: 0
Aug 2, 2022
Visit Reason
The State Agency conducted a Complaint Investigation (CI), MS #19420, and a Focused Infection Control survey at the facility from 7/29/22 through 8/02/22.
Findings
The facility was found to be in compliance with Medicare and Medicaid requirements. The complaint was not substantiated for abuse, neglect, dignity and respect issues, nursing services, pharmacy services, dietary, infection control, falsification of records, medication administration, or care plan adherence. No deficiencies were cited.
Complaint Details
Complaint Investigation MS #19420 was not substantiated for any allegations including abuse, neglect, and medication errors.
Report Facts
Licensed beds: 60
Census: 57
Inspection Report
Routine
Deficiencies: 0
Aug 2, 2022
Visit Reason
A COVID-19 Focused Emergency Preparedness Survey was conducted by the Centers for Medicare & Medicaid Services (CMS) from 7/29/22 through 8/2/22.
Findings
The facility was found to be in compliance with 42 CFR §483.73 related to emergency preparedness requirements.
Inspection Report
Complaint Investigation
Deficiencies: 0
May 17, 2022
Visit Reason
The State Agency conducted a Complaint Investigation at the facility on 5/17/22 regarding dietary services, infection control, and safety/falls.
Findings
The complaint was not substantiated and the facility was found to be in compliance with the Mississippi Regulations Minimum Standards for Institutions for the Aged or Infirm with no deficiencies cited.
Complaint Details
Complaint Investigation MS #18255 regarding dietary services, infection control, and safety/falls was not substantiated.
Inspection Report
Complaint Investigation
Census: 57
Capacity: 60
Deficiencies: 0
May 17, 2022
Visit Reason
The State Agency conducted a Complaint Investigation and Focused Infection Control survey at the facility on 5/17/22.
Findings
The facility was found to be in compliance with Medicare and Medicaid requirements. The complaint regarding dietary services, infection control, and safety/falls was not substantiated and no deficiencies were cited.
Complaint Details
Complaint investigation (CI MS #18255) was conducted and the complaint was not substantiated.
Report Facts
Licensed beds: 60
Census: 57
Inspection Report
Routine
Deficiencies: 0
May 17, 2022
Visit Reason
A COVID-19 Focused Emergency Preparedness Survey was conducted by the Centers for Medicare & Medicaid Services (CMS) on 5/17/22.
Findings
The facility was found to be in compliance with 42 CFR §483.73 related to E-0024 (b)(6).
Inspection Report
Complaint Investigation
Deficiencies: 0
May 17, 2022
Visit Reason
The State Agency conducted a complaint investigation at the facility regarding dietary services, infection control, and safety/falls.
Findings
The complaint was not substantiated and the facility was found to be in compliance with the Mississippi Regulations Minimum Standards for Institutions for the Aged or Infirm with no deficiencies cited.
Complaint Details
Complaint investigation MS #18255 was conducted; the complaint was not substantiated.
Inspection Report
Complaint Investigation
Census: 57
Capacity: 60
Deficiencies: 0
May 17, 2022
Visit Reason
The State Agency conducted a Complaint Investigation and Focused Infection Control survey at the facility on 5/17/22.
Findings
The facility was found to be in compliance with Medicare and Medicaid requirements. The complaint regarding dietary services, infection control, and safety/falls was not substantiated, and no deficiencies were cited.
Complaint Details
Complaint Investigation (CI MS #18255) was conducted and was not substantiated for dietary services, infection control, and safety/falls.
Report Facts
Licensed beds: 60
Census: 57
Inspection Report
Abbreviated Survey
Deficiencies: 0
May 17, 2022
Visit Reason
A COVID-19 Focused Emergency Preparedness Survey was conducted by the Centers for Medicare & Medicaid Services (CMS) on 5/17/22.
Findings
The facility was found to be in compliance with 42 CFR §483.73 related to E-0024 (b)(6).
Inspection Report
Deficiencies: 1
Jan 17, 2022
Visit Reason
The inspection was conducted to assess the facility's compliance with COVID-19 reporting requirements to the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN).
Findings
The facility failed to report complete information about COVID-19 to the NHSN during a seven-day period from 01/10/2022 to 01/16/2022 as required by regulation, which has the potential to cause more than minimal harm to residents.
Severity Breakdown
SS=F: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to report complete information about COVID-19 to the CDC's National Healthcare Safety Network during a seven-day period. | SS=F |
Report Facts
Reporting period: 7
Inspection Report
Complaint Investigation
Census: 58
Capacity: 60
Deficiencies: 0
May 24, 2021
Visit Reason
The State Agency conducted complaint investigations CI MS #17404 and CI MS #17471 regarding verbal abuse and staffing concerns.
Findings
The facility was found to be in compliance with Medicare and Medicaid requirements. The complaints were not substantiated and no deficiencies were cited.
Complaint Details
Complaints CI MS #17404 and CI MS #17471 were not substantiated for verbal abuse and staffing concerns.
Report Facts
Census: 58
Total licensed capacity: 60
Inspection Report
Complaint Investigation
Census: 58
Capacity: 60
Deficiencies: 0
May 24, 2021
Visit Reason
The State Agency conducted complaint investigations CI MS #17404 and CI MS #17471 on 5/24/21 regarding verbal abuse and staffing concerns.
Findings
The facility was found to be in compliance with Medicare and Medicaid requirements. The complaints of verbal abuse and staffing concerns were not substantiated and no deficiencies were cited.
Complaint Details
Complaint investigations CI MS #17404 and CI MS #17471 were not substantiated for verbal abuse and staffing concerns.
Inspection Report
Abbreviated Survey
Deficiencies: 0
Dec 16, 2020
Visit Reason
A COVID-19 Focused Emergency Preparedness Survey was conducted by the State Agency from 12/15/20 through 12/16/20.
Findings
The facility was found to be in compliance with 42 CFR 483.73 related to emergency preparedness requirements.
Inspection Report
Complaint Investigation
Census: 34
Capacity: 60
Deficiencies: 0
Dec 16, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted along with complaint investigations MS 17249 and MS 17335.
Findings
The facility was found to be in compliance with 42 CFR §483.80 infection control regulations and implemented CMS and CDC recommended practices for COVID-19. The complaints MS#17249 and MS#17335 were not substantiated and no citations were issued.
Complaint Details
Complaint investigations MS 17249 related to admit/discharge/transfer rights and equipment, and MS 17335 related to environmental concerns were not substantiated.
Report Facts
Census: 34
Total licensed capacity: 60
Inspection Report
Complaint Investigation
Census: 34
Capacity: 60
Deficiencies: 0
Dec 16, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted along with complaint investigations MS 17249 and MS 17335.
Findings
The facility was found to be in compliance with 42 CFR §483.80 infection control regulations and implemented CMS and CDC recommended practices for COVID-19. The complaints regarding admit/discharge/transfer rights, equipment, and environmental concerns were not substantiated, with no citations.
Complaint Details
Complaint investigations MS 17249 and MS 17335 were not substantiated.
Report Facts
Census: 34
Total licensed capacity: 60
Inspection Report
Abbreviated Survey
Deficiencies: 0
Dec 16, 2020
Visit Reason
A COVID-19 Focused Emergency Preparedness Survey was conducted by the State Agency from 12/15/20 through 12/16/20.
Findings
The facility was found to be in compliance with 42 CFR 483.73 related to emergency preparedness requirements.
Inspection Report
Plan of Correction
Deficiencies: 1
Sep 21, 2020
Visit Reason
The inspection was conducted to assess the facility's compliance with COVID-19 reporting requirements to the CDC's National Healthcare Safety Network (NHSN).
Findings
The facility failed to report complete information about COVID-19 to the NHSN during a seven-day period from 09/14/2020 to 09/20/2020, as required by regulation, potentially causing more than minimal harm to residents.
Severity Breakdown
SS=F: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to report complete COVID-19 information to the CDC's National Healthcare Safety Network during a seven-day period. | SS=F |
Report Facts
Reporting period: 7
Inspection Report
Plan of Correction
Deficiencies: 1
Sep 21, 2020
Visit Reason
The inspection was conducted to assess the facility's compliance with COVID-19 reporting requirements to the CDC's National Healthcare Safety Network (NHSN).
Findings
The facility failed to report complete information about COVID-19 to the CDC's NHSN during a seven-day period between 09/14/2020 and 09/20/2020, as required by regulation. This failure to report has the potential to cause more than minimal harm to all residents.
Severity Breakdown
SS=F: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to report complete COVID-19 information to the CDC's National Healthcare Safety Network during a seven-day period. | SS=F |
Report Facts
Reporting period: 7
Inspection Report
Abbreviated Survey
Census: 43
Capacity: 60
Deficiencies: 0
Aug 25, 2020
Visit Reason
A Covid-19 Focused Infection Control Survey was conducted by the State Agency on 8/25/2020 to assess compliance with infection control regulations and implementation of CMS and CDC recommended practices for COVID-19 preparation.
Findings
The facility was found to be in compliance with infection control regulations and had implemented the CMS and CDC recommended practices to prepare for COVID-19.
Inspection Report
Abbreviated Survey
Census: 43
Capacity: 60
Deficiencies: 0
Aug 25, 2020
Visit Reason
A Covid-19 Focused Infection Control Survey was conducted by the State Agency to assess compliance with infection control regulations and implementation of CMS and CDC recommended practices for COVID-19 preparation.
Findings
The facility was found to be in compliance with infection control regulations and had implemented the recommended practices to prepare for COVID-19.
Inspection Report
Abbreviated Survey
Census: 43
Capacity: 60
Deficiencies: 0
Aug 25, 2020
Visit Reason
A Covid-19 Focused Infection Control Survey was conducted by the State Agency on 8/25/2020 to assess compliance with infection control regulations and implementation of CMS and CDC recommended practices for COVID-19 preparation.
Findings
The facility was found to be in compliance with infection control regulations and had implemented the CMS and CDC recommended practices to prepare for COVID-19.
Inspection Report
Routine
Census: 47
Capacity: 60
Deficiencies: 0
Aug 6, 2020
Visit Reason
A Covid-19 Focused Infection Control Survey was conducted by the State Agency on 8/6/20 to assess compliance with infection control regulations and preparedness for COVID-19.
Findings
The facility was found to be in compliance with 42 CFR §483.80 infection control regulations and had implemented CMS and CDC recommended practices for COVID-19 preparation.
Report Facts
Census: 47
Total licensed capacity: 60
Inspection Report
Abbreviated Survey
Census: 48
Deficiencies: 0
Jun 18, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the Centers for Medicare & Medicaid Services (CMS) to assess the facility's compliance with infection control regulations related to COVID-19.
Findings
The facility was found to be in compliance with 42 CFR §483.80 infection control regulations and had implemented CMS and CDC recommended practices to prepare for COVID-19.
Inspection Report
Abbreviated Survey
Deficiencies: 0
Jun 18, 2020
Visit Reason
A COVID-19 Focused Emergency Preparedness Survey was conducted by the Centers for Medicare & Medicaid Services (CMS) on June 18, 2020.
Findings
The facility was found to be in compliance with 42 CFR §483.73 related to emergency preparedness requirements.
Inspection Report
Abbreviated Survey
Census: 48
Capacity: 60
Deficiencies: 0
May 26, 2020
Visit Reason
A Covid-19 Focused Infection Control Survey was conducted by the State Agency to assess compliance with infection control regulations and preparedness for COVID-19.
Findings
The facility was found to be in compliance with 42 CFR §483.80 infection control regulations and had implemented CMS and CDC recommended practices to prepare for COVID-19.
Inspection Report
Routine
Census: 48
Capacity: 60
Deficiencies: 0
May 26, 2020
Visit Reason
A Covid-19 Focused Infection Control Survey was conducted by the State Agency to assess compliance with infection control regulations and preparedness for COVID-19.
Findings
The facility was found to be in compliance with 42 CFR §483.80 infection control regulations and had implemented CMS and CDC recommended practices to prepare for COVID-19.
Report Facts
Census: 48
Total licensed capacity: 60
Inspection Report
Annual Inspection
Census: 52
Capacity: 60
Deficiencies: 2
Feb 6, 2020
Visit Reason
The State Agency conducted an annual recertification survey at the facility from 02/03/2020 to 02/06/2020 to determine compliance with Medicare and Medicaid participation requirements.
Findings
The facility was found not in compliance with Medicare and Medicaid requirements, with deficiencies cited related to grievance handling and care plan timing and revision. Specifically, the facility failed to promptly resolve a resident grievance regarding missing money and failed to update a resident's care plan to reflect recent falls and interventions.
Severity Breakdown
SS=D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to make prompt efforts to resolve a resident's grievance regarding missing money. | SS=D |
| Failure to revise the care plan related to falls for one resident to include recent falls and interventions. | SS=D |
Report Facts
Deficiencies cited: 2
Resident count: 21
Resident count: 1
Resident count: 1
Facility capacity: 60
Census: 52
Monetary amount: 20
Fall incidents: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Resident #33 | Resident | Named in grievance regarding missing money |
| Resident #33's Resident Representative | Resident Representative | Involved in grievance regarding missing money |
| Administrator | Named in grievance handling and investigation | |
| Director of Nursing | Director of Nursing (DON) | Named in care plan deficiency and grievance investigation |
| Licensed Social Worker | Licensed Social Worker (LSW) | Mentioned in grievance investigation |
| Licensed Practical Nurse #1 | Licensed Practical Nurse (LPN) | Named in care plan review and update process |
Inspection Report
Annual Inspection
Census: 52
Capacity: 60
Deficiencies: 1
Feb 6, 2020
Visit Reason
The State Agency conducted an annual recertification survey at the facility from 02/03/2020 to 02/06/2020 to assess compliance with the Minimum Standards of Institutions for the Aged and Infirm.
Findings
The facility was found not in compliance with the Minimum Standards, specifically regarding residents' rights. The facility failed to make prompt efforts to resolve a resident's grievance concerning missing money, and there were issues with grievance investigations and communication.
Severity Breakdown
Level II: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failed to make prompt efforts to resolve a resident's grievance regarding missing money. | Level II |
Report Facts
Residents reviewed: 21
Missing money amount: 20
Beds certified: 60
Census: 52
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Resident #33 | Resident | Named in grievance regarding missing money |
| Resident #33's Resident Representative | Resident Representative | Involved in grievance and communication with Administrator |
| Administrator | Named in grievance investigation and communication failures | |
| Director of Nursing | Director of Nursing | Mentioned in relation to grievance paperwork not received |
| Licensed Social Worker | Licensed Social Worker | Interviewed regarding knowledge of grievance |
Inspection Report
Annual Inspection
Census: 53
Capacity: 60
Deficiencies: 1
Mar 27, 2019
Visit Reason
The State Agency conducted an annual recertification survey at the facility from 3/25/19 to 3/27/19 to determine compliance with Medicare and Medicaid requirements.
Findings
The facility was found to be in compliance with Medicare and Medicaid requirements overall. However, a deficiency was identified related to smoke barrier doors not closing properly, affecting two of five smoke compartments. No deficiencies were found in emergency preparedness.
Deficiencies (1)
| Description |
|---|
| Smoke barrier doors located near the dining room did not close properly, failing to create the required separation between compartments as per NFPA 101 section 19.3.7.8. |
Report Facts
Facility census: 53
Total licensed capacity: 60
Number of smoke compartments affected: 2
Inspection Report
Annual Inspection
Census: 53
Capacity: 60
Deficiencies: 0
Mar 27, 2019
Visit Reason
The State Agency conducted an annual recertification survey at the facility from 3/25/19 to 3/27/19 to determine compliance with the Minimum Standards for the Aged or Infirmed requirements for participation.
Findings
The facility was found to be in compliance with the Minimum Standards for the Aged or Infirmed requirements during the annual recertification survey.
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