Inspection Reports for
Copiah Living Center
806 West Georgetown Rd, Crystal Springs, MS, 39059
Back to Facility ProfileDeficiencies (last 3 years)
Deficiencies (over 3 years)
8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
111% worse than Mississippi average
Mississippi average: 3.8 deficiencies/yearDeficiencies per year
12
9
6
3
0
Inspection Report
Routine
Deficiencies: 2
Date: Sep 25, 2025
Visit Reason
The inspection was conducted to assess compliance with resident rights and care standards, focusing on meal assistance and resident safety during dining.
Findings
The facility failed to ensure residents' rights to dignified care and safety during meals. Staff did not consistently position themselves properly while assisting residents with eating, and call lights were left out of reach, compromising resident safety and dignity.
Deficiencies (2)
F 0550: The facility failed to ensure resident rights to respectful, dignified care as staff did not position themselves at the resident's side while assisting with eating for one of four sampled residents.
F 0558: The facility failed to promote dignity and safety during dining as a resident was unsafely positioned during a meal and the call light was out of reach for one of four sampled residents.
Report Facts
Residents Affected: 1
Residents Affected: 1
Sampled Residents: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse #1 | Licensed Practical Nurse | Observed assisting Resident #2 improperly and confirmed Resident #1's call light was out of reach |
| Staff Development Nurse | Staff Development Nurse | Provided correction to LPN #1 and confirmed facility policies on meal assistance and call light placement |
| Director of Nurses | Director of Nurses | Confirmed facility policies on proper resident positioning and call light placement |
| Certified Nurse Aide #1 | Certified Nurse Aide | Provided care to Resident #1 and repositioned resident during meal |
| Certified Nurse Aide #2 | Certified Nurse Aide | Interviewed regarding responsibility for Resident #1's call light placement |
Inspection Report
Annual Inspection
Deficiencies: 5
Date: May 8, 2025
Visit Reason
The inspection was conducted as an annual recertification survey to assess compliance with regulatory requirements and quality of care standards at Copiah Living Center.
Findings
The facility was cited for multiple deficiencies including failure to respect residents' dignity by staff using cell phones and earbuds during care, inaccurate coding of antipsychotic medications on the MDS, improper perineal care leading to risk of urinary tract infections, failure of the Quality Assurance and Performance Improvement (QAPI) program to sustain corrective actions, and inadequate infection prevention and control practices during perineal care.
Deficiencies (5)
F 0557: The facility failed to ensure residents' rights for respect and dignity, as staff entered rooms and provided care while using personal cell phones and wearing earbuds, which residents described as rude and disrespectful.
F 0641: The facility failed to accurately code antipsychotic medications on the Minimum Data Set (MDS) for one resident, despite medication orders and administration.
F 0690: The facility failed to provide appropriate perineal care to incontinent residents, risking urinary tract infections, with improper cleaning techniques observed for two residents.
F 0867: The facility's Quality Assurance and Performance Improvement (QAPI) Committee failed to sustain corrective actions, resulting in repeat citations for deficiencies related to incontinent care and infection control.
F 0880: The facility failed to follow infection control practices during perineal care, including improper hand hygiene, glove use, and risk of cross-contamination for two residents.
Report Facts
Residents sampled: 18
Residents affected: 2
Residents affected: 1
Residents reviewed: 2
Residents affected: 2
Previous survey date: Nov 2, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse #1 | Minimum Data Set (MDS) nurse | Acknowledged error in coding antipsychotic medication on MDS |
| Registered Nurse #1 | Minimum Data Set (MDS) nurse | Confirmed error in MDS medication coding and need for correction |
| Certified Nursing Assistant #3 | Acknowledged improper perineal care and infection control breaches | |
| Certified Nursing Assistant #2 | Acknowledged improper perineal care and infection control breaches | |
| Licensed Practical Nurse/Infection Preventionist | Confirmed infection control breaches and improper care practices | |
| Director of Nursing | Director of Nursing (DON) | Acknowledged deficiencies, repeated citations, and expectations for staff care |
| Nursing Home Administrator | Administrator | Commented on repeat citations and staff turnover contributing to deficiencies |
Inspection Report
Annual Inspection
Deficiencies: 3
Date: Nov 2, 2023
Visit Reason
The inspection was conducted as part of an annual recertification survey to assess compliance with care standards, infection control, and quality assurance processes at Copiah Living Center.
Findings
The facility was found deficient in providing appropriate perineal care to incontinent residents, maintaining effective infection prevention and control practices, and sustaining an effective Quality Assurance and Performance Improvement (QAPI) program. Multiple staff failed to perform proper hand hygiene and perineal care, potentially exposing residents to urinary tract infections and other infections.
Deficiencies (3)
F 0690: The facility failed to provide appropriate perineal care to Resident #27, as the Certified Nursing Aide did not thoroughly clean or dry the genital area, risking urinary tract infection.
F 0865: The facility's QAPI Committee failed to sustain the infection control program during leadership transitions, showing a pattern of inability to maintain effective interventions.
F 0880: The facility failed to consistently implement infection control measures for Residents #26 and #33, including improper hand hygiene by staff during perineal and PEG tube care, risking infection transmission.
Report Facts
Residents observed for incontinent care: 4
Residents sampled for infection control: 17
Residents affected by deficiencies: 3
BIMS score: 12
BIMS score: 0
BIMS score: 99
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CNA #1 | Certified Nursing Aide | Named in deficiency for improper perineal care for Resident #27. |
| CNA #2 | Certified Nursing Aide | Named in deficiency for improper hand hygiene during perineal care for Resident #26. |
| RN #1 | Registered Nurse | Named in deficiency for improper hand hygiene during PEG tube care for Resident #33. |
| Director of Nurses | Director of Nursing (DON) | Interviewed regarding deficiencies and confirmed staff failures could cause infections. |
| LPN #2 | Licensed Practical Nurse/Infection Preventionist | Interviewed regarding infection control deficiencies and staff hand hygiene failures. |
Inspection Report
Annual Inspection
Deficiencies: 5
Date: Nov 2, 2023
Visit Reason
The inspection was conducted as part of an annual recertification survey to assess compliance with regulatory requirements in areas including resident care, infection control, food safety, and quality assurance.
Findings
The facility was found deficient in multiple areas including failure to complete a timely Significant Change Minimum Data Set (MDS) assessment for a resident with decline, inadequate perineal care leading to risk of urinary tract infections, improper food storage and labeling with expired items found, failure to sustain Quality Assurance and Performance Improvement (QAPI) activities, and inconsistent infection control practices such as improper hand hygiene by staff.
Deficiencies (5)
F 0637: The facility failed to complete a Significant Change MDS assessment within 14 days for a resident with physical and mental decline following a fall and hip fracture.
F 0690: The facility failed to ensure appropriate perineal care for an incontinent resident, risking urinary tract infection due to improper cleaning and drying.
F 0812: The facility failed to ensure kitchen food items were properly dated, labeled, and expired foods discarded, with multiple expired items found in storage.
F 0865: The facility's QAPI Committee failed to sustain infection control improvements, showing a pattern of ineffective quality assurance over multiple surveys.
F 0880: The facility failed to consistently implement infection control measures, including hand hygiene failures by staff during resident care, risking infection transmission.
Report Facts
Residents observed for incontinent care: 4
Residents sampled: 21
Dietary observations: 3
Residents sampled for infection control: 17
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse (LPN) #1/MDS Nurse | Named in failure to complete Significant Change MDS for Resident #6. | |
| Certified Nursing Aide (CNA) #1 | Named in failure to properly clean perineal area for Resident #27. | |
| Certified Nursing Aide (CNA) #2 | Named in failure to perform hand hygiene during perineal care for Resident #26. | |
| Registered Nurse (RN) #1 | Named in failure to perform hand hygiene during PEG tube care for Resident #33. | |
| Director of Nurses (DON) | Provided multiple confirmations of deficiencies and infection control failures. | |
| Dietary Manager (DM) | Named in failure to ensure expired foods were removed from kitchen. | |
| Licensed Practical Nurse (LPN) #2/Infection Preventionist | Confirmed infection control failures and hand hygiene issues. |
Inspection Report
Complaint Investigation
Deficiencies: 9
Date: Nov 10, 2021
Visit Reason
The inspection was conducted due to complaints regarding failure to administer medications on dialysis days and failure to provide timely notification of hospital transfers for residents.
Complaint Details
The complaint investigation focused on allegations that the facility failed to administer medications to dialysis residents on dialysis days and failed to notify families of hospital transfers. The investigation substantiated these allegations.
Findings
The facility failed to administer prescribed morning medications to two dialysis residents on dialysis days and failed to notify physicians of missed medications. The facility also failed to provide written notice of hospital transfers to residents or their representatives. Additionally, the facility inaccurately coded Minimum Data Set (MDS) assessments and failed to follow care plans and infection control protocols.
Deficiencies (9)
F 0580: The facility failed to notify the physician that dialysis residents #12 and #51 were not receiving their morning medications as prescribed on dialysis days.
F 0600: The facility failed to ensure residents #12 and #51 were free from neglect by not administering medications ordered by the physician on dialysis days.
F 0623: The facility failed to provide timely written notification of hospital transfers to residents #51 and #57 and their representatives.
F 0641: The facility failed to accurately code the Minimum Data Set (MDS) for three residents, including incorrect anticoagulant and physical restraint coding.
F 0656: The facility failed to follow comprehensive care plans for residents #12, #39, and #51, including failure to administer medications as ordered and improper incontinent care.
F 0698: The facility failed to provide appropriate dialysis care and services for residents #12 and #51, including failure to administer medications on dialysis days and lack of pharmacy consultant review of medication administration records.
F 0756: The facility's pharmacy consultant failed to perform monthly drug regimen reviews including review of Electronic Medication Administration Records (EMAR) for dialysis residents #12 and #51.
F 0760: The facility failed to ensure residents #12 and #51 were free from significant medication errors by not administering prescribed medications on dialysis days.
F 0880: The facility failed to implement infection prevention and control practices, including improper hand hygiene and peri care by staff, risking infection for residents #5 and #39.
Report Facts
Missed medication doses: 5
Missed medication doses: 5
BIMS cognitive impairment score: 9
BIMS cognitive impairment score: 5
BIMS cognitive impairment score: 14
BIMS cognitive impairment score: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN #2 | Licensed Practical Nurse | Named in findings related to failure to administer medications on dialysis days for Residents #12 and #51. |
| LPN #3 | Licensed Practical Nurse | Named in findings related to failure to administer medications on dialysis days and failure to report missed medications. |
| Physician #1 | Interviewed regarding unawareness of missed medications for Resident #51. | |
| Physician #2 | Interviewed regarding unawareness of missed medications for Resident #12 and Resident #51. | |
| RN #1 | Registered Nurse Supervisor/Wound Care Nurse | Interviewed regarding unawareness of missed medications and infection control issues. |
| CNA #1 | Certified Nursing Assistant | Observed and interviewed regarding failure to follow infection control procedures during peri care. |
| CNA #3 | Certified Nursing Assistant | Observed and interviewed regarding improper peri care technique risking infection. |
| LPN #4 | Licensed Practical Nurse / MDS Nurse | Interviewed regarding MDS coding errors and care plan adherence. |
| Interim Director of Nursing | Interim DON | Interviewed regarding medication administration, pharmacy consultant role, and infection control. |
| Pharmacy Consultant | Interviewed regarding lack of access to EMAR and unawareness of medication administration issues. |
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