Inspection Reports for
Hattiesburg Health & Rehab

The facility was found not in compliance with several requirements including safe and comfortable living environment, discharge process documentation, and PASARR screening accuracy. Deficiencies included failure to maintain comfortable room and water temperatures, incomplete and untimely written transfer notices for hospitalizations, and inaccurate identification of a resident's major mental illness on PASRR screening.

The facility was found not in compliance with the Minimum Standards for Institutions for the Aged or Infirm, specifically failing to ensure residents' rights to a comfortable living environment by not maintaining comfortable room and water temperatures in three of four halls. Multiple residents reported cold room temperatures and uncomfortable water temperatures, which were confirmed by maintenance measurements.

The facility was found not in compliance with Medicare and Medicaid requirements, citing deficiencies in timely transmission of Minimum Data Set (MDS) assessments, accuracy of assessments regarding hospice services, and food safety practices related to food storage and labeling.

The facility was found not in compliance due to unsafe food handling procedures, including unlabeled food items, improper storage of a scoop in a dry bin, unrefrigerated food items, and failure to discard opened food items after the 'Best Before' date during kitchen observations.

The facility failed to transmit MDS assessments within the required 14-day timeframe for 10 of 52 sampled residents, failed to ensure accurate MDS assessment coding regarding hospice services for one resident, and failed to store food in accordance with professional food safety standards, including unlabeled food, improper storage of a scoop, unrefrigerated items, and expired food items.

The facility failed to provide the required half-hour fire resistance rating in two of eleven smoke compartments due to unsealed holes and inadequate smoke barrier walls. Immediate repairs were made by adding fire caulk, and audits confirmed no other deficiencies.

The complaint was substantiated as the facility failed to protect Resident #1 from sexual abuse by Resident #2. Immediate Jeopardy was identified and later removed after corrective actions were implemented.

The facility failed to provide adequate supervision and monitoring, allowing Resident #2 to be in his room with his pants unzipped and penis exposed with Resident #1, a cognitively impaired and vulnerable resident, in his bed with her clothing pulled down exposing her genital area. This created an Immediate Jeopardy situation beginning on 2023-12-21 due to Resident #2's inappropriate sexual behaviors and lack of supervision.

The complaint investigation was triggered by allegations of sexual abuse involving Resident #1 and Resident #2. The facility was found to have failed in supervision and monitoring, leading to an Immediate Jeopardy situation beginning 12/21/23. The Immediate Jeopardy was removed on 12/23/23 after corrective actions were implemented.

The facility failed to provide adequate supervision and monitoring, allowing Resident #2 to engage in inappropriate sexual behavior with Resident #1, a cognitively impaired and vulnerable resident. This resulted in an Immediate Jeopardy that began on December 21, 2023, which was corrected by December 23, 2023 prior to the surveyor's entrance.

The complaint investigation was substantiated. Resident #1 was found in Resident #2's bed with her pants pulled down and Resident #2 with his pants unzipped and penis exposed. Resident #2 had a history of hypersexual behavior. The facility failed to monitor Resident #2 adequately, leading to the abuse incident on 12/22/23. Immediate Jeopardy was declared on 1/3/24 and removed on 12/23/23 after corrective actions.

The facility failed to provide adequate supervision and monitoring, allowing Resident #2 to sexually abuse Resident #1, a cognitively impaired resident. Immediate Jeopardy was identified but removed after corrective actions were implemented, including separation of residents, increased supervision, medication administration, staff in-service, and care plan reviews.

The facility was found not in compliance with requirements related to transfer/discharge notifications and bed-hold policy notifications for residents transferred to hospitals. Specifically, the facility failed to provide and retain written documentation of transfer and bed-hold notifications for two residents.

The facility was found not in compliance with the ambulation requirements for the Alzheimer's/Dementia Care Unit, as 15 of 29 residents required staff assistance for transfers and could not self-propel their wheelchairs, exceeding the allowed 10% limit. The facility took corrective actions including moving 8 residents off the unit and conducting staff in-service training.

The complaint investigation focused on the failure to provide written notification to residents and their representatives about hospital transfers and bed hold policies. Interviews with residents, family members, the Social Worker, Director of Nursing, and Administrator confirmed the issues. The Social Worker admitted to not retaining copies of notifications and being unaware of the requirement to do so.

The facility failed to provide written documentation of hospital transfers and bed hold notifications for two of four residents reviewed. Interviews and record reviews confirmed that notifications were either not received by residents or their families, and the Social Worker did not retain copies of the notifications sent.

The complaint investigation substantiated misappropriation of money for Resident #9 and physical abuse for Resident #16. Resident #9 gave $10 to CNA #1, who initially accepted it but later returned it. Resident #16 was physically abused by Resident #15, who was placed on 1:1 monitoring and transported to a behavioral health unit. The facility conducted staff in-services and implemented monitoring and corrective actions.

The investigation substantiated misappropriation of money for Resident #9 and physical abuse for Resident #16. The facility was found not in compliance with State Licensure Regulations for the Aged or Infirm.

The complaint investigation was substantiated for misappropriation of money by CNA #1 from Resident #9 and physical abuse by Resident #15 against Resident #16. The facility reimbursed the resident and suspended the CNA. Resident #16 was injured and placed on 1:1 monitoring. The facility conducted staff in-services and reported the incidents to the State Department of Health and Attorney General's office.

The facility was found to have substantiated misappropriation of money for Resident #9 and physical abuse for Resident #16. The facility failed to ensure residents were free from misappropriation and resident-to-resident abuse.

The facility was found not in compliance with standards related to urinary incontinence catheter care, tracheostomy care, and nebulizer treatment administration. Deficiencies included improper catheter care techniques risking infection, failure to maintain sterile technique during tracheostomy care, and failure to supervise nebulizer treatments as required by policy.

The facility was found not in compliance due to failure to provide catheter and perineal care in a manner to prevent the possible spread of infection during catheter care observations for four residents. Staff failed to follow proper catheter care procedures, including improper handling of catheter tubing and wipes, which could lead to urinary tract infections.

The facility failed to timely code significant changes in resident status, provide accurate PASARR screenings, identify Level II referrals timely, follow comprehensive care plans for tracheostomy, nebulizer, and catheter care, and maintain kitchen equipment cleanliness. Several residents' care plans were not updated or followed, and staff failed to adhere to infection control practices during catheter and tracheostomy care.

Complaints related to quality of care and pest control were investigated and not substantiated.

The facility was found not in substantial compliance with Medicare and Medicaid requirements, with deficiencies cited in comprehensive assessment after significant change, PASARR screening, care plan development and implementation, catheter care, respiratory and tracheostomy care, and food safety. Complaint allegations were not substantiated. The facility also had a life safety code deficiency related to an exit door malfunction.

Complaints MS #00015937 and MS #00015956 were investigated and found not substantiated, resulting in no citations related to the complaint.

The complaints were not substantiated and resulted in no citations related to the complaint. The annual survey revealed that the facility was not in substantial compliance with Medicare/Medicaid participation requirements, with deficiencies related to the standard survey.

The complaint regarding an injury during transfer with a lift was substantiated with no deficiencies cited related to the complaint.

The facility failed to revise the pressure wound care plan to address reporting missing, soiled, or dislodged wound dressings for one resident. The facility also failed to promote healing of pressure ulcers consistent with professional standards for one resident with a stage three sacral pressure ulcer. Additionally, one exit door failed to release upon fire alarm activation, obstructing egress.

The facility failed to promote the healing of pressure ulcers for one resident with a stage three sacral pressure ulcer due to missing wound dressings that were not reported promptly by staff. The facility lacked a policy addressing reporting of dislodged, missing, or soiled wound dressings, which was later revised following the inspection.