Inspection Report
Follow-Up
Census: 49
Capacity: 60
Deficiencies: 0
Mar 12, 2025
Visit Reason
The State Agency conducted a follow-up revisit at the facility on 3/12/25 related to a complaint survey conducted on 2/10/25.
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 3/05/25.
Complaint Details
Follow-up visit related to a complaint survey conducted on 2/10/25; facility found in compliance.
Inspection Report
Follow-Up
Deficiencies: 0
Mar 12, 2025
Visit Reason
The State Agency conducted a follow-up revisit at the facility on 3/12/25 related to the complaint survey conducted on 2/10/25.
Findings
The State Agency found the facility to be 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 3/05/25.
Complaint Details
Follow-up visit related to a complaint survey conducted on 2/10/25; facility found in compliance.
Report Facts
Date of complaint survey: Feb 10, 2025
Date of follow-up visit: Mar 12, 2025
Compliance effective date: Mar 5, 2025
Inspection Report
Complaint Investigation
Deficiencies: 2
Feb 10, 2025
Visit Reason
The State Agency conducted a Complaint Investigation at Magnolia Senior Care, LLC on 2/10/2025 regarding accidents and resident safety.
Findings
The facility was found not in compliance with Minimum Standards due to failure to ensure residents were free from accident hazards. Resident #1 was dropped from a lift causing a head laceration, and Resident #2 was transferred without the required two-person assistance, posing accident hazards.
Complaint Details
Complaint Investigation MS #27841 was substantiated regarding accidents and resident safety involving improper resident transfers and failure to follow facility lift policies.
Severity Breakdown
Level III: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to ensure a resident was free from accident hazards when Resident #1 was dropped from a lift causing injury. | Level III |
| Failure to provide two-person assistance as assessed for Resident #2 during transfer, creating potential accident hazard. | Level III |
Report Facts
Deficiencies cited: 2
Date of incident: Feb 2, 2025
Assessment Reference Date: Dec 11, 2024
Assessment Reference Date: Nov 21, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nursing Assistant #1 | CNA | Named in finding for dropping Resident #1 from lift and terminated for failure to follow facility policy |
| Certified Nursing Assistant #3 | CNA | Named in finding for transferring Resident #2 alone against care plan and terminated for failure to follow facility policy |
| Director of Nursing | DON | Informed of incident, confirmed findings, and terminated involved CNAs |
Inspection Report
Complaint Investigation
Census: 47
Capacity: 60
Deficiencies: 2
Feb 10, 2025
Visit Reason
The State Agency conducted a Complaint Investigation (CI), MS #27841, at the facility regarding accidents and resident safety.
Findings
The facility was found not in compliance with Medicare and Medicaid participation requirements, citing deficiencies related to failure to follow comprehensive care plans for manual assistance during transfers, resulting in a resident being dropped from a lift and sustaining injury, and failure to provide adequate supervision and assistance devices to prevent accidents.
Complaint Details
Complaint Investigation MS #27841 was triggered by concerns about accidents and resident safety. Resident #1 was dropped from a lift causing a scalp laceration and was hospitalized. Resident #2 was transferred with insufficient assistance, posing accident hazards. Both CNAs involved were terminated for failure to follow facility policy.
Severity Breakdown
SS=G: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to ensure Certified Nursing Assistants followed the comprehensive plan of care for manual assistance for two of four sampled residents, resulting in a resident being dropped from a lift and injured. | SS=G |
| Failed to ensure residents were free from accident hazards and received adequate supervision and assistance devices to prevent accidents, evidenced by improper transfer assistance causing injury. | SS=G |
Report Facts
Census: 47
Total Capacity: 60
Deficiencies cited: 2
BIMS score: 1
BIMS score: 15
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| CNA #1 | Certified Nursing Assistant | Involved in dropping Resident #1 from lift, terminated for failure to follow policy |
| CNA #3 | Certified Nursing Assistant | Transferred Resident #2 alone despite two-person assist requirement, terminated for failure to follow policy |
| Director of Nursing | Director of Nursing (DON) | Confirmed incidents and terminated involved CNAs |
| CNA #2 | Certified Nursing Assistant | Interviewed about transfer procedures and resident care |
| Minimum Data Set Nurse | MDS Nurse | Provided information on care plan importance and resident status |
Inspection Report
Plan of Correction
Deficiencies: 0
Jan 22, 2025
Visit Reason
The State Agency conducted a desk review of information related to the annual survey completed on 12/18/24 to verify corrective measures taken by the facility.
Findings
The facility provided information confirming that corrective measures were implemented to address deficient practices and sustain compliance with Medicare and Medicaid requirements. The State Agency recommended the facility be placed back in compliance effective 01/15/25.
Report Facts
Annual survey completion date: Dec 18, 2024
Inspection Report
Plan of Correction
Deficiencies: 0
Jan 22, 2025
Visit Reason
The State Agency conducted a desk review of information related to the annual survey completed on 2024-12-18 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 placing the facility back in compliance effective 2025-01-15.
Inspection Report
Annual Inspection
Census: 46
Capacity: 60
Deficiencies: 2
Dec 18, 2024
Visit Reason
The State Agency conducted an Annual Recertification Survey and Complaint Investigation related to abuse, quality of care, and environment at the facility from 12/15/24 through 12/18/24.
Findings
The facility was found not in compliance with Medicare and Medicaid participation requirements, citing deficiencies related to the development and implementation of comprehensive care plans and ensuring dietary services meet residents' needs and preferences. No citations were related to the complaint investigation.
Complaint Details
The complaint investigation (CI MS #26922) related to abuse, quality of care, and environment was conducted but resulted in no citations related to the complaint.
Severity Breakdown
SS=D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to ensure a comprehensive care plan was developed to include a resident's diagnosis of Dementia, with appropriate treatment and interventions for one of 14 care plans reviewed (Resident #9). | SS=D |
| Failure to ensure dietary staff supported and respected a resident's right to make choices about meal preferences for one of 14 sampled residents (Resident #46). | SS=D |
Report Facts
Licensed beds: 60
Resident census: 46
Residents with Dementia diagnosis: 29
Residents unable to independently leave bedroom for meal options: 16
Care plans audited weekly: 5
Care plan audit duration: 3
Resident interviews for meal service satisfaction: 3
Resident interview duration: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Registered Nurse #1 | Minimum Data Set (MDS) Nurse | Interviewed regarding care plan updates and Dementia diagnosis inclusion |
| Director of Nursing | Director of Nursing (DON) | Confirmed care plan requirements and conducted audits and education related to care plans and dietary services |
| Dietary Manager | Dietary Manager | Interviewed about meal menu communication and responsible for dietary staff education and audits |
| Activities Director | Activities Director | Interviewed regarding meal menu announcements and communication responsibilities |
| Certified Nursing Assistant #1 | Certified Nursing Assistant (CNA) | Interviewed about meal preference communication for bed-bound residents |
Inspection Report
Annual Inspection
Deficiencies: 1
Dec 18, 2024
Visit Reason
The State Agency conducted an Annual Recertification Survey and Complaint Investigation (CI MS #26922) related to abuse, quality of care, and environment at Magnolia Senior Care, LLC from 12/15/24 through 12/18/24.
Findings
The facility was found not in compliance with Minimum Standards for Institutions for the Aged or Infirm and state licensure requirements, specifically citing a deficiency in food preparation related to respecting a resident's right to make meal choices. No citations were related to the complaint investigation.
Complaint Details
The complaint investigation (CI MS #26922) related to abuse, quality of care, and environment was conducted but resulted in no citations.
Severity Breakdown
Level II: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Dietary staff failed to support and respect a resident's right to make choices about meal preferences for one of 14 sampled residents (Resident #46). | Level II |
Report Facts
Number of sampled residents: 14
Number of residents identified in audit: 16
BIMS score: 15
Resident admission date: Mar 18, 2024
Dates of survey: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| CNA #1 | Certified Nurse Assistant | Mentioned in relation to meal preference inquiry for Resident #46 |
| Director of Nursing | Director of Nursing | Interviewed regarding facility's process for informing residents of meal options |
| Dietary Manager | Dietary Manager | Interviewed regarding menu posting and meal choice process |
| Activities Director | Activities Director | Interviewed regarding responsibility for asking residents about food preferences |
Inspection Report
Annual Inspection
Census: 46
Capacity: 60
Deficiencies: 1
Dec 18, 2024
Visit Reason
The State Agency conducted an Annual Recertification Survey and Complaint Investigation related to abuse, quality of care, and environment from 12/15/24 through 12/18/24.
Findings
No citations were related to the complaint investigation. However, the facility was found not in compliance with Medicare and Medicaid participation requirements and was cited for deficiencies F656 and F800.
Complaint Details
The complaint investigation (CI MS #26922) related to abuse, quality of care, and environment was conducted with no citations resulting from it.
Deficiencies (1)
| Description |
|---|
| Non-compliance with Medicare and Medicaid participation requirements, cited as F656 and F800. |
Report Facts
Licensed beds: 60
Resident census: 46
Inspection Report
Annual Inspection
Deficiencies: 1
Dec 18, 2024
Visit Reason
The State Agency conducted an Annual Recertification Survey and Complaint Investigation (CI MS #26922) related to abuse, quality of care, and environment at Magnolia Senior Care, LLC from 12/15/24 through 12/18/24.
Findings
There were no citations related to the complaint investigation. However, the facility was found not in compliance with the Minimum Standards for Institutions for the Aged or Infirm and state licensure requirements, resulting in a citation of M855.
Complaint Details
Complaint Investigation (CI MS #26922) related to abuse, quality of care, and environment was conducted and found no citations related to the complaint.
Deficiencies (1)
| Description |
|---|
| Facility was not in compliance with the Minimum Standards for Institutions for the Aged or Infirm and state licensure requirements, cited as M855. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Jul 10, 2024
Visit Reason
The State Agency conducted a Complaint Investigation at the facility from 7/9/24 through 7/10/24 related to injury of unknown origin, resident not groomed, resident assessment, and responsible representative not being informed of resident condition.
Findings
During the survey, the State Agency determined the facility was in compliance with the Minimum Standards for Institutions for the Aged or Infirm, state licensure requirement. There were no deficiencies cited.
Complaint Details
Complaint Investigation MS #24872 was investigated related to injury of unknown origin, resident not groomed, resident assessment, and responsible representative not being informed of resident condition. No deficiencies were cited.
Inspection Report
Complaint Investigation
Census: 53
Capacity: 60
Deficiencies: 0
Jul 10, 2024
Visit Reason
The State Agency conducted a complaint investigation related to injury of unknown origin, resident not groomed, resident assessment, and responsible representative not being informed of resident condition.
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 MS #24872 was conducted from 7/9/24 through 7/10/24 regarding injury of unknown origin, resident grooming, resident assessment, and communication with responsible representative. No deficiencies were found.
Report Facts
Licensed beds: 60
Census: 53
Inspection Report
Plan of Correction
Deficiencies: 0
Aug 8, 2023
Visit Reason
The State Agency conducted a desk review of information related to the annual survey completed on 2023-06-15 to verify compliance with Minimum Standards of Operation for Institutions for the Aged or Infirm.
Findings
The facility was confirmed to be in compliance based on the information provided, and the State Agency recommended the facility be placed back in compliance effective 2023-07-14.
Report Facts
Annual survey date: Jun 15, 2023
Compliance effective date: Jul 14, 2023
Inspection Report
Plan of Correction
Deficiencies: 0
Aug 8, 2023
Visit Reason
The State Agency conducted a desk review of information related to the annual survey completed on 2023-06-15 to verify compliance with Minimum Standards of Operation for Institutions for the Aged or Infirm.
Findings
The facility was confirmed to be in compliance with the Minimum Standards of Operation for Institutions for the Aged or Infirm, and the agency recommended the facility be placed back in compliance effective 2023-07-14.
Inspection Report
Deficiencies: 0
Jun 15, 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 cited.
Inspection Report
Annual Inspection
Census: 43
Capacity: 60
Deficiencies: 3
Jun 15, 2023
Visit Reason
The State Agency conducted an annual re-certification survey at the facility from 06/13/23 through 06/15/23 to determine compliance with Medicare and Medicaid participation requirements.
Findings
The facility was found not in compliance with professional standards in care related to enteral feeding pump operation, incontinent care, and infection prevention and control. Deficiencies were cited for failure to ensure licensed staff operated feeding pumps, improper incontinent care leading to risk of urinary tract infections, and inadequate infection control practices including hand hygiene.
Severity Breakdown
SS=D: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Facility failed to ensure an enteral feeding pump was operated by licensed staff for one resident with PEG tube feedings. | SS=D |
| Facility failed to provide appropriate and sufficient care to prevent urinary tract infections for one resident during incontinent care. | SS=D |
| Facility failed to ensure infection control measures were consistently implemented to prevent transmission of infection for two residents. | SS=D |
Report Facts
Licensed beds: 60
Resident census: 43
Residents observed with PEG tube feedings: 9
Incontinence care observations: 4
Sampled residents for infection control: 16
BIMS score: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nursing Assistant #1 | Certified Nursing Assistant | Observed operating feeding pump, placed on suspension and terminated |
| Certified Nursing Assistant #3 | Certified Nursing Assistant | Failed to provide proper incontinent care and hand hygiene, placed on suspension and returned after training |
| Licensed Practical Nurse #1 | Licensed Practical Nurse | Confirmed improper incontinent care and hand hygiene practices |
| Director of Nursing | Director of Nursing | Provided interviews confirming deficiencies and initiated monitoring and corrective actions |
Inspection Report
Plan of Correction
Deficiencies: 0
Jun 15, 2023
Visit Reason
The State Agency conducted a desk review related to the annual survey completed on 06/15/23 to verify corrective measures taken by the facility.
Findings
The facility provided information confirming corrective actions were implemented to address deficient practices and sustain compliance with Medicare and Medicaid requirements. The State Agency recommended the facility be placed back in compliance effective 07/14/23.
Inspection Report
Annual Inspection
Deficiencies: 2
Jun 15, 2023
Visit Reason
The State Agency conducted an annual re-certification survey at Magnolia Senior Care, LLC from 06/13/2023 through 06/15/2023 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 infection control standards, specifically failing to consistently implement infection control measures to prevent infection transmission for two of sixteen sampled residents. Deficiencies involved failure of staff to perform proper hand hygiene and glove use during resident care.
Deficiencies (2)
| Description |
|---|
| Failure to perform hand hygiene prior to gloving and providing perineal care to Resident #15, including use of contaminated gloves to apply a clean brief and incontinent pad. |
| Failure of CNA #1 to remove gloves and perform hand hygiene after contamination with stool before applying a clean brief and pants to Resident #39, including inappropriate use of hand sanitizer on gloves. |
Report Facts
Sampled residents: 16
Residents with deficiencies: 2
BIMS score: 3
Assessment Reference Date: Apr 3, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nursing Assistant #3 | Certified Nursing Assistant | Failed to perform hand hygiene and used contaminated gloves during care of Resident #15; received in-service training and suspension |
| License Practical Nurse #1 | Licensed Practical Nurse | Failed to perform hand hygiene prior to assisting with care of Resident #15 |
| Certified Nursing Assistant #1 | Certified Nursing Assistant | Failed to remove gloves and perform hand hygiene after contamination during care of Resident #39 |
| Director of Nursing | Director of Nursing | Confirmed infection control failures and initiated monitoring and corrective actions |
| Staff Development Coordinator | Staff Development Coordinator | Provided in-service training on hand hygiene procedures |
| Infection Preventionist Nurse | Infection Preventionist Nurse | Conducted skill check-offs and monitoring of hand hygiene procedures |
Inspection Report
Life Safety
Deficiencies: 0
Jun 15, 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 with no deficiencies cited during this survey.
Inspection Report
Complaint Investigation
Deficiencies: 0
Feb 14, 2023
Visit Reason
The State Agency conducted a complaint investigation at the facility related to infection control practices.
Findings
The facility was found to be in compliance with the Mississippi Regulations for Minimum Standards for Institutions for the Aged or Infirm, and no deficiencies were cited.
Complaint Details
Complaint MS #20679 was investigated for infection control practices and was found to be unsubstantiated with no deficiencies cited.
Inspection Report
Complaint Investigation
Census: 45
Capacity: 60
Deficiencies: 0
Feb 14, 2023
Visit Reason
The State Agency conducted a COVID-19 Focused Infection Control Survey and a Complaint Investigation (CI), MS #20679 at the facility on 2/14/23 to investigate infection control practices.
Findings
The facility was found to be in compliance with infection control regulations and Medicare and Medicaid requirements, with no deficiencies cited related to infection control.
Complaint Details
Complaint Investigation MS #20679 was investigated for infection control practices and there were no deficiencies cited.
Inspection Report
Abbreviated Survey
Deficiencies: 0
Feb 14, 2023
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted at the facility by the State Agency on 2/14/23 to assess compliance with infection control regulations.
Findings
The facility was found to be in compliance with 42 CFR 483.80 infection control regulations and has implemented the CMS and CDC recommended practices to prepare for COVID-19.
Inspection Report
Complaint Investigation
Deficiencies: 0
Feb 14, 2023
Visit Reason
The State Agency conducted a Complaint Investigation (CI), MS #20679, at the facility on 2/14/23 to investigate infection control practices.
Findings
The facility was found to be in compliance with the Mississippi Regulations for Minimum Standards for Institutions for the Aged or Infirm, and no deficiencies were cited.
Complaint Details
Complaint MS #20679 was investigated for infection control practices and was found to be unsubstantiated with no deficiencies cited.
Inspection Report
Complaint Investigation
Census: 45
Capacity: 60
Deficiencies: 0
Feb 14, 2023
Visit Reason
The State Agency conducted a COVID-19 Focused Infection Control Survey and a Complaint Investigation (CI), MS #20679 at the facility on 2/14/23.
Findings
The facility was found to be in compliance with infection control regulations and Medicare and Medicaid requirements, with no deficiencies cited related to infection control practices.
Complaint Details
Complaint Investigation MS #20679 was investigated for infection control practices and there were no deficiencies cited.
Inspection Report
Abbreviated Survey
Deficiencies: 0
Feb 14, 2023
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted at the facility by the State Agency on 2/14/23 to assess compliance with infection control regulations.
Findings
The facility was found to be in compliance with 42 CFR 483.80 infection control regulations and has implemented the CMS and CDC recommended practices to prepare for COVID-19.
Inspection Report
Complaint Investigation
Deficiencies: 0
Oct 19, 2022
Visit Reason
The State Agency conducted a Complaint Investigation at the facility on 10/18/22 through 10/19/22 regarding MS #18653 and MS #18652.
Findings
The facility was found to be in compliance with Mississippi Regulations for Minimum Standards for Institutions for the Aged or Infirm. MS #18653 was not substantiated for resident neglect, dietary services, feeding assistance, inadequate grooming, or following physician orders and plan of care. MS #18652 was not substantiated for administration of medications and no deficiencies were cited.
Complaint Details
Complaint Investigation MS #18653 and MS #18652 were not substantiated and no deficiencies were cited.
Inspection Report
Complaint Investigation
Census: 47
Capacity: 60
Deficiencies: 0
Oct 19, 2022
Visit Reason
A COVID-19 Focused Infection Control Survey and a Complaint Investigation (CI) were conducted due to complaints identified as MS #18653 and MS #18652.
Findings
The facility was found to be in compliance with infection control regulations and implemented recommended COVID-19 practices. Both complaints were not substantiated and no deficiencies were cited.
Complaint Details
Complaint #18653 was not substantiated for resident neglect, dietary services, feeding assistance, inadequate grooming, or failure to follow physician orders and plan of care. Complaint #18652 was not substantiated for administration of medications.
Inspection Report
Abbreviated Survey
Deficiencies: 0
Oct 19, 2022
Visit Reason
A Covid-19 Focused Emergency Preparedness Survey was conducted at the facility by the State Agency on 10/18/22 through 10/19/22.
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
Oct 19, 2022
Visit Reason
The State Agency conducted a Complaint Investigation at the facility on 10/18/22 through 10/19/22 regarding two complaint cases MS #18653 and MS #18652.
Findings
The facility was found to be in compliance with Mississippi Regulations for Minimum Standards for Institutions for the Aged or Infirm. Complaint MS #18653 was not substantiated for resident neglect, dietary services, feeding assistance, inadequate grooming, or following physician orders and plan of care. Complaint MS #18652 was not substantiated for administration of medications and no deficiencies were cited.
Complaint Details
Complaint MS #18653 was not substantiated for resident neglect, dietary services, feeding assistance, inadequate grooming, or following physician orders and plan of care. Complaint MS #18652 was not substantiated for administration of medications.
Inspection Report
Complaint Investigation
Census: 47
Capacity: 60
Deficiencies: 0
Oct 19, 2022
Visit Reason
A COVID-19 Focused Infection Control Survey and a Complaint Investigation (CI) were conducted by the State Agency at the facility on 10/18/22 through 10/19/22.
Findings
The facility was found to be in compliance with infection control regulations and implemented CMS and CDC recommended practices for COVID-19. Complaint investigations #18653 and #18652 were not substantiated and no deficiencies were cited.
Complaint Details
Complaint #18653 was not substantiated for resident neglect, dietary services, feeding assistance, inadequate grooming, or failure to follow physician orders and plan of care. Complaint #18652 was not substantiated for administration of medications.
Report Facts
Licensed beds: 60
Census: 47
Inspection Report
Abbreviated Survey
Deficiencies: 0
Oct 19, 2022
Visit Reason
A Covid-19 Focused Emergency Preparedness Survey was conducted at the facility by the State Agency on 10/18/22 through 10/19/22.
Findings
The facility was found to be in compliance with 42 CFR 483.73 related to emergency preparedness requirements.
Inspection Report
Complaint Investigation
Census: 47
Capacity: 60
Deficiencies: 0
Aug 26, 2021
Visit Reason
A COVID-19 Focused Infection Control Survey with Complaint Investigation was conducted due to complaints identified as CI MS #17427 and CI MS #16647.
Findings
The facility was found to be in compliance with infection control regulations and implemented CMS and CDC recommended COVID-19 practices. Both complaints were unsubstantiated: CI MS #17427 for misappropriation of property/injury and CI MS #16647 for neglect/accidents.
Complaint Details
Complaint investigation included CI MS #17427 (unsubstantiated for misappropriation of property/injury) and CI MS #16647 (unsubstantiated for neglect/accidents).
Inspection Report
Complaint Investigation
Census: 47
Capacity: 60
Deficiencies: 0
Aug 26, 2021
Visit Reason
A COVID-19 Focused Infection Control Survey with Complaint Investigation was conducted by the State Agency on 8/25/21 through 8/26/21 to assess compliance with infection control regulations and investigate complaints CI MS #17427 and CI MS #16647.
Findings
The facility was found to be in compliance with infection control regulations and had implemented CMS and CDC recommended COVID-19 practices. Both complaints were unsubstantiated: CI MS #17427 for misappropriation of property/injury and CI MS #16647 for neglect/accidents.
Complaint Details
Complaint investigation included CI MS #17427 (unsubstantiated for misappropriation of property/injury) and CI MS #16647 (unsubstantiated for neglect/accidents).
Report Facts
Census: 47
Total licensed capacity: 60
Inspection Report
Abbreviated Survey
Deficiencies: 0
Aug 26, 2021
Visit Reason
A Covid-19 Focused Emergency Preparedness Survey was conducted by the State Agency on 8/25/21 through 8/26/21.
Findings
The facility was found to be in compliance with 42 CFR 483.73 related to emergency preparedness requirements.
Inspection Report
Complaint Investigation
Census: 47
Capacity: 60
Deficiencies: 0
Aug 26, 2021
Visit Reason
A COVID-19 Focused Infection Control Survey with Complaint Investigation (CI MS #17427 and CI MS #16647) was conducted by the State Agency on 8/25/21 through 8/26/21.
Findings
The facility was found to be in compliance with infection control regulations and had implemented CMS and CDC recommended practices for COVID-19. Complaint investigations CI MS #17427 and CI MS #16647 were unsubstantiated for misappropriation of property/injury and neglect/accidents respectively.
Complaint Details
Complaint investigation CI MS #17427 was unsubstantiated for misappropriation of property/injury and CI MS #16647 was unsubstantiated for neglect/accidents.
Report Facts
Census: 47
Total licensed capacity: 60
Inspection Report
Complaint Investigation
Census: 47
Capacity: 60
Deficiencies: 0
Aug 26, 2021
Visit Reason
A COVID-19 Focused Infection Control Survey with Complaint Investigation (CI MS #17427 and CI MS #16647) was conducted by the State Agency on 8/25/21 through 8/26/21.
Findings
The facility was found to be in compliance with infection control regulations and had implemented CMS and CDC recommended practices for COVID-19. Both complaints were unsubstantiated: CI MS #17427 for misappropriation of property/injury and CI MS #16647 for neglect/accidents.
Complaint Details
Complaint Investigation CI MS #17427 was unsubstantiated for misappropriation of property/injury and CI MS #16647 was unsubstantiated for neglect/accidents.
Inspection Report
Abbreviated Survey
Deficiencies: 0
Aug 26, 2021
Visit Reason
A Covid-19 Focused Emergency Preparedness Survey was conducted by the State Agency on 8/25/21 through 8/26/21.
Findings
The facility was found to be in compliance with 42 CFR 483.73 related to emergency preparedness requirements.
Inspection Report
Routine
Census: 42
Deficiencies: 0
Dec 21, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the State Agency to assess compliance with infection control regulations and CDC recommended practices 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
Dec 21, 2020
Visit Reason
A COVID-19 Focused Emergency Preparedness Survey was conducted by the State Agency on 12/21/20 to assess compliance with relevant federal regulations.
Findings
The facility was found to be in compliance with 42 CFR 483.73 related to emergency preparedness requirements.
Inspection Report
Abbreviated Survey
Census: 47
Capacity: 60
Deficiencies: 0
Dec 3, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the State Agency from 12/1/20 through 12/3/20 to assess the facility's compliance with infection control regulations and preparedness for COVID-19.
Findings
The facility was found to be in compliance with infection control regulations and has implemented the CMS and CDC recommended practices to prepare for COVID-19.
Inspection Report
Abbreviated Survey
Deficiencies: 0
Dec 3, 2020
Visit Reason
A COVID-19 Focused Emergency Preparedness Survey was conducted by the State Agency from December 1, 2020 through December 3, 2020.
Findings
The facility was found to be in compliance with 42 CFR §483.73 related to emergency preparedness requirements.
Inspection Report
Routine
Census: 47
Capacity: 60
Deficiencies: 0
Dec 3, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the State Agency from 12/1/20 through 12/3/20 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 has implemented the recommended practices to prepare for COVID-19.
Inspection Report
Abbreviated Survey
Deficiencies: 0
Dec 3, 2020
Visit Reason
A COVID-19 Focused Emergency Preparedness Survey was conducted by the State Agency from December 1, 2020 through December 3, 2020.
Findings
The facility was found to be in compliance with 42 CFR §483.73 related to emergency preparedness requirements.
Inspection Report
Routine
Census: 51
Deficiencies: 0
Jun 11, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the Centers for Medicare & Medicaid Services (CMS) 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
Abbreviated Survey
Deficiencies: 0
Jun 11, 2020
Visit Reason
A COVID-19 Focused Emergency Preparedness Survey was conducted by the Centers for Medicare & Medicaid Services (CMS) on June 11, 2020.
Findings
The facility was found to be in compliance with 42 CFR §483.73 related to E-0024 (b)(6).
Inspection Report
Routine
Census: 51
Deficiencies: 0
Jun 11, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted by the Centers for Medicare & Medicaid Services (CMS) 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
Abbreviated Survey
Census: 53
Capacity: 60
Deficiencies: 0
May 27, 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
Abbreviated Survey
Census: 53
Capacity: 60
Deficiencies: 0
May 27, 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
Annual Inspection
Census: 54
Capacity: 60
Deficiencies: 2
Jan 9, 2020
Visit Reason
The State Agency conducted an annual re-certification survey at the facility from 1/6/2020 to 1/9/2020 to determine compliance with Medicare and Medicaid participation requirements.
Findings
The facility was found not in compliance with Medicare and Medicaid requirements, citing deficiencies related to personal privacy/confidentiality of records during wound care and failure to timely revise the comprehensive care plan for a resident's behaviors. The facility took corrective actions including staff inservice training and care plan revisions.
Severity Breakdown
SS=D: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to provide privacy during wound care for one resident, including not closing window blinds during care. | SS=D |
| Failed to revise the comprehensive care plan related to behaviors for one resident in a timely manner. | SS=D |
Report Facts
Deficiencies cited: 2
Census: 54
Total capacity: 60
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RN #2 | Registered Nurse/Wound Care Nurse | Involved in wound care observation where privacy was not maintained. |
| RN #1 | Registered Nurse/Charge Nurse | Assisted in wound care and involved in privacy issue. |
| Director of Nursing | Director of Nursing | Conducted inservice training and interviews related to deficiencies. |
| LPN #1 | Licensed Practical Nurse/MDS Nurse | Provided information about care plan revision and resident behavior status. |
Inspection Report
Original Licensing
Census: 54
Capacity: 60
Deficiencies: 1
Jan 9, 2020
Visit Reason
The State Agency conducted a licensure survey at the facility from January 6, 2020 to January 9, 2020 to determine compliance with the Minimum Standards for the Institutions for the Aged and Infirm.
Findings
The facility was found not in compliance with the residents' rights policies, specifically failing to ensure privacy during wound care for one resident. The facility took corrective actions including staff inservice training and plans for ongoing monitoring of privacy practices.
Severity Breakdown
Level II: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failed to ensure the resident's right to privacy during wound care, affecting Resident #10. | Level II |
Report Facts
Census: 54
Total Capacity: 60
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RN #2 | Wound Care Nurse | Named in wound care privacy deficiency and interview |
| RN #1 | Registered Nurse | Assisted in wound care observation |
| Director of Nursing | Conducted inservice training and interview regarding privacy policy |
Inspection Report
Annual Inspection
Census: 58
Capacity: 60
Deficiencies: 0
Mar 20, 2019
Visit Reason
The State Agency conducted an annual re-certification survey at the facility from 3/18/19 to 3/20/19 to determine compliance with the Minimum Standards for the Aged or Infirm requirements for participation.
Findings
The facility was found to be in compliance with the Minimum Standards for the Aged or Infirm requirements during the annual re-certification survey.
Inspection Report
Annual Inspection
Census: 58
Capacity: 60
Deficiencies: 0
Mar 18, 2019
Visit Reason
The State Agency conducted an annual re-certification survey at the facility from 3/18/19 to 3/20/19 to determine compliance with Medicare and Medicaid requirements.
Findings
The facility was found to be in compliance with Medicare and Medicaid requirements with no deficiencies cited in the Life Safety Code or Emergency Preparedness surveys.
Report Facts
Census: 58
Total Capacity: 60
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