Inspection Reports for
Washington Care Center
1920 Lisa Drive Extended, Greenville, MS, 38703
Back to Facility Profile37 Reports
Inspection Report — Jun 1, 2026
Date: Jun 1, 2026
Visit Reason
On 06/01/26 the State Agency (SA) conducted a desk review of the information that was provided to our agency related to the annual survey that was completed on 04/30/26. The information provided by the facility confirmed the facility had put measures in place to correct the deficient practice and sustain compliance with Medicare and Medicaid requirements of participation.
Findings
The SA is recommending that the facility be placed back in compliance effective 05/26/26. No deficiencies were cited in this desk review.
Inspection Report — Jun 1, 2026
Annual Inspection
Date: Jun 1, 2026
Visit Reason
On 06/01/26 the State Agency (SA) conducted a desk review of the information that was provided to our agency related to the annual survey that was completed on 04/30/26.
Findings
The information provided by the facility confirmed the facility was in compliance with the Minimum Standards of Operation for Institutions for the Aged or Infirm. The SA is recommending your facility be placed back in compliance effective 05/26/26.
Inspection Report — May 26, 2026
Life Safety
Date: May 26, 2026
Visit Reason
The State Agency conducted a desk review of information related to the annual survey conducted on 04/28/26 to confirm the facility had put measures in place to correct deficient practices and sustain compliance with the Life Safety Code.
Findings
The facility was found to be in compliance with the applicable provisions of the 2012 Edition of the Life Safety Code. No deficiencies were cited during this survey.
Inspection Report — Apr 30, 2026
Annual Inspection
Date: Apr 30, 2026
Visit Reason
The State Agency conducted an Annual Recertification survey along with a Complaint Investigation (CI MS #2962685) at the facility from 4/28/26 through 4/30/26. The facility was found not in compliance with Medicare and Medicaid requirements and cited deficiencies at F641, F656, F677, F812, and F883. There were no deficiencies cited for the complaint investigation related to abuse, neglect, and resident rights.
Complaint Details
Complaint Investigation CI MS #2962685 was conducted concurrently with the annual recertification survey. No deficiencies were cited related to abuse, neglect, or resident rights for this complaint.
Findings
The facility was cited for multiple deficiencies including failure to ensure proper food labeling and storage, inaccurate coding of resident assessments, failure to implement care plans for oral hygiene, failure to provide oral care to dependent residents, and failure to administer influenza vaccine according to policy. The complaint investigation found no deficiencies related to abuse, neglect, or resident rights.
Deficiencies (5)
F0812 - Food procurement, storage, preparation, and service were not sanitary as the facility failed to ensure items in the kitchen refrigerator were dated, labeled, and discarded by expiration date during dietary observations.
F0641 - The facility failed to accurately code Section A of the Minimum Data Set for a resident with serious mental illness, resulting in inaccurate assessment documentation.
F0656 - The facility failed to develop and implement a comprehensive care plan for oral hygiene for a resident, resulting in inadequate oral care.
F0677 - The facility failed to provide oral care to a dependent resident, as evidenced by poor oral hygiene and lack of documentation of care provided.
F0883 - The facility failed to ensure administration of the influenza vaccine according to policy for a resident, documenting the vaccine as out of season when it should have been given.
Report Facts
Deficiencies cited: 5
Inspection Report — Apr 30, 2026
Annual Inspection
Date: Apr 30, 2026
Visit Reason
The State Agency (SA) conducted an Annual Recertification survey along with a Complaint Investigation (CI MS #2962685) at the facility from 04/28/26 through 04/30/26.
Complaint Details
Complaint Investigation (CI MS #2962685) was conducted with no deficiencies cited related to resident rights.
Findings
The facility was found not in compliance with the Minimum Standards for Institutions of Aged or Infirm, state licensure requirements, with deficiencies cited at M610, M815, and M1570. No deficiencies were cited related to resident rights for the complaint investigation.
Deficiencies (3)
M0610 - The facility failed to provide oral care to a resident dependent on staff for activities of daily living, as evidenced by observations of Resident #4 with dry, cracked lips and coated teeth, lack of documented oral care, and staff interviews confirming inadequate oral hygiene.
M0815 - The facility failed to ensure items in the kitchen refrigerator were dated and labeled and failed to discard food items by the expiration date, as observed during a dietary tour with unlabeled shredded carrots and salad mix, and expired or improperly dated food items.
M1570 - The facility failed to ensure the administration of the influenza vaccine according to facility policy and accepted standards for one resident, Resident #10, who was documented as not eligible but should have been vaccinated to prevent infection spread.
Report Facts
Deficiencies cited: 3
Inspection Report — Apr 28, 2026
Life Safety
Date: Apr 28, 2026
Visit Reason
The facility was surveyed for compliance with the 2012 Edition of the Life Safety Code (LSC) of the National Fire Protection Association (NFPA).
Findings
One deficiency was cited related to the fire alarm system which was not maintained in proper operating condition, including trouble signals and failure of smoke barrier and exit doors to release and close as designed.
Deficiencies (1)
K0345 - Fire alarm system was not maintained in proper operating condition; trouble signal displayed and smoke barrier and exit doors failed to release and close as designed.
Report Facts
Deficiencies cited: 1
Inspection Report — Jun 3, 2025
Complaint Investigation
Date: Jun 3, 2025
Visit Reason
The State Agency conducted a complaint investigation (CI) survey for MS #28867 and MS #28310 at the facility on 06/03/25.
Complaint Details
Complaint investigation for MS #28867 and MS #28310; the complaints were not substantiated and no deficiencies were cited.
Findings
The facility was found in compliance with the requirements of participation in Medicare and Medicaid and the complaint allegations were not substantiated.
Inspection Report — Oct 8, 2024
Date: Oct 8, 2024
Visit Reason
On 10/08/24 the State Agency (SA) conducted a desk review of the information that was provided related to the annual survey completed on 08/21/24. The information confirmed the facility had put measures in place to correct the deficient practice and sustain compliance with Medicare and Medicaid requirements of participation.
Findings
The State Agency is recommending that the facility be placed back in compliance effective 10/01/24. No deficiencies were cited in this desk review.
Inspection Report — Aug 22, 2024
Life Safety
Date: Aug 22, 2024
Visit Reason
The facility was surveyed for compliance with the 2012 Edition of the Life Safety Code (LSC) of the National Fire Protection Association (NFPA).
Findings
The facility was found to be in compliance with the Life Safety Code. There were no deficiencies cited during this survey.
Inspection Report — Aug 21, 2024
Annual Inspection
Date: Aug 21, 2024
Visit Reason
The State Agency conducted an annual re-certification survey at the facility from 8/20/24 through 8/21/24. During the survey, the SA determined that the facility was not in compliance with Medicare and Medicaid requirements for participation and deficiencies were cited at F641, F758, and F851.
Findings
The facility was found not in compliance with Medicare and Medicaid requirements with deficiencies cited in assessment accuracy, psychotropic medication management, and payroll-based journal staffing data submission.
Deficiencies (3)
F0641 - Accuracy of Assessments. The facility failed to accurately code a quarterly Minimum Data Set Assessment for one of sixteen resident assessments reviewed (Resident #11), miscoding hospice status.
F0758 - Free from Unnecessary Psychotropic Meds/PRN Use. The facility failed to ensure a resident on a PRN psychotropic medication had a stop date for one of five medication reviews (Resident #40).
F0851 - Payroll Based Journal. The facility failed to submit accurate staffing information into the Payroll-Based Journal system for the second quarter of 2024.
Report Facts
Deficiencies cited: 3
Inspection Report — Aug 21, 2024
Annual Inspection
Date: Aug 21, 2024
Visit Reason
The State Agency (SA) conducted an annual recertification survey at the facility from 8/20/24 through 8/21/24.
Findings
During the survey, the SA determined the facility was in compliance with the Minimum Standards for Institutions for the Aged or Infirm, state licensure requirements and no deficiencies were cited.
Inspection Report — Aug 6, 2024
Complaint Investigation
Date: Aug 6, 2024
Visit Reason
On 08/06/24 the State Agency conducted a desk review of the information provided related to the complaint survey completed on 07/01/24. The information confirmed the facility had put measures in place to correct the deficient practice and sustain compliance with Medicare and Medicaid requirements of participation.
Complaint Details
Complaint survey completed on 07/01/24; the facility was found to have corrected the deficient practice and sustained compliance.
Findings
The State Agency found the facility in compliance and is recommending the facility be placed back in compliance effective 07/31/24.
Report Facts
Deficiencies cited: 0
Inspection Report — Jul 1, 2024
Complaint Investigation
Date: Jul 1, 2024
Visit Reason
The State Agency conducted two Complaint Investigations (CI MS# 25458 and CI MS# 25674) at the facility on 7/1/24. The facility was found not in compliance related to inappropriate discharge in CI MS#25458, while CI MS#25674 was not substantiated and no deficiencies were cited.
Complaint Details
Two complaint investigations were conducted: CI MS#25458 and CI MS#25674. CI MS#25458 was substantiated with a deficiency cited (F622) related to inappropriate discharge. CI MS#25674 was not substantiated and no deficiencies were cited.
Findings
The facility failed to honor a resident's right to return following hospitalization for one of three residents reviewed for discharge. Resident #1 was discharged after exceeding bed hold days and the facility did not notify the family or assist in securing a new attending physician, resulting in discharge to an alternative nursing home.
Deficiencies (1)
F0622 - The facility failed to honor a resident's right to return following hospitalization for one of three residents reviewed for discharge. Resident #1 was discharged after exceeding bed hold days without proper notification or assistance in securing a new attending physician.
Report Facts
Deficiencies cited: 1
Inspection Report — Apr 16, 2024
Complaint Investigation
Date: Apr 16, 2024
Visit Reason
The State Agency conducted a complaint investigation (CI MS# 24530) at the facility on 4/16/24.
Complaint Details
Complaint number CI MS# 24530 was investigated regarding Neglect and Quality of care and was found to be unsubstantiated with no deficiencies cited.
Findings
The facility was found in compliance with Medicare and Medicaid participation requirements. No deficiencies were cited related to Neglect and Quality of care.
Report Facts
Complaint investigations: 1
Inspection Report — Mar 28, 2023
Date: Mar 28, 2023
Visit Reason
On 03/28/23 the State Agency (SA) conducted a desk review of the information that was provided to our agency related to the annual survey that was completed on 02/09/23. The information provided by the facility confirmed the facility had put measures in place to correct the deficient practice and sustain compliance with Medicare and Medicaid requirements of participation.
Findings
The State Agency is recommending that the facility be placed back in compliance effective 03/17/23.
Inspection Report — Mar 28, 2023
Life Safety
Date: Mar 28, 2023
Visit Reason
On 2/07/23 the State Agency conducted a desk review of the information provided related to the annual survey conducted on 3/28/23. The information confirmed the facility had put measures in place to correct the deficient practice and sustain compliance with the Life Safety Code.
Findings
The facility was found to be in compliance with the applicable provisions of the 2012 Edition of the Life Safety Code. The State Agency is recommending the facility be placed back in compliance effective 3/13/23.
Inspection Report — Mar 28, 2023
Annual Inspection
Date: Mar 28, 2023
Visit Reason
On 03/28/23 the State Agency (SA) conducted a desk review of the information that was provided to our agency related to the annual survey that was completed on 02/09/23. The information provided by the facility confirmed the facility had put measures in place to correct the deficient practice and sustain compliance with Medicare and Medicaid requirements of participation.
Findings
The State Agency is recommending that the facility be placed back in compliance effective 03/17/23. No deficiencies were cited in this desk review.
Report Facts
Deficiencies cited: 0
Inspection Report — Feb 9, 2023
Annual Inspection
Date: Feb 9, 2023
Visit Reason
The State Agency conducted an annual recertification survey and Complaint Investigations (CI) MS #12065, MS 19039, and MS #19096 at the facility from 02/06/23 through 02/09/23. The survey identified non-compliance with state licensure requirements and cited M610 for CI MS #12065 related to Activities of Daily Living. No deficiencies were cited for the other complaint investigations.
Complaint Details
Complaint Investigation MS #12065 was substantiated with deficiency M610 cited for failure to provide adequate Activities of Daily Living. Complaints MS #19039 and MS #19096 related to injury of unknown origin were not substantiated and no deficiencies were cited.
Findings
The facility was found not in compliance with Minimum Standards for Institutions for Aged or Infirm due to failure to provide adequate Activities of Daily Living (ADLs). Specifically, two residents had long and jagged fingernails and unshaven facial hair, indicating inadequate grooming and nail care.
Deficiencies (1)
M610 - Activities of daily living. The facility failed to provide adequate assistance with activities of daily living as evidenced by two residents having long, jagged fingernails and unshaven facial hair despite requests for care.
Report Facts
Deficiencies cited: 1
Inspection Report — Feb 9, 2023
Annual Inspection
Date: Feb 9, 2023
Visit Reason
The State Agency (SA) conducted an annual recertification survey and Complaint Investigations (CI) MS #20165, MS 19039, and MS #19096 at the facility from 02/06/23 through 02/09/23. During the survey, the SA determined the facility was not in compliance with the requirements of participation in Medicare and Medicaid services.
Complaint Details
Complaint Investigations (CI) MS #20165, MS 19039, and MS #19096 were conducted. Deficiencies were cited only for CI #20165 related to Activities of Daily Living. No deficiencies were cited for CI MS #19096 and CI MS #19039 related to injury of unknown origin.
Findings
The facility was found not in compliance due to failure to develop and implement comprehensive care plans and failure to provide Activities of Daily Living (ADLs) including nail care and shaving for two residents. Deficiencies were cited for Residents #24 and #42 regarding inadequate care planning and unmet grooming needs.
Deficiencies (2)
F0656 - The facility failed to develop a comprehensive care plan for a resident requiring shaving and failed to implement the care plan for residents requiring nail care for two of eighteen residents reviewed, Resident #24 and Resident #42.
F0677 - The facility failed to provide Activities of Daily Living (ADLs) as evidenced by long and jagged nails, and unshaven facial hair for two of eighteen residents observed, Resident #24 and Resident #42.
Report Facts
Deficiencies cited: 2
Inspection Report — Feb 7, 2023
Life Safety
Date: Feb 7, 2023
Visit Reason
The facility underwent a Life Safety Code survey to assess compliance with the 2012 Edition of the Life Safety Code (LSC) of the National Fire Protection Association (NFPA).
Findings
The facility was found deficient in properly protecting hazardous areas due to a damaged Soiled Linen Room door that did not close properly, and in performing and documenting fire drills as required by NFPA 101. These deficiencies had the potential to affect all residents in the facility.
Deficiencies (2)
K0321 - Hazardous areas were not properly protected as the Soiled Linen Room door near the nurse station was damaged and failed to close to a positive latching position, allowing smoke passage.
K0712 - The facility failed to properly perform and document fire drills as required, lacking complete and proper documentation for the 2nd shift fire drills for the 3rd and 4th quarters of 2022.
Report Facts
Deficiencies cited: 2
Inspection Report — Feb 7, 2023
Life Safety
Date: Feb 7, 2023
Visit Reason
Survey conducted on 02/07/23 reveals the above facility meets all applicable Federal, State and local emergency preparedness requirements.
Findings
The facility was found in compliance with all emergency preparedness requirements. No deficiencies were cited.
Inspection Report — May 5, 2022
Complaint Investigation
Date: May 5, 2022
Visit Reason
On 05/5/22 the State Agency conducted a desk review of the information provided related to the complaint survey conducted on 2/24/22. The review confirmed the facility had put measures in place to correct the deficient practice and sustain compliance with Medicare and Medicaid requirements.
Complaint Details
Complaint survey conducted on 2/24/22; the facility was found in compliance with no deficiencies cited.
Findings
The facility was found to be in compliance as the State Agency recommended the facility be placed back in compliance effective 05/02/22.
Inspection Report — Feb 23, 2022
Complaint Investigation
Date: Feb 23, 2022
Visit Reason
On February 21-23, 2022 the State Agency (SA) conducted an onsite complaint investigation for four (4) complaints, CI MS #17795 related to quality of care, and Responsible Party (RP) not notified timely of the resident's change in condition; CI MS #18294, related to quality of care, injuries of unknown origin, and (RP) not notified timely of the resident's change in condition; CI MS #18471, related to staff to resident alleged abuse; and CI MS #18509 related to infection control preventions not provided for an alleged vaccinated resident that tested positive for Covid. The SA unsubstantiated all four (4) complaints.
Complaint Details
Complaint investigation for four complaints: CI MS #17795 (quality of care and RP notification), CI MS #18294 (quality of care, injuries of unknown origin, RP notification), CI MS #18471 (staff to resident alleged abuse), and CI MS #18509 (infection control for vaccinated resident with Covid). All complaints were unsubstantiated but deficiencies were cited for failure to report alleged abuse timely and failure to resolve resident council concerns.
Findings
The facility was found not in compliance with Medicare and Medicaid participation standards due to failure to report alleged abuse timely and failure to resolve resident council group concerns. The facility failed to provide evidence of responses to resident council concerns over many months and failed to timely report alleged staff to resident abuse within two hours of occurrence for Resident #1.
Deficiencies (2)
F0565 - Resident/Family Group and Response. The facility failed to provide evidence of responses to resident council concerns voiced over many months, including issues with food, activities, noise, and resident care, and did not follow their own policies for timely documentation and follow-up.
F0609 - Reporting of Alleged Violations. The facility failed to timely report alleged staff to resident abuse within two hours of the alleged occurrence for Resident #1, with the first notification to the State Agency occurring via US mail on 1/6/2022, well after the incident on 12/09/2021.
Report Facts
Deficiencies cited: 2
Complaints investigated: 4
Licensed beds: 60
Inspection Report — May 11, 2021
Date: May 11, 2021
Visit Reason
A desk review was conducted on 5/11/2021. The facility is in substantial compliance as of 5/7/2021.
Complaint Details
This desk review covered complaint investigations CI MS #16704, CI MS #16966, CI MS #17141, CI MS #17217, CI MS #17244, CI MS #17330, CI MS #17368, CI MS #17499 and CI MS #17639. The facility was found in substantial compliance as of 5/7/2021.
Findings
The facility was found to be in substantial compliance with no deficiencies cited.
Report Facts
Complaint investigations: 9
Inspection Report — May 11, 2021
Life Safety
Date: May 11, 2021
Visit Reason
The document contains only the Initial Comments block with no further text or deficiencies cited.
Findings
The facility was found in compliance with no deficiencies cited.
Inspection Report — Mar 16, 2021
Complaint Investigation
Date: Mar 16, 2021
Visit Reason
The State Agency conducted complaint investigations from 3/8/21 through 3/16/21. CI MS #17499 was substantiated for misappropriation of funds and the facility was cited M500 at a Level II for Resident #1. Several other complaints were investigated and not substantiated.
Complaint Details
CI MS #17499 was substantiated for misappropriation of funds involving Resident #1. The facility was cited M500 at a Level II. Other complaints investigated were not substantiated.
Findings
M500 - The facility failed to ensure residents were free from theft of personal property (cash) for one of fifteen sampled residents, Resident #1. Nursing Assistant #1 was found to have taken money from Resident #1 and was terminated.
Deficiencies (1)
M500 - The facility failed to ensure residents were free from theft of personal property (cash) for one of fifteen sampled residents, Resident #1.
Report Facts
Deficiencies cited: 1
Inspection Report — Mar 16, 2021
Routine
Date: Mar 16, 2021
Visit Reason
A COVID-19 Focused Infection Control Survey, along with complaint investigations (CI), was conducted by the State Agency from 3/8/21 through 3/16/21.
Complaint Details
CI MS #17499 was substantiated for misappropriation of funds involving Resident #1. Several other complaints were investigated and not substantiated.
Findings
The facility was found in compliance with infection control regulations. However, the facility was cited for misappropriation of resident property involving theft of money from Resident #1 by Nursing Assistant #1.
Deficiencies (1)
F0602 - The facility failed to ensure residents were free from theft of personal property (cash) for one of fifteen sampled residents, Resident #1, who had money stolen by a Nursing Assistant who admitted to taking $50.00. The facility took corrective actions including suspension and termination of the employee and implemented monitoring and staff in-service.
Report Facts
Deficiencies cited: 1
Inspection Report — Mar 16, 2021
Routine
Date: Mar 16, 2021
Visit Reason
A COVID-19 Focused Emergency Preparedness Survey was conducted by the State Agency (SA) from 3/8/21 through 3/16/21.
Findings
The facility was found to be in compliance with 42 CFR 483.73 related to E-0024(b)(6).
Inspection Report — Dec 22, 2020
Routine
Date: Dec 22, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey, along with complaints (MS #17371 and MS #17273), was conducted by the State Agency from 12/21/20 to 12/22/20. The SA substantiated MS #17371 and MS #17273 for Resident Rights related to privacy and cited F583.
Complaint Details
Complaints MS #17371 and MS #17273 were substantiated for Resident Rights related to privacy, resulting in citation of F583.
Findings
F0583 - The facility failed to ensure the privacy of two residents when a video and a picture of them were posted on personal social media by a former employee, violating the facility's cell phone and privacy policies.
Deficiencies (1)
F0583 - The facility failed to ensure the privacy for two residents when a video and a picture were posted on personal social media by a former CNA, violating the facility's cell phone and privacy policies.
Report Facts
Deficiencies cited: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
Inspection Report — Dec 22, 2020
Date: Dec 22, 2020
Visit Reason
The Mississippi State Department of Health conducted a licensure survey at Washington Care Center on 12/22/2020. The survey included review of resident rights policies and investigation of privacy violations related to a video and a picture posted on social media involving two residents.
Findings
The facility was found to have failed to ensure resident privacy when a video and a picture of two residents were posted on personal social media accounts by a former employee. The facility had policies prohibiting such actions and took corrective measures including staff in-service and termination of the responsible employee.
Deficiencies (1)
M500 - Residents' rights were violated when the facility failed to ensure privacy for two residents related to a video and a picture posted on personal social media by a former CNA. The facility had policies prohibiting recording or photographing residents and took corrective actions including staff in-service and termination of the responsible employee.
Report Facts
Deficiencies cited: 1
Residents affected: 45
Inspection Report — Dec 22, 2020
Routine
Date: Dec 22, 2020
Visit Reason
A COVID-19 Focused Emergency Preparedness Survey was conducted by the State Agency (SA) from 12/21/20 to 12/22/20.
Findings
The facility was found to be in compliance with 42 CFR 483.73 related to E-0024(b)(6).
Inspection Report — Aug 20, 2020
Routine
Date: Aug 20, 2020
Visit Reason
A Covid-19 Focused Infection Control Survey was conducted by the State Agency (SA) on 8/20/20.
Findings
The facility was found to be in compliance with 42 CFR §483.80 infection control regulations and has implemented the CMS and Centers for Disease Control and Prevention (CDC) recommended practices to prepare for COVID-19.
Inspection Report — May 27, 2020
Routine
Date: May 27, 2020
Visit Reason
A Covid-19 Focused Infection Control Survey was conducted by the State Agency (SA) on 5/27/20.
Findings
The facility was found to be in compliance with 42 CFR §483.80 infection control regulations and has implemented the CMS and Centers for Disease Control and Prevention (CDC) recommended practices to prepare for COVID-19.
Inspection Report — Jan 9, 2020
Annual Inspection
Date: Jan 9, 2020
Visit Reason
The State Survey Agency (SA) conducted an annual recertification survey from 1/6/2020 to 1/9/2020. During the survey, the SA determined the facility was not in compliance with Medicare and Medicaid requirements of participation.
Findings
The facility was found not in compliance with Medicare and Medicaid requirements, citing deficiencies in assessment accuracy, care plan implementation and revision, and respiratory care. The sprinkler system had corroded heads needing replacement, and fire drill documentation was incomplete. Emergency preparedness requirements were met with no deficiencies.
Deficiencies (6)
F0641 - Accuracy of Assessments. The facility failed to accurately complete a Minimum Data Set assessment for one resident, misclassifying Plavix as an anticoagulant.
F0656 - Develop/Implement Comprehensive Care Plan. The facility failed to implement care plans related to oxygen equipment storage for two residents, with oxygen tubing and cannula improperly stored and not changed weekly as required.
F0657 - Care Plan Timing and Revision. The facility failed to revise the nutrition care plan timely for one resident requiring gastrostomy tube feeding, risking inaccurate nutrition management.
F0695 - Respiratory/Tracheostomy Care and Suctioning. The facility failed to store oxygen equipment to prevent cross contamination for two residents, with oxygen tubing and cannulas uncovered, dirty, and not changed weekly as required.
K0353 - Sprinkler System - Maintenance and Testing. The facility failed to ensure operability of the sprinkler system due to corroded sprinkler heads under the front canopy area.
K0712 - Fire Drills. The facility failed to properly perform fire drills as required, lacking documentation of drill times and how alarms were activated, and missing audible notification during drills between 6 AM and 9 PM.
Report Facts
Deficiencies cited: 6
Inspection Report — Nov 20, 2019
Complaint Investigation
Date: Nov 20, 2019
Visit Reason
The State Survey Agency conducted a complaint investigation on 11/20/19.
Complaint Details
Complaint investigation CI MS #15959, CI MS #16123 & CI MS #16139 were unsubstantiated with no deficiencies cited.
Findings
The investigation was unsubstantiated with no deficiencies cited. The facility was found in compliance with Medicare and Medicaid requirements for participation.
Report Facts
Complaint investigations: 3
Inspection Report — Mar 28, 2019
Annual Inspection
Date: Mar 28, 2019
Visit Reason
A Recertification survey was conducted by Healthcare Management Solutions, LLC on behalf of the Mississippi State Department of Health from 03/25/19 through 03/28/19. The facility was found to be not in substantial compliance with requirements of participation for Medicare and Medicaid and cited deficiencies at F565, F690, F712, F880, and F908.
Findings
The facility was found not in substantial compliance with Medicare and Medicaid participation requirements, with deficiencies cited in resident group response, incontinence care, physician visit frequency, infection prevention and control, and equipment maintenance.
Deficiencies (6)
F0565 - Resident/Family Group and Response. The facility failed to ensure efforts were made to resolve grievances regarding incontinent brief practices for multiple residents, causing resident worry and dissatisfaction.
F0690 - Bowel/Bladder Incontinence, Catheter, UTI. The facility failed to develop an individualized toileting plan for one resident reviewed for incontinence, despite assessment indicating candidacy for retraining.
F0712 - Physician Visits-Frequency/Timeliness/Alt NPP. The facility failed to ensure physician visits were conducted at least once every 60 days for two residents, with incomplete documentation and lack of tracking.
F0880 - Infection Prevention & Control. The facility failed to analyze infection control data for trends and goals, follow transmission-based precautions, conduct annual policy review, and maintain sanitary laundry and whirlpool equipment, risking infection spread.
F0908 - Essential Equipment, Safe Operating Condition. The facility failed to maintain the whirlpool tub chair in safe and clean condition, with cracked vinyl and sharp edges posing risk to residents.
K0345 - Fire Alarm System - Testing and Maintenance. The facility failed to maintain a complete manual fire alarm system as the fire panel showed a trouble signal that was not reset until after survey.
Report Facts
Deficiencies cited: 6
Residents affected: 50
Residents affected: 52
Inspection Report — Mar 14, 2019
Complaint Investigation
Date: Mar 14, 2019
Visit Reason
A complaint investigation was conducted on March 14, 2019 in the facility.
Complaint Details
CI MS #15713: A complaint investigation was conducted and was unsubstantiated with no deficiencies cited.
Findings
The result of the investigation was unsubstantiated with no deficiencies cited.
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