Diversicare of Meridian

Inspectors wroteBased on interviews and record review, the facility failed to implement care plan interventions regarding a sling type and size used during a mechanical lift transfer which resulted in Resident #1 falling from the lift and sustaining a subarachnoid hemorrhage (bleeding around the brain) for one (1) of four (4) sampled residents.

Inspectors wroteBased on interviews, record review, and facility lift guidelines review, the facility failed to ensure the correct sling type and size were used during a mechanical lift transfer which resulted in Resident #1 falling from the lift and sustaining a subarachnoid hemorrhage (bleeding around the brain) for one (1) of four (4) sampled residents.

Inspectors wroteBased on interview, record review, and facility policy review, the facility failed to ensure the resident's right to be free from misappropriation of resident property for one (1) of three (3) residents sampled. Resident #1.

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to store food and maintain food quality in accordance with professional standards for food safety related to overly ripe produce and improperly stored foods and unlabeled items during one (1) of three (3) kitchen observations.

Inspectors wroteBased on interviews and Certification and Survey Provider Enhanced Reports (CASPER) reporting data review, the provider failed to ensure their Payroll Based Journal (PBJ) (information of the staffing hours for the appropriate care of the residents) had been corrected before submitting to the Centers for Medicare and Medicaid Services (CMS) for one (1) of four (4) quarters reviewed.

Inspectors wroteBased on record review of resident council minutes, facility policy review, and interviews conducted during the Resident Council meeting, the facility failed to promptly resolve grievances related to condiments and call light response times for 12 of 12 Resident Council members. This failure has the potential to affect 87 residents. Cross Reference F725 Findings Include: A review of the facility's Resident Rights and Protections Under State and Federal Law dated 2022 indicates, You have the right to voice grievances and recommend changes . to representatives . and The nursing home must try to resolve the issue promptly. A review of the facility's Customer Concern (Grievance) Policy, effective date July 2018, indicates, Support residents' right to voice concerns . [...]

Inspectors wroteBased on record review, staff interviews, and facility policy review, the facility failed to assure accurate coding of the Minimum Data Set (MDS) related to discharge status (Resident #90) and an anticoagulant medication (Resident #14) for two (2) of 23 residents sampled. The scope/severity for F641 was increased to E because this tag was cited on the last annual recertification survey 1/25/24. This represents a pattern of deficiency. Findings Include: A review of the facility's policy, MDS and Care Plans, dated August 2019, revealed, .MDS will be developed and maintained per RAI (Resident Assessment Instrument) Guidelines. A record review of the Centers for Medicare & Medicaid Services (CMS) Resident Assessment Instrument (RAI) 3.0 Manual, dated October 2019, revealed, .Completion of the RAI . The RAI process has multiple regulatory requirements . [...]

Inspectors wroteBased on observation, interviews, and facility policy review the facility failed to ensure sufficient nursing staff were available to meet the care needs of residents during a shift change on three (3) of six (6) resident halls, as evidenced by the facility having one (1) Certified Nurse Aide (CNA) available during the transition from day shift to evening shift, while three nurses remained at the nurse's station, and five (5) resident call lights were observed activated for approximately 30 minutes without response.

Inspectors wroteBased on observations, staff interview, record review, and facility policy review, the facility failed to provide a comfortable, homelike environment in the resident rooms for three (3) of 32 rooms on the North Unit.

Inspectors wroteBased on observations, interviews, record reviews, and facility policy review, the facility failed to revise a care plan for a resident no longer requiring the use of a lift for transfers for one (1) of 23 resident care plans reviewed (Resident #14).

Inspectors wroteBased on interviews, record review, and facility policy review, the facility failed to ensure effective and timely pain management for one (1) of three (3) sampled residents (Resident #5) with multiple cancer diagnoses, including lung, pancreatic, rectal, and glottic cancer and was admitted with physician orders for scheduled and as-needed (PRN) opioid analgesics but did not receive PRN pain medication for approximately twelve (12) hours following his admission, which resulted in unmanaged pain.

Inspectors wroteBased on observation, staff and resident interview, and facility policy review the facility failed to ensure residents' rights were respected as evidenced by staff members using their cell phones in the resident's rooms for two (2) of 34 sampled residents. Residents #30, 32, 35 and 61. Findings Include: Review of the facility's policy, Resident's Rights and Quality of Life, with an effective date of 5/1/2012, revealed Policy Statement .It is the policy .that all residents have the right to a dignified existence, self-determination, and communication with an access to people and services inside and outside the facility . [...]

Inspectors wroteBased on staff interview, record review, and facility policy review, the facility failed to ensure a resident's Minimum Data Set (MDS) assessment was accurately coded for ordered medication for one (1) of 21 MDS assessments reviewed. Resident #63 Findings Include: Record review of facility policy titled, RAI (Resident Assessment Instrument) Process Guideline , dated September 2020, revealed, Guideline Statement: The purpose of this guideline is to provide guidance and instruction on how to complete the RAI process. The RAI process consists of three components: The Minimum Data Set (MDS) Version 3.0, The Care Area Assessment (CAA) process, and the RAI utilization guideline .Process .The center will determine how the process is completed ensuring that the process includes direct observation and communication with the residents and direct care staff . [...]

Inspectors wroteBased on observation, staff interview, record review and facility policy review the facility failed to implement a care plan related to resident activities for one (1) of 21 resident care plans reviewed.

Inspectors wroteBased on observation, resident, staff and family interview, record review, and facility policy review, the facility failed to shave a resident who required staff assistance for Activities of Daily Living (ADLs) for one (1) of 21 sampled residents. Resident # 52 Findings Include: A review of the facility policy, ADL's, with an effective date of August 2021, revealed Policy: Ensure ADL's are provided in accordance with accepted standards of practice, the care plan, and reasonable accommodation of the resident's choices and preferences . An observation and interview on 01/22/24 at 2:30 PM, with Resident #52 revealed he had facial hair that was approximately a quarter of an inch in length. The resident's mother was at the bedside and stated, He needs to be shaved and I have told them that I can't do it anymore. The resident confirmed that he wanted to be shaved. [...]

Inspectors wroteBased on observation, staff and resident interview, record review, and facility policy review, the facility failed to invite and assist a dependent resident to group activities for one (1) of 21 sampled residents. Resident #39 Findings Include: Review of the facility policy titled, Activities, with an effective date of April 2022, revealed, Policy .It is the policy of this center to provide an ongoing program to support residents in their choice of activities based on their comprehensive assessment, care plan, and preferences. Center-sponsored group, individual, and independent activities will be designed to meet the interests of each resident, as well as support their physical, mental, and psychosocial well-being. Activities will encourage both independence and interaction with the community .Policy Explanation and Compliance Guidelines .10. [...]

Inspectors wroteCI MS #23089 Based on observations, interviews, record review, and facility policy review, the facility failed to immediately honor and resolve the food/meal grievances, requests, and concerns of the residents. Five (5) of seven (7) sampled residents voiced unresolved food grievances, food/meal requests, and concerns, Residents #1, #2, #3, #5, and #6 and three (3) of (3) unsampled residents voiced food/meal grievances, concerns, and requests that were unresolved. Findings Include: Review of the facility's policy, Customer Concern (Grievance) Policy dated July 2018, revealed, Purpose: [...]

Inspectors wroteMS CI #23089 Based on observation, interviews, record review, and facility policy review, the facility failed to provide and serve foods/meals to residents in a manner that honored their voiced requests and preferences. Five (5) of seven (7) sampled residents #1, #2, #3, #5 and #6 and three (3) of (3) unsampled residents A, B, and C had made requests for better quality foods/meals to be delivered and served in a more timely and palatable manner. Review of the facility's policy, Meal Distribution, revised 9/2017, revealed .Meals are transported to the dining locations in a manner that ensures proper temperature maintenance, protects against contamination, and are delivered in a timely manner . [...]

Inspectors wroteBased on observations, staff interviews, record review and facility procedural guidelines, the facility failed to ensure that residents were treated with respect and dignity while providing personal care for one (1) of six (6) residents reviewed for incontinent/catheter care observations. Resident #1. Findings Include: Record review of the facility's Performance Checklist Procedural Guideline: Perineal Care revealed, .3. Assembled supplies . 5. Performed perineal care for a female: . c. Draped patient appropriately with bath blanket. d. Folded outer corners of blanket around patient's thighs, lifted lower tip of blanket to expose perineum . Record review of the facility's policy titled Residents' Rights Summary dated May 1, 2012 revealed, 1. Exercise of Rights: The resident has the right to exercise his/her rights as a resident of the facility . [...]

Inspectors wroteBased on observation, interviews, record review, and facility policy review the facility failed to follow the comprehensive care plan for two (2) of (19) care plans reviewed. Resident #1 and Resident #87. Findings Include: Review of the facility's policy Care Plans with an effective date of October 2021, revealed Policy .Care plans are developed by the interdisciplinary team and revised as needed according to resident and status or change. Resident #1 On 11/30/21 at 11:00 AM, SA observed incontinent care provided by Certified Nurse Assistant (CNA) #2. The State Agency (SA) noted Resident #1 had an incontinent episode and had a small bowel movement. During the procedure, the resident was lying on her left side and had her back toward the CNA. CNA #2 wiped the resident from behind and continued wiping from front to back until no more bowel movement was noted on the resident. [...]

Inspectors wroteBased on observations, interviews, record review and performance checklist review, the facility failed to provide appropriate incontinent and catheter care for two (2) of six (6) residents observed for incontinent/catheter care. Resident #1 and Resident #87. Findings Include: Resident #1 Record review of the PERFORMANCE CHECKLIST PROCEDURAL GUIDELINE 18.1 PERINEAL CARE revealed PROCEDURAL STEPS .5. Performed perineal care for a female: .e. Washed and dried patient's upper thighs. f. Washed labia majora .g. Separated labia, washed urethral meatus and vaginal orifice front to back .h. Rinsed and dried area thoroughly . On 11/30/21 at 11:00 AM, the State Agency (SA) observed incontinent care provided by Certified Nurse Assistant (CNA) #2 with assistance of CNA #3. The SA noted Resident #1 had an incontinent episode and had a small bowel movement. [...]

Inspectors wroteBased on observations, interviews, record reviews, and facility policy review, the facility failed to prevent the potential spread of infection for one (1) of four (4) days of survey. Resident #39 and Resident #8.