Bedford Care Center Of Picayune

Based on staff interview, record review, and facility policy review, the facility failed to ensure resident medications were protected from misappropriation for one (1) of four (4) medication carts. Findings include:A review of the facility's policy Abuse, Neglect and Exploitation, Revised 2/3/26 revealed, .It is the policy of this facility to provide protections for the health, welfare and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, exploitation and misappropriation of resident property.Definitions.Misappropriation of Resident Property means the deliberate misplacement, exploitation, or wrongful.use of a resident's belongings or money without the resident's consent. A record review of the facility's investigation Alleged Medication Diversion, dated 3/13/26, revealed that on 3/12/26 during the 7:00 PM shift change narcotic count the following medications were missing from the narcotic box on one medication cart: Resident #1, four (4) Percocet 5-325 mg (milligrams); Resident #2, one (1) Percocet…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interviews, record review, and facility policy review, the facility failed to maintain complete and accurate medical records to document the services provided for four (4) of (4) sampled residents (Residents #1, #2, #3, and #4). Specifically, review of the Medication Administration Records (MARs) for the night shift of 12/29/25 revealed multiple medications were not documented as administered and medication administration could not be verified as accurate and timely.Findings include:A review of the facility's policy Administering Medications revised 8/2/22 revealed, Medications shall be administered in a safe and timely manner, and as prescribed.Policy Interpretation and Implementation.10. The resident must be observed taking the medication.14.The nurse will document on the EMAR (Electronic Medication Administration Record) when the medication is administered to the resident.A record review of the facility's Medication Admin Audit Report for Station B with Documentation Type: Missed for 12/29/25 through 12/30/25 revealed 25 residents had medications with no administration…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interviews, the facility failed to complete a required Significant Change PASRR (Preadmission Screening and Resident Review) for 1 (one) of 23 (twenty-three) sampled residents (resident #113) after the initiation of an antipsychotic medication. The facility's failure to complete the Significant Change PASRR prevented the appropriate evaluation of the resident's mental health needs and compliance with federal PASRR requirements. A record review of the Level I PASARR dated July 9, 2019, was completed prior to admission. A review of the admission Record revealed Resident #113 was admitted to the facility on [DATE], with a diagnosis of chronic systolic heart failure. A subsequent review of the admission Record revealed the resident was diagnosed with unspecified psychosis not due to a substance or known physiological condition on May 15, 2025.A review of the Significant Change in Status Minimum Data Set (MDS) with an Assessment Reference ARD) of September 19, 2025, revealed Section C…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview, record review, and facility policy review, the facility failed to develop a comprehensive care plan with appropriate interventions for a resident diagnosed with a urinary tract infection (UTI) for one (1) of 23 sampled residents, Resident #7. Findings include:A review of the facility's policy Comprehensive Care Plans with revised date 8/24/22 revealed . It is the policy of this facility to develop and implement a comprehensive person-centered care plan for each resident.that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessment.A record review of the admission Record revealed the facility admitted Resident #7 on 07/31/2025 with diagnoses including Polyneuropathy. A record review of the Results Urine Culture which was lasted resulted on 12/10/2025, revealed Resident #7 had a urine culture that was positive for greater than 100 thousand counts for an Klebsiella pneumoniae (a type of bacteria).A record review of the Order Summary Report…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and facility policy review, the facility failed to store medications in a safe and secure manner for two (2) of four (4) medication carts reviewed.Findings included:A review of the facility policy, Storage of Medications, revised 8/2/22, revealed, .The facility shall store all drugs and biologicals in a safe, secure, and orderly manner. Policy Interpretation and Implementation.7. Compartments (including, but not limited to.carts.containing drugs and biologicals shall be locked when not in use.carts used to transport such items shall not be left unattended if open or otherwise potentially available to others.On 12/17/25 at 8:05 AM, during an observation of medication pass in Building One with Licensed Practical Nurse (LPN) #1, the medication cart was observed left unattended and unlocked on the resident hallway while LPN #1 went to the medication room. The medication cart remained unattended and unlocked from 8:15 AM to 8:20 AM.On 12/17/25 at 8:21 AM, during an interview with LPN #1, he confirmed that the medication cart was left unlocked while he…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review, staff interview, and facility policy review, the facility failed to ensure an advance directive, specifically a durable Power of Attorney (POA), was available and readily retrievable by facility staff for one (1) of 32 residents reviewed for advance directives. (Resident #100). This deficient practice had the potential to affect all residents who had a durable POA. Findings Include: A review of the facility's policy, Residents' Rights Regarding Treatment and Advanced Directives, revised 11/1/22, revealed, Policy: It is the policy of this facility to support and facilitate a resident's right to .formulate an advance directive. Definitions: Advance Directive is a written instruction, such as a . durable power of attorney for health care .Policy Explanation and Compliance Guidelines .3. Upon admission, should the resident have an advance directive, copies will be made and placed on the chart . Record review of the Acknowledgement of Advance Directives Decisions, Rights, and Information, signed 2/9/24, which was located in the electronic health record and signed…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on staff interview, record review, and facility policy review, the facility failed to revise comprehensive care plan interventions related to oxygen therapy (Resident #3), pain management (Resident #103), and trauma-informed care (Resident #62) for three (3) of 21 sampled residents. Findings include: A review of the facility's policy, Comprehensive Care Plans, revised 8/24/22, revealed, Policy: It is the policy of this facility to develop and implement a comprehensive person-centered care plan for each resident .Definitions . Trauma-Informed care is an approach to delivering care that involves understanding, recognizing, and responding to effects of all types of trauma. A trauma-informed approach to care delivery recognizes the widespread impact, and signs and symptoms of trauma in residents, and incorporates knowledge about trauma into care plans .Policy Explanation and Compliance Guidelines .3. The comprehensive care plan will describe .a. The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, staff interviews, and facility policy review, the facility failed to discard expired foods and failed to label opened foods with a use-by date for one (1) of three (3) kitchen observations. Findings include: A review of the facility's policy, Food Safety Requirements, revised 11/21/22, revealed, .Food will be stored .in accordance with professional standards for food safety .Policy Interpretation and Implementation .1. Food safety will be followed throughout the facility's entire food handling process .b. Storage of food in a manner that helps prevent deterioration or contamination of the food .3. Facility will inspect all food .and ensure timely and proper storage .c. Refrigerated storage .Practices to maintain safe refrigerated storage include .iv. labeling, dating, and monitoring refrigerated food . On 05/20/24 at 8:00 AM, during the initial tour of the kitchen with the Dietary Manager (DM) #1 of Building 1, revealed an opened gallon of buttermilk in the Cook's Refrigerator with a manufacturer's expiration date of 12/2023. DM #1 confirmed the buttermilk was…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, staff interview, and record review, the facility failed to store an O2 (Oxygen) nasal cannula and a nebulizer mask in a designated container and failed to change or discard a disposable humidifier water bottle timely for one (1) of two (2) residents reviewed for oxygen therapy. Resident #3 Findings include: Record review of the facility's policy, Oxygen Administration, revised 8/2/22, revealed Purpose The purpose of this procedure is to provide guidelines for safe oxygen administration . However, the policy did not address O2 and Nebulizer tubing storage or changing the disposable water humidifier bottle. On 5/20/24 at 9:13 AM, Resident #3 was observed sleeping in bed. She was not wearing oxygen and there was an O2 concentrator located next to the bed and bedside table. There was a nasal cannula tubing wrapped around the concentrator and not stored in a bag. The disposable humidifier water bottle attached to the concentrator had a handwritten date of 12/21/23, was half full, and was attached to a nasal cannula tubing that was dated 5/16/24. There was a…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews, record review, and facility policy review, the facility failed to ensure triggers and resident specific interventions were identified and initiated for a resident with Post Traumatic Stress Disorder (PTSD) for one (1) of 21 sampled residents. Resident #62 Findings include: A review of the facility's policy, Trauma Informed Care, revised 6/1/23, revealed, .It is the policy of this facility to provide care and services which, in addition to meeting professional standards, are delivered using approaches which are culturally competent, account for experiences and preferences, and address the needs of trauma survivors by minimizing triggers and/or re -traumatization .Policy Explanation and Compliance Guidelines .2. The facility will use a multi-pronged approach to identifying a resident's history of trauma, as well as his or her cultural preferences. This will include asking the resident about triggers that may be stressors or may prompt recall of a previous traumatic event, as well as screening…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, staff interview, and facility policy review, the facility failed to discard expired stock medications for one (1) of five (5) medication storage areas reviewed. Nurses Station-Building 1 Findings include: Review of the facility policy, Medication Storage, revised 7/17/23, revealed, .It is the policy of this facility to ensure all medications housed on our premises will be stored in the in the pharmacy and/or medication rooms according to the manufacturer's recommendations .Policy Explanation and Compliance Guidelines .8. Unused Medications: The pharmacy and all medication rooms are routinely inspected by the consultant pharmacist for discontinued, outdated, defective or deteriorated medications with worn illegible or missing labels. On 05/20/24 at 9:16 AM, during an observation, there were expired medications in the medication storage area of the nurses' station in Building 1. The expired stock medications were Magnesium 750 milligrams (mg), which had an expiration date of 12/2023, Folic Acid 1 mg with an expiration date of 1/2024, and Aspirin 325 mg with an…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, staff interview, and facility policy review, the facility failed to provide hand hygiene for residents prior to meals for one (1) of four (4) dining rooms observed. Dining Room C. Findings include: A record review of the facility's policy, Handwashing/Hand Hygiene revised 8/2/22, revealed, .This facility considers hand hygiene the primary means to prevent the spread of infections. Policy Interpretation and Implementation .5. Residents .will be encouraged to practice hand hygiene .7. Use an alcohol-based hand rub .or .soap .and water for the following situations .o. Before and after eating or handling food . On 5/20/24 at 10:51 AM, during an observation of Dining Room C, the facility staff did not offer to assist residents with washing or sanitizing their hands. There were four (4) Certified Nurse Aides (CNAs) and one (1) Licensed Practical Nurse (LPN) present. On 5/20/24 at 11:44 AM, during an observation, three (3) residents were assisted to the dining room table in Dining Room C by therapy staff. The residents were not offered assistance with washing or…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interviews, record review, and facility policy review, the facility failed to ensure residents had readily available and reasonable access to their personal funds, seven (7) days a week, for one (1) of 30 residents with personal fund accounts. Findings Included: Record review of the facility's Policy and Procedures Resident Trust, undated, revealed, .Access to Funds The residents shall have access to funds daily during normal business hours and for some reasonable time of at least two hours on Saturdays and Sunday unless approved otherwise by the resident council . On 08/15/22 at 08:39 AM, in an interview with Resident #35, he stated he has a trust fund at the facility, but he is not able to get any money on the weekends. If he wanted money for the weekend, he would have to request it on Friday. On 08/17/22 at 03:53 PM, in an interview with the Business Office Manager (BOM), she stated the residents can come to her anytime on Monday through Friday and get money from their account. She stated that the facility does not have anyone to give out the money on weekends, but the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interviews, record review, and facility policy review, the facility failed to develop a comprehensive care plan for pain for two (2) of 19 sampled residents. Resident #20 and Resident #38. Findings Include: Record review of the facility's policy, Care Plans - Comprehensive with a review date of 8/2/22 revealed, Policy Statement An individualized Comprehensive Person-Centered Care Plan that includes measurable objectives and timetables to meet the resident's medical, nursing, mental and psychological needs is developed for each resident . Resident #20 On 08/16/22 at 1:31 PM, in an interview Resident #20, she stated that she frequently has back pain that requires her to take pain medication. Record review Resident #20's Order Summary Report with Active Orders As Of: 08/18/2022 revealed a Physician's Order dated 11/5/21 for Ultram Tablet 50 MG (Milligrams) . by mouth every 6 hours as needed for pain. Record review of the Quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 6/15/22 revealed Resident #20 had a Brief Interview of Mental Status (BIMS) score…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.