Southern Tenn Medical Center SNF

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on facility policy review, medical record review, and interviews, the facility failed to ensure 3 residents (Resident #4, Resident #11, and Resident #17) were offered the opportunity to formulate an advanced directive upon admission to the facility of 3 residents reviewed for advanced directives. The findings include: Review of the facility's undated policy titled, Advanced Directives, revealed .The facility will provide information to the resident/ resident representative on Advanced Directives and will assist the resident/ resident representative in formulating advanced care planning .Upon admission, the resident/ resident representative will be provided with written information concerning the right to .formulate an advanced directive if he or she chooses to do so .Prior to or upon admission of a resident, the Social Services Director or designee will inquire of the resident, his/ her family members and/ or his or her legal representative, about existence of any written advanced Directives .If 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review and interviews the facility failed to provide the required Notice of Medicare Non-Coverage (NOMNC) and Advanced Beneficiary Notice (ABN) for 3 residents (Resident #3, Resident #5, and Resident #33) of 3 residents reviewed for beneficiary notification.The findings include: Review of the medical record revealed Resident #3 was admitted to the facility on [DATE] with diagnoses including Myocardial Infarction [Heart Attack] and Muscle Weakness. Review of a 5 day Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #3 scored a 4 on the Brief Interview for Mental Status (BIMS) assessment which indicated the resident had severe cognitive impairment. Review of a Nursing progress note for Resident #3 dated 8/26/2025, revealed .Patient left unit .to be discharged home, transferred out of unit .EMS [Emergency Medical Services] via stretcher . Review of the medical record for Resident #3, revealed no NOMNC or ABN had been provided to the resident or resident representative. Review…

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 job description review, facility policy review, medical record review, and interview, the facility failed to provide effective administrative leadership and oversight to ensure the required documentation was maintained or obtained related to Notice of Medicare Non Coverage (NOMNC) for 3 residents (Resident #3, Resident #5, and Resident #33), failed to maintain or obtain the required documentation related to Advanced Beneficiary Notices (ABN) for 3 residents (Resident #3, Resident #5, and Resident #33), failed to offer assistance with the formulation of Advanced Directives for 3 residents (Resident #4, Resident #11, and Resident #17), and had not documented staff or residents received education on COVID-19 vaccination for 5 residents (Resident #7, Resident #11, Resident #19, Resident #24, and Resident #32), and had not offered the COVID-19 vaccine to the staff since 2022.The findings include: Review of a Job Description Report for Post Acute/ Skilled Care Administrator dated 10/11/2024, revealed…

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 facility policy review, job description review, Quality Assurance Performance Improvement (QAPI) meeting minutes review, medical record review, and interview, the facility's leadership and QAPI Committee failed to identify, address and initiate corrective action plans for quality deficiencies to ensure the residents attained or maintained their highest practicable physical, functional, mental, and psychosocial well-being when the residents were not offered the opportunity to formulate advanced directives upon admission, were not provided Advance Beneficiary Notices (ABN) or Notice of Medicare Non-Coverage (NOMNC) documentation upon discharge, and had not documented the staff or residents received education on the COVID-19 vaccine for 5 residents (Resident #7, Resident #11, Resident #19, Resident #24, and Resident #32), and had not offered the COVID-19 vaccine to the facility's staff since 2022.The findings include: Review of a facility policy titled Quality Assurance Performance Improvement Committee [QAPI], dated 7/19/2025, revealed .The facility will maintain systems and…

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 medical record review , facility policy review, review of current Centers for Disease Control (CDC) recommendations and interviews the facility failed to document education was provided to residents and staff regarding COVID-19 vaccination, failed to document offering the COVID vaccine to residents and completing a declination form if the vaccine was declined, and failed to offer staff COVID-19 vaccines affecting all staff and 5 of 5 (Resident #7, #11, #19, #24 and #32) sampled residents reviewed. The findings include: Review of the facility's policy titled, Infection Prevention and Control Plan effective 8/2023, revealed .Referral for assessment, potential testing, immunization .counseling as appropriate of hospital staff, independent practitioners .is providers when there is a risk of occupational exposure, or illness from an infectious disease that may put the population they serve at risk .continued education is provided to all staff .including their responsibilities in preventing the spread of…

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 facility policy review, medical record review, observation, and interviews, the facility failed to obtain a physician's order for the use of an indwelling urinary catheter [a tube inserted into the bladder that drains urine] for 1 resident (Resident #12) of 4 residents reviewed for the use of an indwelling catheter.The findings include: Review of the facility policy titled Foley Catheter, dated 10/2024, revealed .Insertion of .[an indwelling urinary] .catheter should only be used for appropriate indications .Indications should be documented by the physician in the .[indwelling urinary] .catheter order .indications, date of insertion, time of insertion, staff inserting, catheter type, size, and proper technique . Review of the medical record revealed Resident #12 was admitted to the facility on [DATE] with diagnoses including Pressure Ulcer of the Sacral Region and Urinary Tract Infection. Review of the baseline care plan for Resident #12 dated 8/23/2025, revealed the resident had an indwelling urinary…

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 facility policy review, Centers for Disease Control and Prevention (CDC) guidance, observation, and interview, the facility failed to properly prevent COVID-19 (an infectious disease caused by the SARS-CoV-2 virus) by failing to implement universal use of eye protection as part of Personal Protective Equipment (PPE) during resident care interactions in a community with high COVID-19 transmission which had the potential to result in COVID-19 transmission to all 11 residents in the facility. The findings include: Review of the facility's policy titled, Infection Prevention and Control Plan, revised 4/20/2021, showed .following objectives are in place to reduce or eliminate risks .appropriate use of personal protective equipment . Review of the facility's policy titled, Standard Operating Procedure, revised 6/15/2021, showed .Core Principles of COVID-19 Infection Prevention .Appropriate staff use of Personal Protective Equipment . Review of the CDC guidance titled, Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease…

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 review of the facility policy, medical record review, and interview, the facility failed to develop a comprehensive care plan that included person-centered interventions for 2 residents (Resident #8 and Resident #15) of 4 residents reviewed for comprehensive care plans. The findings include: Review of the facility's policy titled, Admissions, Transfers, and Discharges Skilled Care, with an effective date of 2/2022, showed .The facility will develop a person-centered plan of care to address patient needs and services, with input from the Patient/ Representative to ensure the needs and services are provided in accordance with resident choices and with consideration of cultural, ethnic, and spiritual preferences . Review of the facility's undated policy titled, Interdisciplinary Care Plan, showed .The result of the MDS [Minimum Data Set] assessment will be used to develop, review and revise the resident's comprehensive Plan of Care. The assessment will be conducted or coordinated through participation of…

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 facility policy review, medical record review, and interview the facility failed to follow physician's orders for 1 resident (Resident #15) of 3 residents reviewed for insulin administration. The findings include: Review of the facility's policy titled, Medication Administration, with an effective date of 8/2021, showed .Medications may be administered to patients upon order of the medical staff or other individuals who have been granted clinical privileges to write such orders . Resident #15 was admitted to the facility on [DATE] with diagnoses including Type 2 Diabetes Mellitus, Cellulitis, Schizophrenia, Post-Traumatic Stress Disorder, and Major Depressive Disorder. Review of a physician's order dated 6/8/2022, showed an order for finger stick blood sugar checks daily before breakfast. Review of a physician's order dated 6/10/2022, showed Resident #15 received a Diabetic Consistent Carbohydrate diet. Review of a physician's order dated 6/15/2022, showed .INSULIN GLARGINE [long acting diabetic…

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 medical record review, and interview the facility failed to monitor behaviors and side effects for psychotropic medications for 1 resident (#116) of 5 residents reviewed for unnecessary medications. The findings include: Medical record review revealed Resident #116 was admitted to the facility on [DATE] with diagnoses including Urinary Tract Infection, Dementia, Congestive Heart Failure, and Depression. Medical record review of Physicians Orders revealed the following: 4/30/19- Trazodone (medication to treat depression) 50 milligrams (mg) po (by mouth) QHS (every night time) 4/30/19- Mirtazepine (medication to treat depression) 15 mg po Q HS Medical record review of the facility Psychoactive Drug Monitoring dated 5/4/19 and 5/5/19, revealed .Does the patient receive Psychoactive Drugs .N [No] . Observation and interview of Resident #116 on 5/6/19 at 12:55 PM, in the residents room revealed the resident was alert and oriented, sitting up in a recliner chair. Interview with the Director of Nursing on…

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.