Diversicare Of Amory

F 0600

indicating the resident was cognitively intact.

Level of Harm - Minimal harm or potential for actual harm

Resident# 6

Residents Affected - Few

Record review of an interview with Resident #6 conducted as part of the facility’s investigation revealed he heard CNA #1 threaten to slap Resident #1 and say she would put him in the morgue. He stated Resident #1 accused CNA #1 of slamming the door in his face. At first, CNA #1 denied it, but later admitted it.

On 8/21/25 at 11:00 AM during an observation and interview, Resident #6 confirmed he heard CNA #1 threaten to slap Resident #1 and said she would put him in the morgue. He reported Resident #1 accused her of slamming the door in his face and that the two argued and cursed at each other.

Record review of the “admission Record” revealed Resident #6 was admitted on [DATE REDACTED] with

a diagnosis of centrilobular emphysema.

Record review of the Quarterly MDS for Resident #6 with an ARD of 7/28/25, Section C, revealed a BIMS score of 15, indicating the resident was cognitively intact.

Resident #7

Record review of an interview with Resident #7 conducted as part of the facility’s investigation revealed, “I heard an argument between Resident #1 and CNA #1. I heard Resident #1 say CNA #1 let the door close in front of him before he could get to it. She got upset and they argued.”

Record review of the “admission Record” revealed Resident #7 was admitted on [DATE REDACTED] with

a diagnosis of major depressive disorder.

Record review of the Quarterly MDS for Resident #7 with an ARD of 6/3/25, Section C, revealed a BIMS score of 14, indicating the resident was cognitively intact.

On 8/21/25 at 8:25 AM during an interview, the Administrator confirmed she substantiated the allegation of verbal abuse because CNA #1 had received previous training on abuse prevention and the investigation determined that another cognitively intact resident corroborated hearing CNA #1 curse at Resident #1. The Administrator stated CNA #1 denied saying she would put the resident in the morgue but admitted she cursed at him after he cursed at her. The Administrator confirmed CNA #1 acted in an unprofessional manner and that this conduct constituted verbal abuse which could lead to fear or psychosocial harm.

On 8/21/25 at 8:35 AM during a phone interview, CNA #1 denied cursing Resident #1 or saying she would put him in the morgue. She confirmed she had received training on the definition of verbal abuse and de-escalation of potentially abusive situations. She stated she did not know why residents were reporting

she had said this, but acknowledged she knew cursing at a resident is considered verbal abuse. She again denied closing the door on Resident #1 and stated he continued to accuse her of doing so.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Diversicare of Amory

1215 Earl Frye Drive Amory, MS 38821

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.

Based on staff interviews and record review, the facility failed to ensure that newly hired licensed nurses and certified nurse assistants (CNAs) received skills competency checkoffs before providing resident care for three (3) of three (3) new hires reviewed. Findings include:

Review of a form presented by the Administrator titled, “We Are Knowledgeable and Competent,” revealed the expectation that new hire licensed practical charge nurses (LPN) complete

a three-week skills checkoff process, to be signed by both the Administrator and the LPN charge nurse upon successful completion.

On 8/21/25 at 8:48 AM during a phone interview conducted as part of the complaint investigation, Graduate Practical Nurse (GPN) # 1 stated she had graduated nursing school and began employment at the facility

on 7/15/25. She reported that no staff had checked her off on any skills and she had not been provided with

a skills checkoff form. She explained that she had not been assigned a specific preceptor and stated, “If I had questions, I just asked whoever was around.” She further reported she felt overwhelmed with charting, admission paperwork, and incident reporting because the staff she shadowed

during her first days of employment had not reviewed these processes with her.

On 8/21/25 at 11:16 AM during an interview conducted as part of the complaint investigation, the Clinical Educator (CE) confirmed she was on vacation when GPN #1 began employment on 7/15/25. The CE stated that when she returned on 7/18/25, GPN #1 was on the medication cart by herself and each time she passed her in the hall, she was alone. She confirmed she had not performed any skills checkoffs with GPN #1 and was unsure if the former Director of Nursing (DON) had. She further stated, “She should not have been on the medication cart alone. She could have hurt someone.” After reviewing the skills checkoff forms for Certified Nurse Assistant (CNA) #2 and CNA #3, the CE confirmed the forms were not signed by staff or trainers and she could not verify that the competencies had been completed. The CE explained it was very difficult to complete her educator responsibilities because she was frequently pulled to work the medication cart. She reported she had been in the educator role since March 2025 and had never obtained completed new hire skills checkoffs. She also stated she only learned of the “We Are Knowledgeable and Competent” LPN skills checkoff form one week prior during a meeting.

Review of the “Z Slider Lift Skills Checklist” for CNA #2, dated 7/15/25, revealed the form was not signed as completed. The “Peri-Care Audit Tool” was not signed or dated by CNA #2, and

the “Shaving, Nail, and Foot Care Audits” were checked as skills met but contained no staff or trainer name.

Review of the “Z Slider Lift Skills Checklist” for CNA #3, dated 7/29/25, revealed the form was not signed as completed and no staff name was identified. The “Peri-Care Audit Tool” was not signed or dated by CNA #3, and the “Shaving, Nail, and Foot Care Audits” were checked as skills met but contained no staff or trainer name.

On 8/21/25 at 12:00 PM during an interview, the Administrator stated the previous DON would have started GPN #1 on 7/15/25. She confirmed the facility was unable to locate any skills review forms for GPN #1. The Administrator acknowledged that all new hires should have skills checkoffs to ensure they are competent in their skills, and that failing to do so could result in residents not receiving care or receiving the wrong care.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet