Diversicare Of Brookhaven
Inspection Findings
F-Tag F0657
F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Based on observation, interview, facility policy review, and record review, the facility failed to revise the comprehensive care plan to reflect ongoing behavioral concerns and physical aggression for one (1) of three (3) sampled residents (Resident #1). Findings Include:A policy review of the facility's Care Plan policy dated 10/21 revealed culturally component goals and interventions for mood, behaviors, history of trauma, cognitive concerns. should be added to the comprehensive care plan .On 11/24/25 at 11:29 AM, in a phone interview, Certified Nursing Assistant (CNA) #1 stated Resident #1 had been physically abusive toward her
on multiple occasions, including hitting, kicking, and grabbing her. She reported the behavior to the Nursing Home Administrator and was moved off the resident's hall.On 11/24/25 at 12:18 PM, Resident #1 was observed calm in bed, oriented to two domains, intermittently providing appropriate responses.On 11/24/25 at 12:30 PM, CNA #2 stated she had witnessed Resident #1 become aggressive with CNAs.On 11/24/25 at 12:53 PM, Resident #3, the roommate of Resident #1, stated he had observed Resident #1 hit CNAs.On 11/24/25 at 1:00 PM, CNA #3 stated that Resident #1's verbal and physical aggression was directed toward CNAs and confirmed being struck herself.On 11/24/25 at 5:35 PM, Registered Nurse #1 stated she was aware of the behavior concerns but had not witnessed them herself. She stated behavior concerns should be reflected in the care plan, which is used by all staff to direct care.On 11/24/25 at 5:47 PM, CNA #4 stated she uses the care plan to guide her care provision.On 11/24/25 at 5:55 PM, the Interim Director of Nursing confirmed that the Kardex, used by CNAs, is based on the comprehensive care plan. She stated behavior issues must be included in the care plan to guide all staff.A record review of Resident #1's admission Record revealed an admission date of 9/30/25 with diagnoses including cerebral infarction, unspecified dementia, psychotic disturbance, mood disturbance, and anxiety.A record review of progress notes revealed behavioral incidents including:10/12/25 - Combative behavior toward CNA; 10/18/25 Slapped a CNA in the face and kicked her in the chest; 10/20/25 - Slapped a CNA in the face and pulled her hair down and punched her in the face; 10/18/25 - Hit a nurse in the abdomen; 11/02/25 - Punched a CNA with a closed fist.A record review of the Minimum Data Set (MDS) with an Assessment Reference Date of 10/7/25 revealed a Brief Interview for Mental Status (BIMS) score of 13, indicating cognitive intactness. The MDS with ARD 10/24/25 coded for physical behavioral symptoms directed toward others and verbal behavioral symptoms directed toward others.A record review of the comprehensive care plan revealed no documentation of person-centered goals and interventions to address Resident #1's repeated verbal and physical aggression toward staff.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
DIVERSICARE OF BROOKHAVEN in BROOKHAVEN, MS inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in BROOKHAVEN, MS, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from DIVERSICARE OF BROOKHAVEN or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.