Edgewood Health & Rehabilitation

F 0656 Level of Harm - Actual harm Residents Affected - Few

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

lifts to nursing staff. He stated that the base of the lift should be open during surface-to-surface transfers, and the chair or Geri-recliner wheel locks should be locked. He stated that the lifts were designed for in-home use and that facility staff were required to follow facility policy for transfers and lift use.On 10/29/25 at 4:55 PM, during an interview the DON stated she had no idea why CNA #1 attempted to transfer Resident #1 using a mechanical lift without assistance of a second staff member. She stated that the facility provided in-service training and policy review for all nursing staff during orientation and at least annually using videos and demonstration and that all CNA s were required to complete the training and participate in

a competency check-off to determine safe transfer skills, including always having (2) staff for all transfers with mechanical lifts.Record review of the admission Record for Resident #1 revealed the facility admitted

the resident on 12/06/23 and the resident had diagnoses of acute respiratory failure with hypoxia, lack of coordination and osteoporosis.Record review of the Optional State Assessment (OSA) Minimum Data Set (MDS) with an Assessment Reference Date (ARD) 9/23/25 for Resident #1 revealed the resident had a Brief Interview for Mental Status (BIMS) score of 15, which indicated the resident was cognitively intact.

Section GG indicated the resident was dependent for mobility and transfers.

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

10/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Edgewood Health & Rehabilitation

205 Byram Parkway Byram, MS 39272

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 0689 Level of Harm - Actual harm Residents Affected - Few

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

of consciousness. She confirmed that the resident did not leave the wheelchair during the fall. On 10/29/25 at 4:55 PM, during an interview the DON stated she had gone outside with CNA#3 and CNA #4 on 10/22/25 to ensure they were able to provide safe transportation for return of Resident #2 to the facility and verbally explained safe operation of the resident securement system in the van but had not taken a wheelchair, provided a demonstration or required a return demonstration by either CNA to ensure they were able to safely secure Resident #2 in his wheelchair in the van.On 10/29/25 at 5:00 PM, during an interview, the Administrator stated that he expected all staff to have adequate training to perform procedures within their scope of practice in a safe manner that provided a safe environment for all residents. The Administrator stated that transportation services should be provided by staff well trained in

the use of safety precautions for the facility van, lift and resident securement system. He confirmed that adequate training included demonstration of competency.Record review of the admission Record for Resident #2 revealed the facility admitted the resident on 7/20/2020 and the resident had diagnoses of acute kidney failure, cognitive communication deficit, vascular dementia and muscle weakness.Record

review of the Quarterly MDS with ARD 9/30/25 for Resident #2 revealed the resident had a BIMS score of 7, which indicated severe cognitive impairment. MDS review revealed the resident required setup/clean-up assistance for surface-to-surface transfers and to walk 50 feet and used a wheelchair for mobility.

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

10/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Edgewood Health & Rehabilitation

205 Byram Parkway Byram, MS 39272

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 - Few

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

mirror Resident #2's wheelchair turned over backwards and landed on the van floor. CNA#3 stated she had not received any training for the safe use of the securement system on or prior to 10/22/25.At 2:10 PM on 10/29/25, during an interview CNA #4 stated that she went with CNA #3 to pick up Resident #2 from a local hospital to return him to the facility. She stated that she observed Resident #2 turn over backwards with the back of the wheelchair landing on the floor of the van during the transport. She stated that she was riding along for accompaniment and supervision of the resident. She stated that she was not sure if CNA #3 secured the resident in the facility van appropriately or not and that she had not received any training for

the safe use of the securement system on or prior to 10/22/25. She stated that Resident #2 had not complained of pain and did not have any obvious injury or change of level of consciousness. She confirmed that the resident did not leave the wheelchair during the fall. At 4:30 PM on 10/29/25, observation and

interview revealed CNA #6 demonstrated use of the facility van lift and securement system. CNA #6 stated that she had received training from the former Maintenance Supervisor and was required to participate in competency checkoffs and return demonstrations of the safe operation of the van, lift and securement system. She demonstrated how if the wheelchair was secured properly by four metal hooks attacked to the floor of the van with a seatbelt applied across the chest of the resident, the chair would not fall over or move. She stated that she had not been on duty when the hospital called for the facility to provide transportation to return the resident to the facility.At 4:45 PM on 10/29/25, during an interview the Maintenance Supervisor revealed that 10/29/25 was his first day in the position. He confirmed that he had received training for the use of the facility van and its lift and resident securement system. He stated he was aware that it would be his responsibility to provide one-on-one training with required return demonstration for any staff designated to operate the facility van and transport residents, but he had not done so yet.At 4:55 PM on 10/29/25, during an interview the DON stated she had gone outside with CNA #3 and CNA #4

on 10/22/25 to ensure they were able to provide safe transportation for return of Resident #2 to the facility and verbally explained safe operation of the resident securement system in the van but had not taken a wheelchair or provided a demonstration or required a return demonstration by either CNA to ensure they were able to safely secure Resident #2 in his wheelchair in the van.At 5:00 PM on10/29/25, during an interview, the Administrator stated that he expected all staff to have adequate training to perform procedures within their scope of practice in a safe manner that provided a safe environment for all residents. The Administrator stated that transportation services should be provided by staff well trained in

the use and safety precautions for the facility van, lift and resident securement system. He confirmed that adequate training included competency check-off with demonstration.Record review of the personnel files for CNA #3 and CNA #4 revealed no documentation of training specific to the operation of the facility van, or its lift or securement system for residents in wheelchairs.Record review of the admission Record for Resident #2 revealed the facility admitted the resident on 7/20/2020 and the resident had diagnoses of acute kidney failure, cognitive communication deficit, vascular dementia and muscle weakness.Record

review of the Quarterly MDS with an ARD of 9/30/25 for Resident #2 revealed the resident had a BIMS score of 7, which indicated severe cognitive impairment. Section GG revealed the resident required setup/clean-up assistance for surface-to-surface transfers and to walk 50 feet and used a wheelchair for mobility.

Event ID:

Facility ID:

If continuation sheet