Lakeview Nursing Center

F-F584 was cited due to stains on the privacy curtain and large pieces of missing paint on the wall behind the bed and

F-F656 was cited regarding prescription medicine being left on the residents overbed table.

During the current recertification survey, failed to ensure a resident's right to a clean, comfortable, homelike environment for two (2) of four (4) days of survey and failed to implement a care-planned intervention related to falls for one (1) of eighteen (18) sampled residents.

On 04/02/25 at 03:52 PM, during an interview with the Administrator, she affirmed that deficiencies from the previous annual survey were found during the current survey. The Administrator reported the facility has hired several new staff and particularly a floor tech to keep the facility clean. The Administrator stated the facility staff are working to make things better and keep the facility clean and free of odors. The Administrator stated she will have a meeting with the nursing staff to come up with a plan to meet the residents' needs and promote individualized care.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 8 of 9 255182 Department of Health & Human Services Printed: 08/31/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 255182 B. Wing 04/02/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Lakeview Nursing Center 16411 Robinson Road Gulfport, MS 39503

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 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 48181 potential for actual harm Based on interviews, record review, and facility policy review, the facility failed to ensure timely Residents Affected - Few administration of pneumonia vaccinations for one (1) of five (5) residents reviewed for immunizations (Residents #70).

Findings include:

A record review of the facility's policy, Pneumococcal Vaccine (Series), dated 6/19/23, revealed .It is our policy to offer residents .immunizations against pneumococcal disease in accordance with current CDC (Center for Disease Control) guidelines and recommendations. Policy Explanation and Compliance Guidelines: 1. Each resident will be assessed for pneumococcal immunization upon admission .2 .Following assessment for any medical contraindications, the immunization may be administered in accordance with physician-approved standing orders .

A record review of the Admission Record revealed the facility admitted Resident #70 on 2/3/25 with diagnoses including Encounter for Surgical Aftercare following surgery on the Digestive System.

A record review of the Admission Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 2/10/25 revealed Resident #70 had a Brief Interview for Mental Status (BIMS) score of 7, indicating severe cognitive impairment.

A record review of the Vaccination Record, dated 2/3/25, revealed Resident #70 had not received the Pneumonia vaccine and requested to receive the vaccine upon the Physician's recommendation.

On 04/02/25 at 9:58 AM, an interview with the Resident Representative (RR) for Resident #70 revealed she acknowledged the resident was admitted on [DATE REDACTED] and the consent to receive the pneumonia vaccine was signed 2/3/25. The RR acknowledged that she was not informed of any delay in getting the vaccine and was unaware that the resident had not received her pneumonia vaccine. The RR stated she expected the resident to have had his pneumonia vaccine.

On 04/02/25 at 10:15 AM, an interview with the Infection Preventionist (IP) revealed she acknowledged Resident #70 have not received their pneumonia vaccine from time they were admitted . The IP nurse confirmed it was her responsibility to ensure residents received vaccines and the process was to allow a couple of residents to be admitted to the facility before she calls the pharmacist to administer the vaccines.

The IP nurse stated she has been focusing on the flu vaccines and had hoped to get the pneumonia vaccines caught up this April.

On 04/02/25 at 1:05 PM, an interview with the Director of Nursing (DON) revealed she acknowledged that Residents #70 had not received the pneumonia vaccinations since admission. The DON stated it was the responsibility of the IP nurse to make sure the residents are vaccinated. The DON noted that going forward

she will arrange to have the immunizations done in-house rather than outsourcing to pharmacies to help get better control the timeliness of administering the pneumonia vaccine.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 9 of 9 255182