Pine Forest Health And Rehabilitation
PINE FOREST HEALTH AND REHABILITATION in JACKSON, MS — inspection on September 4, 2025.
Found 2 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
Report with a date initiated of 7/15/22 for Resident #1 revealed Focus: She (Resident #1) enjoys visits from her sister and other family members, listening to music, devotions.Interventions: Encourage family visits and patient participation in daily group activities/programs with music therapy, movies, conversation.A record review of the admission Record revealed Resident #1 was admitted on [DATE] with diagnoses including Unspecified Focal Traumatic Brain Injury with Loss of Consciousness of 30 Minutes or Less, Sequela.A record review of the Quarterly MDS (Minimum Data Set) with an Assessment Reference Date (ARD) of 6/14/25 revealed a Brief Interview for Mental Status (BIMS) score of 0, indicating the resident could not participate in the interview.Resident #2A record review of the Care Plan Report revealed a care plan with a date initiated of 8/23/22 for Resident #2 Focus: (Proper name of Resident) takes pleasure in listening to classical music .
Interventions.Staff will provide therapeutic activities for the resident to bring about a change.A record review of the admission Record revealed Resident #2 was admitted on [DATE] with diagnoses including Unspecified Dementia and Unspecified Psychosis.A record review of the Quarterly MDS with ARD of 7/16/25 revealed a BIMS score of 0, also indicating the resident could not participate in the interview.
Facility ID:
IDENTIFICATION NUMBER:
A.
Building
COMPLETED
09/04/2025
STREET ADDRESS, CITY, STATE, ZIP CODE
Pine Forest Health and Rehabilitation
1116 Forest Avenue Jackson, MS 39206
SUMMARY STATEMENT OF DEFICIENCIES
Observation revealed Resident #1 slouched in her Geri-chair, eyes closed, and not interacting. Resident #2 remained in the dayroom with no activities observed until 4:00 PM.During an observation on 9/4/25 at 8:27 AM, the SA observed Resident #2 again sitting at an empty table in the dayroom with her back to the television and no structured activity occurring.
During an interview on 9/4/25 at 10:01 AM, Certified Nursing Assistant (CNA) #1 confirmed she had cared for Resident #1 for over a year.
She stated that Resident #1 is nonverbal but appears to enjoy music when her family plays the radio in her room.
She explained that bingo is not appropriate for her due to her inability to comprehend or participate meaningfully.
During an interview on 9/4/25 at 10:14 AM, the Activities Director confirmed Resident #1 did not attend the music activity on 9/3/25 and stated, That was an oversight.
She acknowledged the resident cannot comprehend bingo and said she only brought her to the game so she could be there.
During an interview on 9/4/25 at 10:41 AM, the Director of Nursing (DON) confirmed the SA's observation that Resident #2 had not been engaged in any activities and had been seated with her back to the television for several hours.
The DON stated, She definitely needs to be in stimulating activities, and acknowledged a lack of follow-through by staff.
During an interview on 9/4/25 at 10:48 AM, the Administrator stated that activities should occur daily for all residents.Resident #1A record review of the admission Record revealed Resident #1 was admitted on [DATE] with diagnoses including Unspecified Focal Traumatic Brain Injury with Loss of Consciousness of 30 Minutes or Less, Sequela.A record review of the Quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 6/14/25 revealed a Brief Interview for Mental Status (BIMS) score of 0, indicating the resident could not participate in the interview.Resident #2A record review of the admission Record revealed Resident #2 was admitted on [DATE] with diagnoses including Unspecified Dementia and Unspecified Psychosis.A record review of the Quarterly MDS with an ARD of 7/16/25 revealed a BIMS score of 0, also indicating the resident could not participate in the interview.
Facility ID:
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.