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Complaint Investigation

Pine Forest Health And Rehabilitation

September 4, 2025 · Jackson, MS · 1116 Forest Avenue
Citations 2
CMS Rating 1/5
Beds 120
Provider ID 255326
Healthcare Facility
Pine Forest Health And Rehabilitation
Jackson, MS  ·  View full profile →
Inspection Summary

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.

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Inspection Findings

FF0656
Resident Assessment and Care Planning Deficiencies
Potential for More Than Minimal Harm

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:

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 JACKSON, 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 PINE FOREST HEALTH AND REHABILITATION or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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