Bedford Care Center Of Marion

F-F565:

1. Based on observation, interviews, record review, and facility policy review the facility failed to ensure resident council members' complaints regarding food that was served cold were recorded and resolved in a timely manner for nine (9) of 11 Resident council members. (Resident #4, #18, #20, #27, #42, #49, #52, #62, and #68)

On 7/8/24 at 12:30 PM, during an observation of two (2) lunch meal trays, the meal consisted of fried pork chop, pinto beans, turnip greens, corn bread, fruited gelatin, tea and water. The Administrator brought the two trays directly from the kitchen and the food was cold to taste and touch.

On 7/8/24 at 2:18 PM, during an interview with Resident#38, she complained she is currently upset at the facility because she had issues with staff not wanting to reheat her food. She complained her breakfast was always cold and she was tired of it because it had been going on for a while.

At 11:15 AM on 7/9/24, during an interview with Resident #38, she explained her breakfast was cold again

this morning and she had to get someone to reheat the food.

On 7/9/24 at 11:28 AM, during an observation and interview with Dietary #2/Cook, he prepared the meal trays to be served to residents in the dining room. He stated he cannot prepare meal trays for the residents

on the hall until all residents in the dining room were served. At 11:42 AM, the cook began preparing the meal trays for the halls. At 11:57 AM, one of the dietary aides began placing meal trays onto the cart but stopped because she had to prepare more silverware for the trays. At 12:00 PM, Dietary #2 had to stop preparing hall trays to make more mechanical soft meat loaf for the residents, and Dietary #1 continued preparing the trays for the residents on the hall.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 8 of 15 255328 Department of Health & Human Services Printed: 09/18/2025 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 255328 B. Wing 07/11/2024

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

Bedford Care Center of Marion 6434 A Dale Dr Marion, MS 39342

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 0804 On 7/9/24 at 12:11 PM, during an observation, the last tray cart was sent to the last hall with two (2) test trays on the cart. The tray cart was an open metal tray cart that was not insulated. There were three (3) Level of Harm - Minimal harm or insulated carts pushed to the side and one (1) insulated tray cart that did not have a door. The open tray cart potential for actual harm was pushed to the hall by a Dietary Aide and Dietary #1 and explained the Certified Nurse Aides (CNAs) on

the hall would pass out the trays to the residents. After four (4) minutes a CNA started to pull trays and pass Residents Affected - Some them out to the residents.

At 12:23 PM on 7/9/24, during an interview and observation, Dietary #1 tested the temperature of the last tray on the last cart. The temperatures were the following: country meatloaf 80 degrees Fahrenheit (F); garlic mashed potatoes 100 F; buttered green peas 84 F; pork cutlet 80 F; stewed tomatoes 90 F and steamed rice 84 F. The temperatures of the individual food items had dropped from country meatloaf 170 F; garlic mashed potatoes 170 F; buttered green peas 164 F; pork cutlet 160 F, stewed tomatoes 135 F; and steamed rice 170 F. The food on the two test trays were tasted by the State Agency (SA) and Dietary #1 and was cold and not at an appetizing temperature. Dietary #1 explained the food was at room temperature, but confirmed it was cold. She explained if she was served the food at a restaurant, she would send it back because the food was not hot enough for her to eat.

At 1:10 PM on 7/9/24, during an interview with CNA #1, she explained Resident #38 had complained that her food was cold, and it had been reported to the kitchen staff several times.

During an interview on 7/11/24 at 11:18 AM, with the Administrator, he confirmed the residents had complained the food was cold. He had dietary to started serving the dining room first and then serve the residents on the hall that were complaining first. He thought the complaints were resolved, and he did not know the resident's council continued to complain in June. He expected all residents to be served food at an appetizing temperature.

Resident #38

A record review of the Admission Record revealed the facility admitted Resident #38 on 11/19/18 with diagnoses including Bipolar Disorder and Anxiety Disorder.

A record review of the Order Summary Report with active orders as of 7/9/24, revealed Resident #38 had a Physician's Order, dated 5/3/24, for a Regular diet, Regular texture, and Regular consistency with chopped ham and turkey.

A record review of the Annual Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 5/9/24, revealed Resident #38 had a Brief Interview for Mental Status (BIMS) summary score of 15, which indicated she was cognitively intact.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 9 of 15 255328 Department of Health & Human Services Printed: 09/18/2025 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 255328 B. Wing 07/11/2024

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

Bedford Care Center of Marion 6434 A Dale Dr Marion, MS 39342

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 0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food

in accordance with professional standards. Level of Harm - Minimal harm or potential for actual harm 41680

Residents Affected - Few Based on observation, staff interview, and facility policy review, the facility failed to ensure the chemical sanitizer for a low-temperature dishwasher had a concentration of at least 50 parts per million (ppm) for one (1) of two (2) dishwasher observations.

Findings Include:

Review of the facility's policy, Sanitization with a revision date 10/04/22, revealed, The food service area will be maintained in a clean and sanitary manner. Policy Interpretation and Implementation .3. All equipment, food contact surfaces and utensils will be washed to remove or completely loosen soils by using the manual or mechanical means necessary and sanitized using hot water and or chemical sanitizing solutions .6. Dishwashing machines must be operated using the following specifications .Low-Temperature Dishwasher (Chemical Sanitization) .b. Final rinse with 50 parts per million (ppm) hypochlorite (chlorine) for at least 10 seconds .

On 7/9/24 at 11:08 AM, during an observation and interview of the tray line, Dietary #2/Cook was preparing trays for the residents in the dining room. Dietary #2 frequently stopped the line and placed dishes to the side. He stated that upon inspection, the dishes were not clean. There were 12 small bowls, five (5) plates, three (3) large serving bowls, and one (1) platter set aside. Some of the dishes had large amounts of dried food on them and some of them had small specks of food residue on them.

On 7/9/24 at 1:48 PM, in a follow-up interview with Dietary #2, he stated he thought the dishwasher was not cleaning the dishes properly and explained that he never used soiled dishes when preparing meal trays for

the residents.

On 7/9/24 at 1:59 PM, in an interview with Dietary #1/Assistant Dietary Manager, she confirmed the facility had problems with the dishwasher and it had been rebuilt approximately two (2) months ago. She explained

they had minor problems with the dishwasher which required a repairman to come to the facility to repair it.

She reported it was the responsibility of the dietary aides to check the dishes before the dishes were stored to make sure they were clean.

On 7/9/24 at 2:10 PM, in an observation with Dietary #1 and Dietary #3, there were four (4) dirty plates. Dietary #3 sprayed the dishes and placed them in the low temperature dishwasher. After the dishwasher cycle ended, she removed the plates, and they had specks of food residue on them. The dishwasher temperature reached 130 degrees Fahrenheit (F), which was within the required temperature range and the chlorine measured 10 ppm on the dish surface, which was less than 50 ppm. Dietary #1 confirmed the plates were not clean and the sanitation was less than the required amount.

On 7/9/24 at 2:25 PM, in an interview with the Corporate Dietary Consultant, she stated the sanitation had been changed earlier today and was not coming through the tubing properly because the tubing had not been primed. She stated that after priming the tubing, the sanitation reading was 50 ppm.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 10 of 15 255328 Department of Health & Human Services Printed: 09/18/2025 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 255328 B. Wing 07/11/2024

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

Bedford Care Center of Marion 6434 A Dale Dr Marion, MS 39342

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 0812 On 7/11/24 at 1:00 PM, in an interview with the Administrator, he stated he was made aware the dietary staff had not primed the sanitation tubing after installing a new container of sanitation in the dishwasher and Level of Harm - Minimal harm or explained that education and training had begun immediately for the dietary staff as soon as the issue was potential for actual harm observed.

Residents Affected - Few

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 11 of 15 255328 Department of Health & Human Services Printed: 09/18/2025 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 255328 B. Wing 07/11/2024

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

Bedford Care Center of Marion 6434 A Dale Dr Marion, MS 39342

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 48181 potential for actual harm Based on record review, staff interview, and facility policy review, the facility failed to provide evidence that Residents Affected - Few residents refused the Influenza and/or Pneumococcal vaccine for two (2) of five (5) residents reviewed for immunizations. Resident #22 and Resident #37

Findings include:

A review of the facility's policy, Vaccination of Residents, dated 8/2/22, revealed, .All residents will be offered vaccines .Policy Interpretation and Implementation 1. Prior to receiving vaccinations, the resident or legal representative will be provided information and education regarding the benefits and potential side effects of

the vaccinations .2. Provision of such education shall be documented in the resident's medical record .5. If vaccines are refused, the refusal shall be documented in the resident's medical record .

Resident #22

A record review of the facility's Transfer/Discharge Report revealed the facility admitted Resident #22 on 11/22/23 with diagnoses including Hemiplegia and Hemiparesis.

A review of the medical record revealed there was no documentation that indicated Resident #22 had received or refused an influenza and pneumococcal vaccination.

Resident # 37

A record review of the facility's Transfer/Discharge Report revealed the facility admitted Resident #37 on 09/22/23 with diagnoses including Chronic Atrial Fibrillation.

A review of the medical record revealed there was no documentation that indicated Resident #22 had received or refused an influenza and pneumococcal vaccination.

On 7/10/24 at 10:15 AM, in an interview with the Director of Nursing (DON), she stated Resident #22 and Resident #37 had refused the influenza and pneumococcal vaccines. She confirmed the facility did not have

a signed copy of the declination or refusal forms for Resident #22 and Resident #37 in their medical records.

The DON explained the Resident Care Coordinator (RCC) was responsible for ensuring immunization records were available in the resident's medical record.

On 7/11/24 at 11:00 AM, in an interview with the Administrator, he acknowledged he was aware the facility was unable to provide evidence Resident #22 and Resident #37 had refused influenza and pneumococcal immunizations. The Administrator stated the RCC was responsible for maintaining immunization documents

in the medical records and expected the RCC to have documentation available as required.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 12 of 15 255328 Department of Health & Human Services Printed: 09/18/2025 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 255328 B. Wing 07/11/2024

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

Bedford Care Center of Marion 6434 A Dale Dr Marion, MS 39342

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 On 07/11/24 at 11:37 AM, in an interview with the RCC, she confirmed she was unable to provide declination forms or documentation of refusal for Resident #22 and Resident #37 regarding the influenza and Level of Harm - Minimal harm or pneumococcal immunizations. The RCC confirmed she was responsible for maintaining the immunization potential for actual harm records and she planned to begin scanning the documents herself to ensure they are properly added to the medical record. Residents Affected - Few

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 15 255328 Department of Health & Human Services Printed: 09/18/2025 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 255328 B. Wing 07/11/2024

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

Bedford Care Center of Marion 6434 A Dale Dr Marion, MS 39342

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 0887 Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. Level of Harm - Minimal harm or potential for actual harm 48181

Residents Affected - Few Based on record review, staff interview, and facility policy review, the facility failed to provide evidence that residents refused the COVID-19 vaccine for two (2) of five (5) residents reviewed for immunizations. Resident #22 and Resident #37

Findings include:

A review of the facility's policy, Vaccination of Residents, dated 8/2/22, revealed, .All residents will be offered vaccines .Policy Interpretation and Implementation 1. Prior to receiving vaccinations, the resident or legal representative will be provided information and education regarding the benefits and potential side effects of

the vaccinations .2. Provision of such education shall be documented in the resident's medical record .5. If vaccines are refused, the refusal shall be documented in the resident's medical record .

Resident #22

A record review of the facility's Transfer/Discharge Report revealed the facility admitted Resident #22 on 11/22/23 with diagnoses including Hemiplegia and Hemiparesis.

A review of the medical record revealed there was no documentation that indicated Resident #22 had received or refused a COVID-19 vaccination.

Resident # 37

A record review of the facility's Transfer/Discharge Report revealed the facility admitted Resident #37 on 09/22/23 with diagnoses including Chronic Atrial Fibrillation.

A review of the medical record revealed there was no documentation that indicated Resident #22 had received or refused a COVID-19 vaccination.

During an interview on 7/10/24 at 10:15 AM, the Director of Nursing (DON), she stated Resident #22 and Resident #37 had refused COVID-19 vaccines. She confirmed the facility did not have a signed copy of the declination or refusal forms for Resident #22 and Resident #37 in their medical records. The DON explained

the Resident Care Coordinator (RCC) was responsible for ensuring immunization records were available in

the resident's medical record.

During an interview on 7/11/24 at 11:00 AM, with the Administrator, he stated he was aware the facility was unable to provide evidence Resident #22 and Resident #37 had refused COVID-19 vaccines. The Administrator stated the RCC was responsible for maintaining immunization documents in the medical records and expected the RCC to have documentation available as required.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 15 255328 Department of Health & Human Services Printed: 09/18/2025 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 255328 B. Wing 07/11/2024

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

Bedford Care Center of Marion 6434 A Dale Dr Marion, MS 39342

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 0887 In an interview on 07/11/24 at 11:37 AM, with the RCC, she confirmed she was unable to provide declination forms or documentation of refusal for Resident #22 and Resident #37 regarding COVID-19 vaccines. The Level of Harm - Minimal harm or RCC confirmed she was responsible for maintaining the immunization records and she planned to begin potential for actual harm scanning the documents herself to ensure they were properly added to the medical record.

Residents Affected - Few

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 15 255328