Adams County Nursing Center

F-F550, .Based on observations, interviews, record review, and the facility policy review, the facility failed to honor a resident's right to smoke at the designated times to smoke per facility's policy .

During the current recertification survey, the facility failed to honor a resident's preference related to smoking

during the scheduled smoking times, in accordance with the facility's designated smoking schedule, for one (1) of eighteen (18) residents reviewed for resident rights.

On 4/23/25 at 3:37 PM, during an interview with the Director of Nursing (DON), she confirmed the facility was cited for the same deficient practice during their last recertification. She also confirmed 12:30 PM as one of

the scheduled smoking times designated by the facility. She explained the deficiency was repeated due to

the need to adjust the smoking time, as staff are usually busy during the 12:30 PM smoke break. She acknowledged that despite this, residents still have the right to expect to go out at the scheduled time.

On 4/24/25 at 11:37 AM, during an interview with the Interim Administrator, she explained that since the 12:30 PM smoke break falls during the lunch period, the facility either needs to adjust the scheduled time or specifically assign staff to that task. The Interim Administrator agreed that residents have the right to expect to go out at the designated smoking time.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 15 255169 Department of Health & Human Services Printed: 08/28/2025 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 255169 B. Wing 04/24/2025

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

Adams County Nursing Center 587 John R Junkin Drive Natchez, MS 39120

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 0880 Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or 50751 potential for actual harm Based on observation, staff interview, record review, and facility policy review, the facility failed to follow Residents Affected - Few infection prevention practices by not ensuring respiratory equipment was properly stored when not in use for one (1) of two (2) residents reviewed for respiratory services. (Resident #37)

Findings Included:

A review of the facility's Nebulizer and Oxygen Tubing Storage Policy, dated April 2007, revealed, .It is the policy of this facility to decrease the risk of potential and/or direct exposure to infectious disease, air contaminants and bacterial exposure. We will provide our residents with the proper storage and cleaning of respiratory equipment. Procedure .These tubings will be .stored in a dated plastic bag when not in use .

On 4/22/25 at 7:37 AM, during an observation, Resident #37's oxygen and nebulizer tubing were observed unbagged, lying on each piece of equipment. No clean storage method was in place.

A record review of the Admission Record revealed the facility admitted Resident #37 on 11/15/24 with diagnoses including Chronic Obstructive Pulmonary Disease.

A record review of Resident #37's Quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 2/13/25 revealed a Brief Interview for Mental Status (BIMS) score of 12, which indicated the resident's cognition was moderately impaired.

On 4/22/25 at 8:00 AM, during an interview with the Director of Nursing (DON) at Resident #37's bedside,

she confirmed the oxygen cannula and nebulizer tubing/masks were not bagged and stated they should be kept in a bag when not in use to prevent the spread of respiratory infection. She explained that it is the Sunday night cart nurse's responsibility to bag and change out tubing for each resident.

On 4/23/25 at 2:47 PM, during an interview with Licensed Practical Nurse (LPN) #1, the Infection Preventionist (IP) Nurse, she stated that nasal cannula, oxygen, nebulizer tubing, and masks should be kept

in a bag to prevent respiratory infections. She further stated they should be changed weekly by the Sunday night nursing staff and confirmed that this task appears on the Medication Administration Record (MAR).

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 15 255169