Cedars Health Center
Cedars Health Center in TUPELO, MS — inspection on October 22, 2025.
Found 1 citation. 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
jeopardy to resident health or safety
name of Resident #1 removed) was.
Asked if she was OK and if she was hot.
She replied, ‘I thought y'all had forgot me, but I am OK'. I then took her to (proper name of facility's building removed) and unloaded her.
Record review of Progress Note for Resident #1 on 10/14/25 revealed, During post incident assessment of elder, elders skin visualized with no redness, rashes, bruising or open areas noted.
Skin warm and dry to touch and intact throughout.
Skin turgor good, color appropriate to ethnicity.
Resident denies any pain or discomfort.
Elder has edema to BLE (bilateral lower extremities) and swelling to right hand, which is baseline for elder.
Record review of Medical Doctor's progress note with encounter date of 10/14/25 revealed, Notified around 12:30 PM today that patient had an appointment today.
She was transported back to (proper name of facility removed) but was left in the van for 1 to 2 hours.
Patient seen and examined .
Family members present.
Patient notes generalized weakness but denied other symptoms.
Family member states she looked drenched when they saw her earlier.
She did not eat breakfast or lunch.
She has not had much to drink. On exam, she is sitting in her recliner.
Lungs CTAB (clear to auscultation bilaterally). No increased work of breathing. On room air.
Will encourage oral hydration.
Patient had AKI (Acute Kidney Injury) on CKD (chronic kidney disease) with recent hospitalization; creatinine has been down trending.
With this event, will recheck BMP (Basic Metabolic Panel) today.
Will check vital signs every 30 minutes and space if normal. If tomorrow, vital signs are normal, will resume routine vital checks.Record review of admission Record revealed the facility admitted Resident #1 on 9/10/25 with diagnoses of Paroxysmal Atrial Fibrillation and Chronic Kidney Disease.
Record review of Resident #1's Minimum Data Set (MDS) with Assessment Reference Date (ARD) of 9/17/25 revealed a Brief Interview for Mental Status (BIMS) of 10 which indicated a moderate cognitive impairment.The SA validated on 10/22/25 that the facility had put measures in place to remove the immediacy of the event and had immediately acted to protect Resident #1 and all other residents in the facility.
The facility had an emergency Quality Assurance (QA) meeting, began in-services with all staff, completed a health assessment and monitoring for Resident #1, notified reporting officials of the incident and continued to monitor through their QA program.
The Director of Nursing and Assistant Director of Nursing will utilize End-of-Route Witness Audit Form to monitor both the vehicle walk-throughs and the completion of the End-of-Route Two-Person Checklist.
Monitoring will occur daily for two weeks, then three times per week for the following two weeks, weekly for the next four weeks, and monthly thereafter.
All measures were completed or began on 10/14/25 and the SA confirmed the plan of corrections that were put in place and found that the facility was PNC as of 10/15/25, prior to the SA entrance into the facility on [DATE].
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