Miami Nursing Center, Llc

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

stated the facility routinely trained their staff on abuse and neglect with their most recent two in-services on abuse dated 11/28/25 and 12/11/25. The DON stated CNA #3 was an agency aide who had worked at the facility for the last month without incident. The DON stated the agency who employed CNA #3 performed background checks on the employees and provided a copy of the background check for CNA #3. The DON stated CNA #3 did not provide a statement and did not return their calls. The DON stated the facility provided an orientation packet to all agency staff which provided them answers to frequently asked questions, copies of policies related to abuse and neglect, and a skills check. The DON stated the facility kept a copy of the orientation packet once completed. The DON stated they were not able to find the orientation packet for CNA #3.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Miami Nursing Center, LLC

1100 East Street Northeast Miami, OK 74354

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 potential for actual harm

Based on observation, record review, and interview, the facility failed to minimize the risk of spreading infection for 1 (#6) of 1 sampled resident exposed to COVID-19. The DON identified six residents and seven facility staff members who contracted COVID-19 since 12/01/25. Findings:On 12/12/25 at 12:35 p.m., Resident #6 was observed in their room with their roommate, Resident #5. Resident #5 was in their bed and Resident #6 was standing beside their own bed. Neither resident was wearing a mask. There were no barriers between the two residents. There were no visible signs of isolation gowns, gloves, masks used within the room, such as biohazard bags of used gowns, gloves, and masks present. Resident #6's room did not have signage for isolation on or around the resident's door and no personal protective equipment (mask, gloves, gown, etc.) was stored near the entrance to their room. On 12/12/25 at 12:40 p.m., Resident #6 exited their room and walked with their walker down to the lobby area near the front office and nurses' station. Resident #6 did not have on an isolation mask. Nursing staff were observed to pass Resident #6 in

the hall and lobby area. None of the staff working on the hall with the resident were observed to wear isolation masks while in the hallway and none were observed to encourage Resident #6 to wear a mask while Resident #6 was in the hallway or ask Resident #6 to return to their room. A quarterly assessment, dated 11/30/25, showed Resident #6 was severely impaired in cognition with a BIMS score of three, exhibited no behaviors, and ambulated with a walker.A care plan, dated 11/30/25, showed Resident #6 required supervision/assistance with all decision making. A nurse's progress note, dated 12/11/25, showed Resident #6 removed isolation signage from their door and personal protective equipment basket from outside of their door. A nurse's progress note, dated 12/12/25, showed Resident #6 continued to remove signage off their door and biohazard bins from their room. A lab report, dated 12/16/25, showed Resident #6 was negative for COVID-19. On 12/12/25 at 12:35 p.m., LPN #1 stated Resident #6 resided in the same room as Resident #5. LPN #1 stated Resident #5 was in isolation for COVID-19 but Resident #6 was not in isolation and could come and go from the room as they wished. On 12/12/25 at 12:45 p.m., the DON stated Resident #5 was not part of the facility's initial COVID-19 exposure testing performed on 12/01/25. the DON stated Resident #5 tested positive for COVID-19 on 12/10/25 while out of the facility for an appointment.

The DON stated on 12/10/25, Resident #6 tested negative for COVID-19 and was given the option to move to another room while Resident #5 isolated in their room or remain in the room with Resident #5 in isolation. The DON stated Resident #6 decided to remain in their room with Resident #5 in isolation. The DON stated Resident #6 would remove the isolation signs, move the isolation carts from on and around their room's door, and the biohazard containers from their room. The DON stated the facility informed Resident #6 they needed to wear a mask when they left their room, but it was the resident's right to decline to wear a mask and their right to leave their room whenever they wished.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet