Cornerstone Rehabilitation And Healthcare Center
Inspection history, citations, penalties and survey trends for this long-term care facility in Corinth, Mississippi.
- Location
- 302 Alcorn Drive, Corinth, Mississippi 38834
- CMS Provider Number
- 255232
- Inspections on file
- 29
- Latest survey
- April 9, 2026
- Citations (last 12 mo.)
- 9
Citation history
Health deficiencies cited at Cornerstone Rehabilitation And Healthcare Center during CMS and state inspections, most recent first.
Unsanitary food storage and dietary conditions were observed in the kitchen area. Food debris, spilled liquids, discarded silverware, paper, condiment packs, and food items were found on the floor, and grease and food buildup were seen on the steam table backsplash. A bag of breadsticks was over a month old, Freezer 2 was at 48 degrees F with thawed food inside, a clean dish rack had dirty gloves and food debris on it, and a dietary employee handled dinner rolls with soiled gloves during tray line assembly.
The facility failed to submit accurate PBJ staffing data for one quarter reviewed. The Administrator and PBJ Coordinator confirmed that DON, RN, and LPN administrative hours were included in PBJ even when those staff did not provide direct resident care, and the CASPER report triggered for excessively low weekend staffing.
Improper labeling of opened multi-dose medication vials was found on two medication carts. An LPN and the ADON identified that several opened multi-dose vials, including insulin and ophthalmic solutions, were missing open dates or had dates that did not align with the facility policy for dating and discarding after opening. Residents affected had active orders for the medications observed, including eye drops and insulin.
Failure to provide required Medicare coverage notices. The facility did not ensure a resident or the resident’s representative received the SNF ABN, and staff stated they believed the NOMNC was the only notice needed. The facility also had no policy specific to Beneficiary Notices, including ABNs. The resident had been admitted with HF.
A resident receiving dialysis three times weekly was not coded for dialysis in Section O on two quarterly MDS assessments. The MDS Nurse confirmed the resident attended all scheduled dialysis treatments but did not code them because dialysis center communication sheets were unavailable during the look-back period. The resident had ESRD and dependence on renal dialysis, and the ADM stated the MDS should accurately reflect dialysis services.
Failure to develop and implement comprehensive person-centered care plans for three residents. One resident with Alzheimer's disease and severe cognitive impairment had unwashed, matted hair and a foul odor, and staff confirmed he needed hands-on bathing and shampoo assistance but was coded as independent. Another resident with dementia and weakness had unclean, matted hair with scalp buildup despite a bathing/showering intervention in the care plan. A third resident who used tobacco had no smoking care plan, and the MDS Nurse confirmed the omission.
Failure to Provide Hair Care and Shampooing Assistance: Two residents who depended on staff for ADL care were observed with unclean, matted, and tangled hair, and one had a foul odor. Staff and the Administrator confirmed the hair had not been washed, despite facility policy and routine bathing expectations. Both residents had severe cognitive impairment and diagnoses including dementia-related conditions.
Improper perineal care was observed for a resident during CNA care when the aide cleansed the front perineal area, then after the resident had a BM, re-dipped previously used washcloths into the same water basin and used that water to cleanse the back perineal area. The CNA said she reused the washcloths because she was out of clean supplies and acknowledged the practice was incorrect; the DON confirmed additional clean washcloths should have been obtained. The resident had epilepsy, needed assistance with personal care, had moderate cognitive impairment, and was always incontinent of bowel and bladder.
Several residents and their representatives reported that certain CNAs consistently displayed rude and unfriendly behavior, including abrupt communication and lack of assistance with personal care tasks. Staff interviews and disciplinary records confirmed ongoing issues with unprofessional conduct, such as loud and disrespectful interactions with residents and their families. Facility leadership was aware of these concerns, but the behavior persisted, resulting in a deficiency related to resident dignity and respect.
The facility inaccurately submitted the Payroll-Based Journal (PBJ) for the 4th quarter of FY 2024, triggering low weekend staffing. The facility's policy requires electronic reporting of staffing data to CMS, including agency and contract staff hours. The DON and Administrator confirmed that some agency staff hours were not accurately submitted, resulting in the low staffing trigger.
The facility failed to provide adequate personal hygiene care for five residents, as observed and confirmed through interviews and record reviews. A resident was found with facial hair that had not been addressed since her admission, despite her preference for hair removal. Both a CNA and an RN Supervisor acknowledged that facial hair should be managed during bath or shower times. Another resident had long, jagged fingernails that had not been trimmed since his admission, which he expressed a desire to have cut. The CNA and RN Supervisor confirmed the need for regular nail care to prevent potential injuries and infections.
A facility failed to obtain a Level II PASARR status change for a resident after an inpatient psychiatric hospital stay. The resident, with diagnoses including Parkinsonism and Bipolar II Disorder, was discharged to a psychiatric facility. The former Social Services Director did not submit the required change of status form, mistakenly believing a negative Level I PAS exempted further action. The Administrator confirmed the oversight, which led to the deficiency.
A resident with Huntington's Disease was found lying on a deflated air mattress, which was supposed to be a low air loss mattress for pressure redistribution. Despite staff presence, the deflated mattress was not reported or addressed promptly. A CNA noticed the issue but did not report it, and an LPN confirmed the mattress was deflated. The Maintenance Director later turned on the control box, inflating the mattress. The DON acknowledged the potential for worsening conditions due to the deflated mattress.
A resident was left with ten pills unattended on their over bed table by an LPN, contrary to facility policy requiring observation during medication administration. The RN Supervisor and DON confirmed the policy breach, highlighting the risk of medication errors or unauthorized access. The resident, cognitively intact, had diagnoses including Major Depressive Disorder and Anxiety Disorder.
The facility failed to implement ADL care plans for five residents with cognitive impairments and physical limitations, resulting in unmet personal hygiene needs. Observations revealed residents with unshaved facial hair and long, jagged fingernails, despite care plans specifying assistance with these tasks. Staff confirmed the care plans were not followed, highlighting a deficiency in meeting residents' personal hygiene needs.
The facility failed to maintain clean wheelchairs for three residents, as observed by surveyors. Interviews revealed that night shift CNAs were responsible for cleaning, but there was no documentation to confirm completion. The wheelchairs were found with a thick gray substance and one had cracked wheels. The residents had medical conditions such as respiratory failure and cerebrovascular disease.
A facility failed to document and address grievances from a resident and their family, despite multiple complaints about care issues such as the resident being left wet or dirty. The facility's grievance log showed no entries for the resident, and interviews with staff confirmed frequent complaints. The administrator and DON were aware of the issues but did not complete formal grievance documentation or ensure proper follow-up.
The facility failed to follow a comprehensive care plan for a resident who was incontinent of bladder. The resident was not checked every two hours as required, resulting in the resident being found with a soaked incontinent brief. Staff interviews confirmed the care plan was not followed.
A resident with multiple diagnoses, including a Stage 3 Pressure Ulcer, was left in a wet brief for over four hours because the CNA did not check on him as required. The ADON and DON confirmed that CNAs must check incontinent residents every two hours, even if they are asleep.
Unsanitary Food Storage and Dietary Department Conditions
Penalty
Summary
The facility failed to store and serve food in a sanitary manner and failed to maintain a clean dietary department. Facility policy stated that all food preparation areas, food services, and dining areas were to be maintained in a clean and sanitary condition, and that the Dining Services Director was responsible for ensuring the kitchen was maintained in a clean and sanitary manner. During observation, a large amount of food debris and spilled liquids were seen throughout the dietary department, along with discarded silverware, paper, butter packs, jelly packs, dried pasta, shredded cheese, and lettuce on the floor. The floor was described as extremely sticky and the area as very unkept, and there was also a large amount of grease and food buildup on the glass of the steam table backsplash. Additional observations showed a gallon-size plastic bag dated 02/24/26 containing about 20 breadsticks on a cart beside a blender, and the Dietary Manager confirmed the breadsticks should have been discarded and were over a month old. Freezer 2 was observed at 48 degrees F with thawed biscuits, rolls, and breaded chicken strips inside that were mushy to the touch and not frozen; the Dietary Manager stated a freezer had broken down about a week earlier and the items had been moved to this freezer, but she thought it was working. A clean dish rack in the dish room had dirty gloves on it with clean dishes, discarded salt and pepper packets, and food debris on the bottom rack. During tray line assembly, a dietary employee with soiled gloves touched dinner rolls while assembling lunch trays, and the Dietary Manager confirmed dietary employees should not touch food with dirty gloves.
Inaccurate PBJ Staffing Reporting
Penalty
Summary
The facility failed to submit accurate staffing data into the Payroll-Based Journal (PBJ) system for one quarter reviewed, specifically the 4th Quarter 2025 (July 1-September 30). Review of the facility policy on reporting direct-care staffing information showed that staffing and census information are to be reported electronically to CMS through the PBJ system in compliance with Section 6106 of the Affordable Care Act. Review of the PBJ Staffing Data Report CASPER Report 1705D for FY Quarter 4 2025 showed the facility triggered for excessively low weekend staffing. During interview, the Administrator and PBJ Coordinator confirmed the facility included DON hours, RN administrative hours, and LPN administrative hours in PBJ reporting even when those staff did not provide direct resident care. The Administrator stated that entering those hours incorrectly increased the number of staff shown during the week and caused staffing numbers to fall on the weekends.
Improper labeling of opened multi-dose medication vials
Penalty
Summary
The facility failed to ensure medications were properly labeled and stored in accordance with accepted standards of practice for two of three medication carts observed. During observation of the A-Hall medication cart, several opened multi-dose vials were found with missing or outdated open dates, including Olopatadine HCl ophthalmic solution, Latanoprost ophthalmic solution, Lantus subcutaneous solution, Artificial Tears ophthalmic solution, and Timolol maleate solution. The facility policy reviewed stated that multi-dose vials that have been opened or accessed are to be dated and discarded within 28 days, and the LPN observing the cart stated that insulin and other multi-dose vials were good for 30 days after opening. During observation of the B-Hall medication cart, an opened multi-dose vial of Latanoprost ophthalmic solution for another resident was also found without an open date. The ADON confirmed that all multi-dose vials should have an open date and stated insulin is only good for 28 days after opening, while other multi-dose medications such as eye drops are typically good for 30 days after opening. The residents involved included individuals with diagnoses such as heart failure, Alzheimer's disease, type 2 diabetes mellitus, protein-calorie malnutrition, Huntington's disease, and traumatic subdural hemorrhage, and active orders were present for the medications observed.
Failure to Provide Required Medicare Coverage Notices
Penalty
Summary
The facility failed to ensure that residents or their representatives were provided with required Beneficiary Notices, including Skilled Nursing Facility Advanced Beneficiary Notices (ABNs), for one of three residents reviewed for Beneficiary Protection Notifications. Review of a statement on facility letterhead dated 4/7/26 and signed by the Administrator showed the facility did not have a policy specific to Beneficiary Notices, including ABNs. Review of the Skilled Nursing Facility Beneficiary Protection Notification Review form showed that one resident remained in the facility, but Resident #4 was not provided with a Skilled Nursing Facility ABN. During interview, the Business Office Manager stated she did not provide the SNF ABN to the resident or responsible party and believed the Notice of Medicare Non-Coverage (NOMNC) was enough to cover all required notice. The Administrator confirmed the same understanding and believed the NOMNC was the only notice required. The admission record showed Resident #4 was admitted on 12/19/2025 with a diagnosis of Heart Failure.
MDS Dialysis Coding Not Accurately Completed
Penalty
Summary
The facility failed to accurately complete Section O of the MDS quarterly assessment for one resident who received dialysis three times a week. Record review showed the resident had an order for dialysis on Tuesday, Thursday, and Saturday at a dialysis center, with diagnoses including End Stage Renal Disease and Dependence on Renal Dialysis. However, the resident’s Quarterly MDS assessments with ARDs of 1/6/26 and 4/1/26 were both not coded to reflect dialysis in Section O. During interview, the MDS Nurse confirmed the resident received dialysis services three times weekly and stated the resident was not coded for dialysis on the two quarterly MDS assessments because all three communication sheets from the dialysis center were unavailable during the 7-day look-back period. The MDS Nurse also confirmed the resident attended and received dialysis on all scheduled days during the look-back period. The Administrator stated that if the resident was receiving dialysis services, the MDS should accurately reflect that. The resident’s MDS with ARD of 4/1/26 also showed a BIMS score of 11, indicating moderate cognitive impairment.
Failure to Develop and Implement Comprehensive Person-Centered Care Plans
Penalty
Summary
The facility failed to develop and implement a person-centered comprehensive care plan with measurable objectives and timetables for three residents. For one resident with Alzheimer's disease and severe cognitive impairment, staff observed the resident lying in bed with oily, matted, tangled hair, a foul odor, and a foul odor in the room. A CNA confirmed the resident's hair was unclean and stated the resident needed assistance with soap and shampoo because he would stand in the shower and let the water splash him without awareness to bathe his body or shampoo his hair. The Administrator also confirmed the hair had not been washed and was unclean, and the MDS Nurse stated the resident's care plan was not implemented for shower assistance because he had been marked as independent. For another resident with unspecified dementia, muscle weakness, and need for assistance with personal care, the care plan included bathing/showering intervention to provide a sponge bath when a full bath or shower could not be tolerated. However, observations showed the resident lying in bed with uncombed, matted, tangled hair and visible yellowish, dry, flaky buildup across the front scalp area consistent with lack of washing, and an LPN confirmed the hair was unclean with visible residue and buildup. For a third resident, the care plan report contained no smoking care plan even though the MDS indicated the resident currently used tobacco, the resident stated he was a smoker, and the MDS Nurse confirmed a smoking care plan should have been developed but had not been, stating the omission occurred in error.
Failure to Provide Hair Care and Shampooing Assistance
Penalty
Summary
The facility failed to ensure residents who were dependent on staff for hair care and shampooing received the hygiene services needed to maintain personal cleanliness and grooming. Facility policy stated that residents unable to carry out activities of daily living independently would receive services necessary to maintain good nutrition, grooming, and personal and oral hygiene. During observation, Resident #10 was found lying in bed with oily, matted, and tangled hair, along with a foul odor in the resident and the room. A CNA confirmed the hair was unclean and stated the resident needed aide assistance with soap and shampoo because he would stand in the shower and let the water splash him. The Administrator also confirmed the hair had not been washed and was unclean. Resident #10 was admitted with Alzheimer's Disease and had a BIMS score of 1, indicating severe cognitive impairment. Resident #40 was observed lying in bed with uncombed, matted, and tangled hair, and visible yellowish, dry, flaky buildup on the front scalp area consistent with lack of washing. An LPN confirmed the visible hair residue and buildup and stated that shampooing was part of bathing and should be completed by the aide on the resident's scheduled bath days. The Administrator also confirmed the hair had not been washed and was unclean. Resident #40 was admitted with diagnoses including unspecified dementia, muscle weakness, and need for assistance with personal care, and had a BIMS score of 3, indicating severe cognitive impairment.
Improper Perineal Care During Incontinence Care
Penalty
Summary
Improper perineal care was observed for one resident during a surveyor observation of care. During perineal care for Resident #45, the CNA cleansed the front perineal area, then turned the resident onto her side and found that the resident had a bowel movement. The CNA re-dipped previously used washcloths into the same water basin after it had been used to clean the bowel movement and then used that same water to cleanse the back perineal area. The aide stated before leaving the room that she realized the practice was incorrect. The CNA later confirmed she reused washcloths while providing care because she was out of clean supplies and acknowledged she should have stopped to get additional supplies. She also stated that the improper perineal care increased the resident's risk for spread of bacteria and urinary tract infection. The DON confirmed the aide should have obtained additional clean washcloths to prevent the spread of germs. Resident #45 was admitted with diagnoses including epilepsy and need for assistance with personal care, had a BIMS score of 11 indicating moderate cognitive impairment, and was always incontinent of bowel and bladder.
Failure to Ensure Residents Are Treated with Dignity and Respect
Penalty
Summary
The facility failed to ensure that residents were treated with dignity and respect, as required by their own policy and federal regulations. Multiple residents and their representatives reported that certain Certified Nurse Aides (CNAs) displayed rude, abrupt, and unfriendly behavior. Specifically, three residents described negative interactions with CNA #1, including being spoken to in a snappy or gruff tone, being told to perform tasks they were unable to do due to their physical limitations, and generally feeling that the aide was not kind or considerate. These residents had varying medical conditions, such as cerebral infarction, hemiplegia, orthopedic aftercare, and required assistance with personal care, with cognitive assessments indicating that at least two were cognitively intact and able to report their experiences. Staff interviews corroborated the residents' accounts, with several employees and nurses acknowledging that CNA #1 had a reputation for being abrupt, loud, and unfriendly, though not physically abusive. The Director of Nursing (DON) and Administrator were aware of these complaints and had previously spoken to CNA #1 about her tone and demeanor, noting that disciplinary action had been taken in the past for similar grievances. Additionally, another CNA (CNA #3) was reported and disciplined for being loud, rude, and cursing in the hallway, including in the presence of residents and their families. Documentation showed that CNA #3 had a history of similar incidents, including being suspended and later terminated after repeated complaints and investigations. Observations by the surveyor further confirmed the unprofessional conduct, such as a CNA responding to questions in a rude manner and displaying an unapproachable demeanor. The DON and Administrator acknowledged the ongoing issues with staff behavior and confirmed that residents have the right to be treated with respect and kindness. The facility's failure to address these repeated concerns and ensure all residents are treated with dignity resulted in a deficiency related to resident rights and dignity.
Inaccurate PBJ Submission Leads to Low Weekend Staffing Trigger
Penalty
Summary
The facility failed to accurately submit the Payroll-Based Journal (PBJ) for the 4th quarter of the fiscal year 2024. A review of the facility's policy on reporting direct-care information revealed that staffing and census information must be reported electronically to CMS through the PBJ system, including data on staff hired directly, through an agency, and contract employees. The PBJ Staffing Data Report indicated that the facility triggered for low weekend staffing during this period. In an interview, the Director of Nursing (DON) and the Administrator confirmed that the facility was heavily reliant on agency nursing staff during this time, and some agency staff hours were not accurately submitted to the PBJ, leading to the low weekend staffing trigger.
Deficiencies in Personal Hygiene Care for Residents
Penalty
Summary
The facility failed to provide adequate personal hygiene care for five residents, as observed and confirmed through interviews and record reviews. Resident #15 was found with facial hair that had not been addressed since her admission, despite her preference for hair removal. Both a CNA and an RN Supervisor acknowledged that facial hair should be managed during bath or shower times. Resident #71 had long, jagged fingernails that had not been trimmed since his admission, which he expressed a desire to have cut. The CNA and RN Supervisor confirmed the need for regular nail care to prevent potential injuries and infections. Resident #31 was observed with excessively long fingernails and facial hair, which he wanted to be trimmed and shaved, respectively. Despite previous refusals, the DON emphasized the importance of offering grooming services regularly. Resident #55 also had long, jagged fingernails, which he preferred to be shorter. A CNA confirmed that nail care should be part of daily hygiene routines to prevent skin tears. Resident #67 had a dark brown substance under her fingernails, suspected to be feces, indicating a lack of recent nail care and hand hygiene. The LPN and CNA acknowledged the infection control concerns associated with this deficiency. The facility's policy on supporting activities of daily living, revised in March 2018, states that residents unable to perform these activities independently should receive necessary services to maintain grooming and hygiene. However, the observations and interviews revealed that the facility did not adhere to this policy, resulting in unmet personal hygiene needs for the residents involved. The deficiencies were confirmed by various staff members, including CNAs, an RN Supervisor, and the DON, highlighting a systemic issue in the facility's care practices.
Failure to Obtain Level II PASARR Status Change After Psychiatric Stay
Penalty
Summary
The facility failed to obtain a Level II Preadmission Screening and Resident Review (PASARR) status change for a resident following an inpatient psychiatric hospital stay. This deficiency was identified for one of the three PASARRs reviewed. The facility's policy, which follows the PASRR Rules of the Mississippi Division of Medicaid, requires a Level 2 PASRR evaluation to ensure residents receive appropriate psychiatric care. However, the former Social Services Director did not submit a new change of status form for the Level 2 PASARR, mistakenly believing that a negative Level I Preadmission Screening exempted the resident from further submissions. Resident #57 was admitted to the facility with diagnoses including Parkinsonism, Anxiety Disorder, Bipolar II Disorder, and Major Depressive Disorder, Recurrent. The resident's Minimum Data Set indicated a discharge status to an inpatient psychiatric facility. During interviews, the former Social Services Director acknowledged the oversight, and the Administrator confirmed that a change in status form should have been completed after the resident's psychiatric hospital stay. This oversight resulted in the failure to ensure the resident received the necessary psychiatric care evaluation.
Failure to Maintain Functioning Pressure Redistribution Mattress
Penalty
Summary
The facility failed to provide necessary services to promote healing and prevent the development of new pressure ulcers for a resident with existing wounds. The resident, who was admitted with a diagnosis of Huntington's Disease, was observed lying on a deflated air mattress, which was supposed to be a low air loss mattress for pressure redistribution. The air mattress control box was found to be off, and the mattress was completely deflated, causing the resident to lie in a sunken area of the bed. Despite the presence of staff, the deflated mattress was not reported or addressed in a timely manner. A CNA admitted to noticing the deflated mattress earlier in the morning but did not report it. An LPN confirmed the mattress was deflated and could not turn on the control box. The Maintenance Director later confirmed the control box was off and turned it on, inflating the mattress. The DON acknowledged that the resident's condition could worsen due to lying on a deflated mattress and confirmed that the CNA should have reported the issue immediately.
Medication Storage and Administration Deficiency
Penalty
Summary
The facility failed to ensure medications were safely and securely stored, as evidenced by an incident involving Resident #72. On one of the survey days, a Licensed Practical Nurse (LPN) prepared and delivered ten pills to Resident #72, leaving them on the over bed table at the resident's request. The LPN did not remain in the room to observe the resident taking the medication, which is against the facility's policy. This action was confirmed by the LPN, who acknowledged that leaving medications unattended could lead to other individuals accessing them or the resident taking them at an inappropriate time. The incident was further corroborated by a Registered Nurse (RN) Supervisor and the Director of Nursing (DON), both of whom confirmed that the facility's policy requires nurses to observe residents taking their medications to prevent potential misuse or errors. Resident #72, who was cognitively intact with a Brief Interview for Mental Status (BIMS) score of 15, had been admitted with diagnoses including Major Depressive Disorder and Anxiety Disorder. The failure to adhere to medication administration protocols posed a risk of medication errors or unauthorized access by others.
Failure to Implement ADL Care Plans for Residents
Penalty
Summary
The facility failed to implement Activities of Daily Living (ADL) care plans for five residents who were dependent on staff for assistance with personal hygiene. These residents included individuals with various cognitive impairments and physical limitations, such as weakness, impaired mobility, and poor balance. The care plans for these residents specified that they required assistance with personal hygiene tasks, including shaving and nail care, which were not adequately provided by the facility staff. Resident #15, who had moderate cognitive deficits and required assistance with personal hygiene, was observed with facial hair that had not been shaved since her admission. Similarly, Resident #71, with moderate cognitive deficits, had long, jagged fingernails that had not been trimmed as per his care plan. Resident #31, with severe cognitive impairment, also had long fingernails and facial hair that had not been addressed, despite his requests for assistance. Additionally, Resident #55 and Resident #67, both with cognitive impairments and physical limitations, were found with long, untrimmed fingernails. The staff confirmed that these residents' care plans, which included regular nail care on bath days, were not followed. The observations and interviews with staff and residents highlighted the facility's failure to adhere to the care plans, resulting in unmet personal hygiene needs for these residents.
Failure to Maintain Clean Wheelchairs for Residents
Penalty
Summary
The facility failed to maintain a clean and comfortable environment for its residents, as evidenced by the condition of wheelchairs used by three residents. Observations and interviews revealed that the wheelchairs were dirty, with a thick gray substance on the frames and spokes of the wheels. One resident's wheelchair also had cracked wheels. The facility's policy requires that resident-care equipment be cleaned and disinfected according to CDC recommendations, but this was not adhered to in practice. Interviews with staff, including a CNA and the Director of Nurses, confirmed that the responsibility for cleaning wheelchairs lies with the night shift aides, who are supposed to follow an assignment sheet. However, there was no sign-off sheet to document when the cleaning was completed. The Director of Nurses and the Administrator acknowledged the issue, confirming that the wheelchairs were indeed dirty and some required repairs. The residents involved had various medical conditions, including respiratory failure, heart failure, and cerebrovascular disease, and were either moderately cognitively impaired or cognitively intact.
Failure to Document and Address Resident Grievances
Penalty
Summary
The facility failed to document and address grievances raised by a resident and their family, as required by their grievance policy. The policy mandates that grievances can be submitted in various forms and should be investigated by the Grievance Officer, with findings communicated to the complainant. However, the facility's grievance log showed no entries for the resident in question, despite multiple complaints being made. The resident's husband reported having six meetings with the administrator about issues such as the resident being left wet or dirty for extended periods, yet no formal grievance documentation was completed. Interviews with staff, including the Director of Rehab, a Registered Nurse, and the Director of Nurses, confirmed that the resident's family frequently voiced complaints. The Director of Rehab recalled an instance where the resident needed changing before therapy, and the RN reported a complaint about noise disturbances. Despite these issues being brought to the attention of the administrator and the Director of Nurses, neither completed a formal grievance form or ensured proper follow-up, resulting in a failure to resolve the grievances effectively.
Failure to Implement Comprehensive Care Plan for Incontinent Resident
Penalty
Summary
The facility failed to ensure a comprehensive care plan was implemented for Resident #1, who was incontinent of bladder. The care plan required that the resident be checked every two hours for incontinence episodes. However, observations revealed that Resident #1 was not checked as required. At 10:50 AM, the resident was found lying in bed with a wet and saggy incontinent brief, emitting a mild odor of urine. Further observation at 11:20 AM confirmed that the brief was soaked with urine, and the resident stated he had not been changed since before breakfast. CNA #1 confirmed that the resident had not been changed since the last shift left at 7 AM that morning. Interviews with the Assistant Director of Nursing (ADON) and the Minimum Data Set (MDS) Nurse confirmed that CNAs were supposed to round on residents every two hours and report any refusals of care to the nurse. The MDS Nurse emphasized that the care plan was designed to identify the care each resident needed and put individualized interventions in place. The failure to check on Resident #1 every two hours as required by the care plan indicated that the care plan was not followed, leading to the deficiency.
Failure to Provide Timely ADL Care
Penalty
Summary
The facility failed to ensure Activities of Daily Living (ADL) care was completed for a dependent resident. During an observation, Resident #1 was found lying in bed with a wet and sagging incontinent brief, emitting a mild odor. The resident confirmed that he had not been changed since before breakfast, and CNA #1 admitted that she had not changed him since the last shift left at 7 AM because he was sleeping. The Assistant Director of Nursing (ADON) and the Director of Nursing (DON) confirmed that CNAs are required to check on residents every two hours, even if they are asleep, to prevent skin breakdown and other complications. Resident #1, who has diagnoses including Huntington's Disease, Spina Bifida, and a Stage 3 Pressure Ulcer of the Right Hip, was left wet for an undetermined amount of time. The ADON and DON both emphasized that it is unacceptable for a CNA to leave a resident without checking and changing them for over four hours. The facility policy requires that residents who are unable to carry out ADLs independently receive the necessary services to maintain good nutrition, grooming, and personal hygiene, which was not adhered to in this case.
Latest citations in Mississippi
A resident with advanced dementia and severe cognitive impairment sustained a bruised left eye and facial bruising after being struck by a CNA. The CNA initially claimed the injury occurred accidentally while pushing the resident to a dining table and denied hitting the resident, but an LPN and another CNA reported that the resident stated she had hit the CNA and was hit back in the eye, demonstrating a slapping motion. Nursing documentation described left orbital ecchymosis, bruising along the bridge of the nose and cheek, tenderness, minimal edema, and the resident’s complaint of soreness, confirming a significant injury resulting from the physical abuse.
The facility failed to protect residents’ right to a dignified and comfortable environment when it did not effectively manage one cognitively impaired resident’s ongoing nighttime yelling, which repeatedly disrupted the sleep of two cognitively intact residents. Staff, including a CNA, the DON, and the Administrator, were aware that this resident, diagnosed with dementia and psychosis, frequently yelled and screamed at night while often sleeping during the day. Progress notes documented nighttime hollering, and interviews confirmed that the disruptive behavior persisted over time, interfering with other residents’ ability to rest.
Surveyors found that the facility failed to protect two residents’ rights to dignity and privacy during routine care. One resident, with moderate cognitive impairment and dependent for toilet hygiene, was observed receiving incontinence care while uncovered, with the room door open and the privacy curtain only partially drawn, allowing visibility into the hallway despite facility policy requiring full privacy. Another resident, dependent for eating and with hemiplegia after a stroke, was assisted with lunch by a CNA who stood over the resident instead of sitting at eye level as required by the facility’s feeding skills checklist. Staff interviews, including with CNAs, an LPN, the DON, and the Administrator, confirmed that existing policies and in-service training directed staff to provide privacy during incontinence care and to sit beside residents when assisting with meals to ensure dignified care.
A resident with epilepsy, skin infection, an upper arm wound, gastrostomy status, and moderate cognitive impairment was observed twice resting in bed with a lunch tray while the call light was not within reach—once on the floor under the bed and once hanging behind the mattress, out of sight. The resident reported being able to use the call light but not knowing where it was. Staff, including CNAs, an LPN, the DON, and the Administrator, stated that call lights are expected to be left within residents’ reach and that training and competencies address this requirement, but there was no specific written policy on call light placement.
A resident with moderate cognitive impairment, dependent for toilet hygiene and with multiple medical conditions, was observed receiving incontinent care in which a CNA removed a urine-soaked brief, changed the bed sheet, and applied a clean brief without performing any required perineal cleansing of the front or back. Facility policy and the peri-care skills checklist specified that male residents must have the perineal area, including the penis, scrotum, and inner thighs, washed, rinsed, and dried during incontinent care. The CNA later acknowledged having been trained and competency-checked on this procedure and knowing cleansing was required. Other staff, including a CNA supervisor, an LPN, the DON, and the Administrator, confirmed that proper incontinent care includes full perineal cleansing in addition to brief changes, establishing that the observed omission did not follow facility policy or professional standards intended to prevent UTIs.
Surveyors found that staff failed to follow infection control practices during PEG tube and wound care. Two residents with PEG tubes had sites with visible brown, crusted or yellowish drainage that had not been cleaned for several days, despite physician orders for daily cleansing and, when indicated, dressings. In another case, a CNA provided peri-care for stool and then assisted with a stage IV sacral pressure ulcer dressing change without changing gloves or performing hand hygiene, contrary to facility policy and staff expectations for aseptic technique.
Surveyors found that the facility failed to maintain a safe, clean, and homelike environment when a resident’s room contained odorous soiled linens left on the floor and later placed on furniture with clean clothing, and the bed was made with torn linens exposing the mattress. Other residents reported that housekeeping did not clean under beds, and multiple large dead roaches were repeatedly observed under several beds, with one resident stating he often disposed of dead roaches himself. Residents also reported refusing to use the north shower room due to dirty clothing, feces, and residue on shower chairs and floors; an observation confirmed the presence of soiled clothing, a soiled brief, and unidentified substances on the shower chair and floor, despite staff acknowledging that CNAs were expected to clean and sanitize the shower room after each use.
The facility failed to maintain an effective pest control program, as evidenced by repeated observations of roaches and other insects in multiple resident rooms and common areas. Surveyors found gnats and dead roaches under beds, while several residents reported seeing roaches on ceilings, walls, and floors, including roaches falling onto them at night and having to remove dead roaches themselves. A family member reported bringing her own roach spray due to concerns about roaches in a loved one’s room. During a Resident Council meeting, roaches were seen crawling across the floor, and residents stated that roaches were commonly observed throughout the building. Although the contracted pest control provider reported monthly service focused mainly on entry points and exterior areas and facility staff described processes for reporting pests, the persistent roach activity showed the program was not effectively preventing or controlling pests.
A resident with multiple chronic conditions, who relied on phone contact with a seriously ill significant other, lost access to private communication after her personal cell phone was broken and sent out for repair. Facility policy guarantees residents access to a telephone and private communication, but there was no cordless phone available on the relevant hall, and staff, including the DON, SSD, and Administrator, confirmed there was no convenient method for residents on that hall to make private calls without arranging to use a staff office. This resulted in the resident having no readily available, private telephone option.
A resident with heart failure, chronic kidney disease, hypertension, moderate cognitive impairment, and total dependence on staff for personal and toilet hygiene reported difficulty obtaining assistance with ADLs. Observation revealed the resident had ten long, dirty fingernails extending several millimeters beyond the fingertips with black material underneath, and the resident stated they needed cleaning and cutting. An LPN confirmed the nails were too long and dirty, acknowledged that nursing staff were responsible for daily and weekly fingernail checks and for providing fingernail care as part of ADLs, and noted that such nails could cause skin damage or scratches. The DON and Administrator both confirmed that personal hygiene and grooming are part of ADLs and are expected to be provided for all residents dependent on staff.
Failure to Protect Cognitively Impaired Resident From Physical Abuse by CNA
Penalty
Summary
The deficiency involves the facility’s failure to protect a resident from abuse, resulting in the resident being struck in the eye by a CNA. Facility records show that a CNA reported to an LPN that the resident had a bruised left eye and initially stated the injury may have occurred while pushing the resident to the dining table due to the resident’s short, stooped posture. The CNA also reported that the resident used a racial slur toward her and that she verbally responded but denied striking the resident. However, subsequent interviews and the facility’s investigation determined that the resident’s injury was not caused by accidental contact with the dining table. Interviews with staff revealed conflicting accounts that led to the conclusion that the resident had been hit. An LPN stated that the resident reported being hit in the eye by the CNA and that another CNA heard a commotion and later observed bruising to the resident’s left eye. When this second CNA asked what happened, the resident reported that she hit the CNA and was hit back in the eye, while making a motion consistent with a slap. The LPN confirmed that the resident gave a similar account to her, indicating that the CNA had physically struck the resident. The resident involved was admitted to the Memory Care Unit with diagnoses including Alzheimer’s disease, cognitive communication deficit, and unspecified dementia with behavioral disturbance, and had a BIMS score of 5 indicating severe cognitive impairment. A nursing progress note documented an acute follow-up assessment of left orbital ecchymosis, describing a dark red circular bruise to the left eye region, dark purple bruising along the lateral bridge of the nose extending to the superior left cheek, tenderness on palpation, minimal edema, and the resident’s complaint that the area was sore. Due to advanced Alzheimer’s disease, the resident was unable to reliably express additional symptoms, but the documented physical findings supported that the resident sustained a significant injury to the eye area as a result of being struck by the CNA.
Failure to Protect Residents’ Right to Rest Due to Unmanaged Nighttime Yelling
Penalty
Summary
The deficiency involves the facility’s failure to ensure a dignified and comfortable environment by not effectively addressing ongoing disruptive nighttime behaviors of one resident that interfered with other residents’ ability to rest. Resident #1, admitted with diagnoses including Psychosis and Dementia and a BIMS score of 4 indicating severely impaired cognition, had documented episodes of hollering and yelling during nighttime hours, as noted in progress notes on 3/12/26 and 3/13/26. Interviews with cognitively intact residents, Resident #2 and Resident #3 (both with BIMS scores of 15), revealed that they frequently experienced disrupted sleep due to Resident #1 yelling loudly at night, while the environment was generally quiet during the day. Staff interviews confirmed awareness of the pattern of behavior. CNA #1, who worked both day and night shifts, reported that Resident #1 frequently yelled and screamed at intervals throughout the night and was generally quiet and often slept during the day, with staff assisting the resident out of bed into a geri-chair during both day and nighttime hours. The DON acknowledged the facility was aware of Resident #1’s increased nighttime yelling and extended daytime rest, attributing it to the resident’s Dementia and Psychosis, and stated that interventions such as monitoring, repositioning, offering care, and attempts at redirection had not stopped the behaviors. The Administrator also confirmed awareness of concerns that nighttime noise from Resident #1 affected other residents’ ability to rest. Despite this awareness and ongoing complaints from other residents, the disruptive nighttime yelling continued, resulting in a failure to uphold residents’ rights to a dignified existence and a comfortable environment.
Failure to Ensure Privacy and Dignified Care During Incontinence Care and Feeding
Penalty
Summary
The deficiency involves the facility’s failure to ensure residents were treated with dignity and provided privacy during care, as required by resident rights policies and skills checklists. The facility’s Nursing Facility Resident Rights policy guaranteed residents the right to be treated with dignity, courtesy, and respect, and to have privacy during personal care. Facility skills checklists for feeding and peri/incontinent care specified that staff should sit facing residents at eye level when feeding and provide privacy by drawing curtains and closing doors during incontinence care. For Resident #2, surveyors observed a CNA providing incontinent care without closing the resident’s room door and with the privacy curtain only partially drawn. From the surveyor’s position at the bottom right corner of the bed, it was possible to see into the hallway while the resident was uncovered and exposed. Resident #2’s records showed admission with diagnoses including epilepsy, infection of the skin and subcutaneous tissue, an open wound of the left upper arm, and gastrostomy status. A recent MDS assessment documented a BIMS score of 11, indicating moderate cognitive impairment, and that the resident was dependent for toilet hygiene. The CNA later confirmed awareness that incontinence care required provision of privacy and that she had been trained and competency-checked on this requirement. For Resident #3, surveyors observed a CNA assisting the resident with eating while standing over the resident rather than sitting beside her, contrary to the facility’s feeding skills checklist and training. The DON intervened during the observation and instructed the CNA that staff were to sit next to residents while assisting with eating. The CNA stated she had forgotten to sit beside the resident. Resident #3’s records showed recent admission with diagnoses of cerebral infarction (stroke), anemia, and hemiplegia and hemiparesis affecting the right dominant side, and a baseline care plan indicating the resident was dependent for eating. Other staff interviews, including with a CNA supervisor, an LPN, the DON, and the Administrator, confirmed that staff were trained at least monthly on residents’ rights, respectful and dignified care, provision of privacy during incontinence care, and the expectation that staff sit beside residents when assisting with eating.
Failure to Maintain Accessible Call Light for a Resident
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident’s call light was maintained within reach as required by the facility’s feeding skills checklist. The skills checklist for feeding a resident specifies that staff must leave the call light within the resident’s reach after feeding. For Resident #2, surveyors observed on two separate occasions that the call light was not accessible. On one observation, the resident was awake in bed with a lunch tray on the overbed table, and the call light was found lying on the floor under the head of the bed. The resident stated he could use his call light but did not know where it was. On a subsequent observation, Resident #2 was again in bed with a lunch tray in front of him, and the call light was hanging behind the mattress at the head of the bed, out of his sight and reach. The resident again stated he could use the call light but did not know where it was. Record review showed the resident had epilepsy, an infection of the skin and subcutaneous tissue, an open wound of the left upper arm, gastrostomy status, and a BIMS score of 11 indicating moderate cognitive impairment. Staff interviews with CNAs, an LPN, the DON, and the Administrator confirmed that call lights were expected to be within residents’ reach and answered timely, and that staff had received in-service training and competency checks on leaving call lights within reach. The Administrator also confirmed there was no specific written policy regarding call light placement.
Failure to Provide Required Perineal Cleansing During Incontinent Care
Penalty
Summary
The deficiency involves the facility’s failure to provide incontinent care in accordance with its own peri-care policy and professional standards of practice for a male resident who was dependent for toilet hygiene. The facility’s written policy for peri/incontinent care for male residents, revised in January 2023, required cleansing of the perineal area starting at the urethra and working outward, including washing and rinsing the penis, scrotum, inner thighs, and perineal area front and back, followed by thorough drying. Record review showed the resident had diagnoses including epilepsy, infection of the skin and subcutaneous tissue, an open wound of the left upper arm, and gastrostomy status, and a Quarterly MDS with a BIMS score of 11 indicating moderate cognitive impairment, with the resident assessed as dependent for toilet hygiene. On the observed date and time, CNA #1 provided incontinent care to this resident by removing a wet urine-soaked brief, changing the fitted sheet, and applying a clean, dry brief without cleansing the resident’s perineal area, front or back, contrary to facility policy. During a subsequent interview, CNA #1 acknowledged she had received in-service training and competency check-offs on peri-care and knew she was supposed to cleanse the perineal area but did not do so, stating she was nervous. Additional interviews with CNA #2 (CNA supervisor and scheduler), an LPN, the DON, and the Administrator confirmed that staff were trained using the Peri Care–Incontinent Care Skills Checklist and that proper incontinent care includes cleansing the perineal area, front and back, in addition to changing the brief. The failure to perform the required cleansing during incontinent care constituted the cited deficiency related to prevention of urinary tract infections.
Failure to Maintain Infection Control Practices During PEG Tube and Wound Care
Penalty
Summary
The deficiency involves the facility’s failure to implement its infection prevention and control program by not maintaining aseptic technique and not providing ordered dressing changes for residents with PEG tubes and a sacral pressure injury. Facility policies on infection control and clean dressing changes required wound care to be provided in a manner that decreases the potential for infection and cross-contamination, including removal of soiled dressings with gloves, discarding gloves, performing hand hygiene, and donning clean gloves before continuing care. The peri-care audit tool also required glove removal, hand hygiene, and re-gloving after peri-care. These standards were not followed during multiple observed care episodes. For one resident with a PEG tube and diagnoses including Alzheimer’s disease, functional quadriplegia, and gastrostomy status, surveyors observed the PEG tube site without a dressing and with a yellowish-brown substance beneath and around the external skin disk extending about one-fourth inch onto surrounding skin. A CNA and an LPN both confirmed there was no dressing in place and acknowledged the drainage at the site. The LPN stated PEG tube site care should be completed daily and as needed for increased drainage and acknowledged that, with no dressing and the amount of drainage present, there was no way to tell when the site was last cleaned. Record review showed a physician order, effective several months prior, for daily cleansing of the PEG tube stoma with normal saline, patting dry, and applying a dry drain dressing to avoid skin breakdown. For another resident with severe protein-calorie malnutrition and gastrostomy status, the PEG tube site was observed with thick brown, crusted substance beneath the external skin disk extending approximately one-half to three-fourths of an inch to the surrounding area. The resident reported the site had not been cleaned in about three days and later stated they might have to clean it themselves. Follow-up observations confirmed the site remained unclean with visible drainage, and an LPN and the DON both confirmed the presence of thick, brown drainage and that the site had not been cleaned in several days, despite an order for daily cleansing with soap and water, rinsing, patting dry, and leaving open to air or applying a dry dressing if drainage was present. In a separate observation involving a resident with a stage IV sacral pressure ulcer and severe cognitive impairment, a CNA provided peri-care for stool soiling, then immediately assisted with wound care using the same gloves worn during peri-care, without performing hand hygiene or changing gloves. The CNA, treatment nurse, DON, and ADON all acknowledged that hand hygiene and glove change should have occurred between peri-care and wound care and that this represented an infection control concern.
Failure to Maintain Clean Resident Rooms and Shower Facilities
Penalty
Summary
The deficiency involves the facility’s failure to provide a safe, clean, comfortable, and homelike environment, as required by its Resident Rights & Quality of Life Policy. For one resident, surveyors observed a bag of odorous soiled linens resting on the floor of the room, and the resident’s bed was made with a bedspread that had a football-sized hole exposing the mattress. The resident, who was cognitively intact with a BIMS score of 14 and had Type 2 Diabetes Mellitus, reported that it was not unusual for bags of soiled linens to be left on the floor and for bedding to be damaged. A CNA confirmed that soiled linens were commonly left in bags on the floor after morning care and that torn bedding should not be used, and later placed the bag of soiled linens on the resident’s furniture where his clean clothing was hanging. The resident remained upset the following day, and a dead roach was observed under his bed near the headboard. Additional deficiencies were identified in other resident rooms. One resident with End Stage Renal Disease and a severely impaired cognition (BIMS score of 5) reported that housekeeping did not clean under the bed; surveyors observed three large dead roaches under the bed, which remained there the following day. When the Housekeeping Supervisor later observed the room, five dead roaches were present under the bed, and he stated the area should not have been in that condition. Another resident, with a diffuse traumatic brain injury and a moderately impaired cognition (BIMS score of 10), reported frequently picking up and disposing of dead roaches himself because staff did not remove them, and a large dead roach was observed under his bed. The facility also failed to maintain a clean and sanitary north shower room. During a Resident Council interview, multiple cognitively intact and moderately impaired residents reported refusing to use the shower room due to cleanliness concerns, including observations of dirty clothing, feces, and residue on shower chairs and floors. A housekeeper stated that while she cleaned the shower rooms multiple times a day, CNAs were responsible for cleaning and sanitizing the shower room after each use and that she had observed occasions when CNAs failed to do so. A subsequent observation of the north shower room revealed soiled clothing, including a soiled brief, on a shower chair, a yellow fluid-like substance on the floor and shower chair, and a white powdery substance on the floor, with no staff present. The Social Services Assistant, DON, and Administrator each acknowledged that staff were expected to clean and sanitize the shower room after each use.
Ongoing Roach Activity Demonstrates Ineffective Pest Control Program
Penalty
Summary
The facility failed to maintain an effective pest control program as required by its pest control policy dated 9/1/2014, which states the center will maintain an ongoing program to keep the building free of insects and rodents. Surveyors observed multiple instances of roach and insect activity in resident rooms and common areas. In one cognitively intact resident’s room, gnats were seen flying and a dead roach was later found under the bed near the headboard. Another resident’s room contained three large dead roaches under the bed on two consecutive days; this resident reported that roaches were regularly seen in the room, especially at night, crawling on the ceiling and falling onto him and his roommate, and that staff had been notified but he had not seen staff respond to assess or treat the issue. A third resident reported seeing roaches on the ceiling and under the bed and stated he often removed dead roaches himself because staff did not; a large dead roach was observed under his bed. A family member of another resident reported feeling it was necessary to bring her own roach spray due to concerns about roaches in the resident’s room and stated she was told she could not keep the spray in the room, expressing concern that the roach problem needed to be addressed. During a Resident Council meeting, two large roaches were observed crawling across the floor, and residents reported that roaches were commonly seen in rooms and common areas, including on walls, ceilings, and floors, particularly at night. The contracted pest control provider reported he provides monthly services, focusing on different areas each visit, primarily treating entry points and exterior areas, and stated he had not personally observed roaches and received only occasional complaints. Facility leadership, including the housekeeping supervisor, DON, and Maintenance Director, described expectations that staff report pest sightings and that pest control services are available monthly and as needed, but the ongoing presence of roaches and dead insects in resident rooms and common areas demonstrated that the pest control program was not effectively preventing or controlling pests.
Failure to Ensure Resident Access to Private Telephone Communication
Penalty
Summary
The facility failed to ensure a resident’s right to reasonable access to and privacy in the use of a telephone for communication. Facility policy on Resident Rights, revised December 2016, states that residents are guaranteed access to a telephone, mail, and email, and the ability to communicate in person and by mail, email, and telephone with privacy. Resident #1 was admitted on 12/18/24 with diagnoses including Sjogren syndrome, rheumatoid arthritis, chronic kidney disease, and morbid obesity. During an interview, the resident reported that she had dropped and broken her personal cellular telephone, which she had used for private communication, and that the facility did not have any telephone that was convenient for her to use privately. She stated that no staff had offered her the use of a staff office or any other mechanism for private communication, and she was upset because she relied on telephone contact with her significant other, who had cancer and was unable to visit. Observations and staff interviews confirmed the lack of accessible, private telephone options for residents on South Hall. An observation on the 100 Hall revealed there was no cordless telephone available for resident use. The DON confirmed that the facility did not have a method to provide residents on South Hall with private communication without first making arrangements or an appointment to use a staff office, and that the cordless telephones in the facility did not have sufficient range to reach South Hall. The SSD confirmed there were no cordless telephones at the South Hall nurses’ station that could be taken to residents’ rooms and acknowledged that Resident #1’s cell phone had been broken and sent out for repair. The Administrator also confirmed that residents on South Hall did not have a method for private communication without prior arrangements and acknowledged that access to private communication is a guaranteed resident right.
Failure to Provide Adequate ADL Assistance for Personal Hygiene
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs) to maintain personal hygiene for one resident who was dependent on staff for care. Facility policy on ADLs, revised March 2018, stated that residents unable to carry out ADLs independently would receive services necessary to maintain good grooming and personal and oral hygiene. Record review showed the resident was admitted with heart failure, chronic kidney disease, and hypertension, had a BIMS score of 12 indicating moderate cognitive impairment, was always incontinent of bowel and bladder, and required substantial/maximal assistance for personal hygiene and was dependent for toilet hygiene. A complainant reported that the resident had expressed difficulty getting staff to provide assistance with ADLs. During an observation and interview with the resident, accompanied by an LPN, the resident reported ongoing difficulty obtaining assistance with ADLs. The surveyor observed that the resident had ten long, dirty fingernails protruding 3.0 to 3.5 millimeters past the fingertips, with a black substance beneath all fingernails; the resident stated they needed cleaning and cutting and were too long. The LPN described the fingernails as too long and dirty, confirmed that nursing staff were responsible for checking fingernails daily during care and weekly during body audits, and acknowledged that staff were responsible for providing fingernail care as part of ADLs. The LPN also confirmed that long, dirty, unkempt fingernails had the potential to cause damage or scratches to the resident’s skin. The DON stated she was not aware of any complaints from the resident but confirmed her expectation that ADLs for residents dependent on staff for personal hygiene would be maintained and provided as needed, and that licensed nurses trimmed fingernails for some residents while any nursing staff could clean under fingernails. The Administrator confirmed that personal hygiene and grooming were part of resident ADLs and were expected to be provided for all dependent residents.
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