Citations in Mississippi
Statistics, citations and compliance trends for long-term care facilities in Mississippi.
Statistics for Mississippi (Last 12 Months)
Financial Impact (Last 12 Months)
Latest citations in Mississippi
A resident was transported from dialysis in a wheelchair that was not secured in the van. When the CNA lowered the lift gate and turned away, the resident rolled backward out of the van, struck his head on the ramp, and sustained head and arm injuries requiring ED evaluation. The resident had CKD stage 4 and hemiplegia, and the ED record documented head and arm contusions, a skin tear, and a small posterior head laceration.
Failure to provide required written transfer notice: A resident with respiratory failure and hypoxia was sent to a hospital with return anticipated, but the resident representative did not receive written notice with the reason for transfer, effective date, and destination. The BOM said she believed the resident was being discharged rather than transferred, and the Administrator confirmed the notice was not provided.
Failure to develop and implement comprehensive care plans: one resident with an active UTI had no care plan interventions for the new diagnosis despite a physician order for antibiotics, and another resident’s oxygen therapy care plan and physician order called for 3 L via NC, but staff observed and confirmed the resident was receiving only 2 L. RN and DON interviews confirmed care plans were expected to guide staff care and include interventions for new diagnoses.
A resident with CHF and COPD had a physician order for oxygen at 3 L/min via NC, but staff observed the resident receiving oxygen at 2 L/min on multiple occasions. An LPN confirmed the mismatch and stated there was no order authorizing the lower flow rate, while the MAR documented oxygen as being given at 3 L/min on those same dates.
Missing Separate Charge Nurse on Evening Shift: The facility failed to designate a separate charge nurse for the 3:00 PM to 11:00 PM shift, instead having the medication/treatment nurse also serve as charge nurse. The Staff Reporting Form showed no designated charge nurse for three reviewed shifts, and the DON and Administrator both confirmed this practice during interview, despite the state standard requiring a charge nurse to supervise total nursing activities on that shift.
A resident with dementia and severe cognitive impairment was found in bed with a flat sheet tied across her torso from side rail to side rail, restricting movement without a physician order. An RN removed the sheet and found no injury or distress. The CNA later stated she used the sheet to keep the resident from getting out of bed while staff were rounding, and the DON confirmed the resident’s care plan addressed supervision and fall prevention without restraints.
Unsafe wheelchair transport led to resident fall and injury
Penalty
Summary
The facility failed to ensure a resident was transported safely and that appropriate safety devices were used to prevent an accident for one of two residents reviewed for accidents, Resident #11. Resident #11, who had diagnoses including Chronic Kidney Disease stage 4 and hemiplegia affecting the left nondominant side, was transported in a wheelchair that was not secured with a wheelchair restraint or securement system in the facility van. When the lift gate was lowered, the resident rolled backward out of the van, struck his head on the ramp, and sustained a laceration to his arm and head that required emergency-room evaluation. Record review showed the emergency physician documented a fall during a wheelchair transfer with headache, left elbow injury, head contusion, left arm contusion, a skin tear to the left elbow, and a small laceration to the posterior head. The resident stated he fell out of the van after returning from dialysis when the CNA lowered the lift gate and walked toward the front of the van. The Administrator reported reviewing camera footage and observing the CNA turn her back after lowering the lift gate, at which time the resident fell backward out of the van. The CNA stated the resident's wheelchair was not secured with a safety buckle and that he was wedged against the lift gate, while the Housekeeping Supervisor confirmed the van was designed to transport one wheelchair and that the resident was not properly secured during transport.
Failure to Provide Required Written Transfer Notice
Penalty
Summary
The facility failed to provide the resident representative with written notice containing the required transfer information when a resident was transferred to the hospital with return anticipated. The facility policy, Transfer or Discharge Notice, required written notification to include the specific reason for the transfer or discharge, the effective date of the transfer, and the location to which the resident was being transferred or discharged. Resident #38 was admitted with diagnoses including respiratory failure with hypoxia and had a BIMS score of 15, indicating cognitive intactness. The record showed the resident was discharged to a short-term general hospital with return anticipated, and a physician order was written for discharge to a local hospital. However, the medical record did not contain documentation that the resident representative received the required written transfer notice for the hospitalization. During interviews, the BOM acknowledged she did not provide the written transfer notice because she believed the resident was being discharged rather than transferred with return anticipated, and the Administrator confirmed the resident representative did not receive the notice.
Failure to Develop and Implement Comprehensive Care Plans
Penalty
Summary
The facility failed to develop a comprehensive person-centered care plan for a resident with an active UTI. The resident was admitted with diagnoses including Type 2 Diabetes Mellitus and UTI, and after a hospital evaluation received instructions for a female UTI and a physician order for Cephalexin 500 mg four times daily for 10 days. Review of the comprehensive care plan showed no designated care plan with interventions related to the new diagnosis of UTI. An RN stated that floor nurses were responsible for entering care plans for new physician orders and confirmed that the resident returned from the hospital with antibiotics and a UTI diagnosis, but no care plan had been developed with a problem or focus for UTI. The DON stated that care plans were expected for residents with new diagnoses and should include interventions for staff to follow. The facility also failed to implement an existing comprehensive care plan for oxygen therapy for another resident. The care plan directed oxygen at 3 L via nasal cannula to maintain O2 greater than 92% and to obtain O2 saturation every shift, and the physician order also specified oxygen at 3 L per minute via nasal cannula. During two observations, the resident was receiving oxygen at 2 L per minute instead of the ordered 3 L per minute. An LPN confirmed the lower flow rate, reviewed the physician order, and acknowledged there was no order authorizing the discrepancy. An RN confirmed staff were expected to implement the interventions in the comprehensive care plan, and the Administrator confirmed staff were expected to verify oxygen flow rates, follow physician orders, notify the physician of discrepancies, monitor residents receiving oxygen therapy, and implement the resident's comprehensive care plan.
Oxygen Flow Rate Did Not Match Physician Order
Penalty
Summary
The facility failed to provide care and services in accordance with physician orders by administering oxygen at a flow rate different from the ordered therapy for one resident reviewed for oxygen use. Resident #28, who was admitted with diagnoses including congestive heart failure and chronic obstructive pulmonary disease, had a physician order dated 03/09/26 for oxygen at 3 liters per minute via nasal cannula. The resident’s quarterly MDS showed a BIMS score of 15, indicating the resident was cognitively intact. During observations on 07/28/26 and 07/29/26, Resident #28 was receiving oxygen via nasal cannula at 2 liters per minute. On 07/29/26, an LPN confirmed the resident was receiving oxygen at 2 liters per minute, reviewed the physician order, and verified that the prescribed flow rate was 3 liters per minute; the LPN stated there was no physician order authorizing the lower flow rate and could not explain the discrepancy. The MAR for July 2026 documented oxygen was administered at 3 liters per minute on the same dates the resident was observed receiving 2 liters per minute. The Administrator later confirmed staff were expected to verify oxygen flow rates, follow physician orders, notify the physician of discrepancies, and monitor residents receiving oxygen therapy.
Missing Separate Charge Nurse on Evening Shift
Penalty
Summary
The facility failed to comply with state nursing facility staffing requirements by not designating a charge nurse responsible for supervision of the total nursing activities during the 3:00 PM to 11:00 PM shift, separate from the medication/treatment nurse assignment, for three reviewed shifts. The facility policy titled, Staffing, stated that the facility maintains adequate staffing on each shift to ensure residents' needs and services are met. However, the Staff Reporting Form showed no designated charge nurse for the 3:00 PM to 11:00 PM shift on 07/28/26, 07/29/26, or 07/30/26. The Minimum Standards for Institutions for the Aged or Infirm for Rule 45.4.1 Nursing Facility required a registered nurse or licensed practical nurse to serve as charge nurse and be responsible for supervision of the total nursing activities during the 7:00 AM to 3:00 PM and 3:00 PM to 11:00 PM shifts. During interview, the DON stated he served as charge nurse until approximately 4:30 PM on some days and then the medication/treatment nurses also served as charge nurses after that time. The DON acknowledged the facility did not designate a separate charge nurse from the medication/treatment nurse role and was unaware the standard required a designated charge nurse separate from the medication/treatment nurse assignment for the 3:00 PM through 11:00 PM shift. The Administrator confirmed the medication/treatment nurses also served as charge nurses during that shift and stated the purpose of a separate charge nurse was to provide supervision of nursing services while allowing the medication/treatment nurse to focus on medication administration and treatments.
Unauthorized Sheet Used as a Physical Restraint
Penalty
Summary
The facility failed to ensure a resident was free from the use of a physical restraint when a flat sheet was tied from one side rail to the other across the resident’s torso while she was in bed. The resident had diagnoses of dementia, hypertension, and anxiety, and the most recent MDS indicated no BIMS score, severely impaired cognitive skills for daily decision making, and dependence for bed mobility, surface-to-surface transfers, and all activities of daily living. According to the incident and investigation records, an RN observed the resident restrained in bed with the sheet secured across her body. The sheet was removed immediately, and the resident was assessed with no injury or distress. The facility’s investigation identified that the restraint had been applied by a CNA during the night shift after the resident was transferred from a geri recliner to bed. The CNA stated she folded a flat sheet and tied it to the quarter side rails across the resident’s torso to keep her from getting out of bed while staff were rounding on other residents, and she acknowledged that it was a restraint. The resident did not have a physician’s order for any restraint, and the DON confirmed that the resident’s care plan addressed supervision and assistance for safety and fall prevention without the use of restraints. The facility records also show that the CNA was terminated for the unauthorized use of a physical restraint and violation of resident rights, and the Administrator and DON stated that the action violated facility policy and resident rights.
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Compliance trends in Mississippi
Data through Jun 2026Comparisons below measure the most recent period Jul 2025 – Jun 2026 against the prior period Jul 2024 – Jun 2025 (two equal 12-month windows). The most recent 1 months are excluded because CMS is still publishing them.
Top tags by month · last 24 months
dashed = still reportingMonthly citation counts for the 5 most-cited tags. The dashed tail is the 1-month reporting lag.
Frequency movers
Biggest change in how often each tag is cited, as a rate per 100 inspections (so it isn't skewed by survey volume): Jul 2025 – Jun 2026 vs the prior period Jul 2024 – Jun 2025. Only tags with at least 20 citations in both periods are shown.
Severity movers
Tags whose average scope/severity shifted the most: Jul 2025 – Jun 2026 vs the prior period Jul 2024 – Jun 2025. The number is the average severity on the A–L scale (A=0…L=11); the letter is the band it falls in. A rise means the same tag is being cited at a more serious level — note the average can move enough to rank here while staying within the same letter. Same 20-citation minimum applies.
Care domain movers
Citations grouped into CFR care domains — F-tags by their §483 regulatory section (CMS State Operations Manual, Appendix PP) — measured as a rate per 100 inspections: Jul 2025 – Jun 2026 vs the prior period Jul 2024 – Jun 2025. Share is the domain's portion of citations this period; avg severity is the mean scope/severity letter and immediate jeopardy the percentage cited at J–L, both over the current period. Domains with at least 20 citations in both periods are shown; the sparkline tracks the last 12 months (left = oldest).
Immediate jeopardies · this period
Citations at the most serious scope/severity — J–L, immediate jeopardy, residents placed at risk of serious harm or death — over Jul 2025 – Jun 2026 vs the prior period Jul 2024 – Jun 2025. "Surveys with an IJ" counts distinct health inspections that had at least one.
Survey activity · by month
faded/dashed = still reportingCitations each month split into complaint-driven (unscheduled, triggered by grievances) vs standard surveys — bars, left axis — with the number of inspections as a line on the right axis. Rising inspections signal more scrutiny; a rising complaint share means more off-cycle surveys. The most recent 1 months are still being reported.
Deficiency-free survey rate
Share of health surveys that found zero deficiencies — the odds of a clean survey. Jul 2025 – Jun 2026 vs the prior period Jul 2024 – Jun 2025; the most recent 1 months are still being reported (dashed).
Penalties · by month
faded = still reportingTotal civil money penalty dollars imposed on the state's facilities each month — how hard the state is enforcing. The most recent 1 months are still being reported, and penalties often lag citations by several months.
Emerging tags
Tags that weren't established last period but surged — an early warning, distinct from movers (which track already-common tags). Criteria: fewer than 20 citations in the prior period, but at least 10 this period and 2.5× their prior volume. The sparkline shows monthly counts over the last 12 months (left = oldest).
Trusted data from CMS and state health departments
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