F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited
to receiving treatment and supports for daily living safely.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observations and interview, the facility failed to maintain a safe and clean environment for 7 of 62 occupied
rooms. (Rooms 314, 316, 404, 405, 407, 409, 411)
The findings include:
On 2/19/24 at 12:30 PM, during the initial tour of the facility, the following environmental issues were
observed:
In occupied room [ROOM NUMBER], a rusted toilet seat riser was in use inside the bathroom.
In occupied room [ROOM NUMBER], the drawer and armoire had layers of paint peeling.
In occupied room [ROOM NUMBER], a brown substance was observed on the wall.
In occupied room [ROOM NUMBER], the dresser and armoire had peeled off layers of paint and there was
a hole on the wall.
In occupied room [ROOM NUMBER], the wall and ceiling had bubbled paint and a water-like stain around
the ceiling and air conditioning unit.
In occupied room [ROOM NUMBER], there was paint peeling on the wall and the toilet seat riser inside the
bathroom was rusted.
In occupied room [ROOM NUMBER], there was a rusted toilet seat riser inside the bathroom.
(Photographic evidence was obtained of all above issues)
On 2/22/24 at 10:15 AM, a follow up tour was conducted with the Maintenance Director. He stated the toilet
seat risers in rooms 314, 409 and 411 will be replaced with new ones. He further stated the peeling layers
on the furniture on room [ROOM NUMBER] will be fixed and the hole on the wall repatched and paint over,
as well as the brown-colored stain on room [ROOM NUMBER] will be cleaned and painted over. Upon
looking at the bubbled paint on rooms [ROOM NUMBERS], he stated the facility will need to investigate the
cause of it and will make some repairs.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Facility ID:
If continuation sheet
Page 1 of 2
Event ID:
105970
Printed: 05/28/2026
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
105970
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/22/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Marianna Nursing and Care Center
2600 Forest Glen Trail
Marianna, FL 32446
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 0693
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and
provide appropriate care for a resident with a feeding tube.
Based on observations, staff interviews, and resident record review, the facility failed to implement and
follow the recommendations of the Registered Dietician (RD) for 1 of 1 residents sampled for enteral
feeding. (Resident #64)
The findings include:
On 02/21/24 at 9:05 AM, an interview with Staff B, a Licensed Practice Nurse (LPN), was conducted. Staff
B stated that Resident #64's used to receive continuous enteral feeding (24 hours a day). She stated the
enteral feeding was changed some time in January 2024. Resident #64's Treatment Administration Record
(TAR) was reviewed with Staff B. The TAR revealed, on 01/11/2024, an entry for Jevity 1.5 (a nutritional
supplement) to be infused at 65 ml/hr for 20 hours a day (to be discontinued between 10:00 am and 2:00
pm). This order was confirmed with Staff B.
On 02/21/24 at 9:57 AM, an interview was conducted with Staff A, a licensed practical nurse (LPN) and unit
manager. Staff Member A stated that the tube feeding is now scheduled to run at 22 continuous hours per
day. Staff Member A then accessed Resident #64's electronic medical record (EMR) and realized the
resident's enteral feeding was ordered for 20 hours per day. Staff Member A stated she must have confused
the continuous feed with another resident.
On 02/21/24 at 10:00 AM, an additional review of Resident #64's EMR revealed a dietary progress notes
from the RD dated 02/06/2024, which identified the resident to be overweight / borderline obese with a BMI
(body mass index) higher than desired for a bed bound and tube fed resident. The resident's current weight
was documented at 174 pounds with a BMI of 29.9. The RD estimated the resident's nutritional needs,
based on current weight adjustment, and documented a target weight of 133 lbs. The RD's
recommendations indicated to decrease Jevity rate to 55 mL/hr and change water flush to 45 mL/hr. Weekly
weights for 3 weeks and draw CMP (Comprehensive Metabolic Panel - lab work). Additional review of the
record revealed a failure to identify the completion of weekly weights and failed to include the results of a
CMP.
On 02/21/24 at 10:39 AM, Resident #64 was observed in bed in high position with a tube feed infusing at
65 ml/hr.
On 02/22/24 at 10:13 AM, a follow-up interview was conducted with Staff B, LPN, to inquire about the
procedure for new dietitian recommendations. Staff B indicated that when the dietitian made
recommendations, these were communicated to the unit manager who processed them from there. Staff B,
LPN was unsure of the entire process as she was not involved in that part.
On 02/22/24 at 10:20 AM, a follow-up interview was conducted with Staff A, LPN, to clarify the process
when new recommendations were received from the dietitian. Staff A indicated that the dietitian emailed the
Interdisciplinary team (IDT), which included upper management. The unit manager on the applicable unit
would then take the recommendations to the provider for orders, and the unit manager would then put the
new orders in the EMR. She acknowledged that the current dietitan recommendations did not match the
current order.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105970
If continuation sheet
Page 2 of 2
