General Information: BOLIVAR MEDICAL CENTER LTC
Nursing home name BOLIVAR MEDICAL CENTER LTC
Address901 E SUNFLOWER RD/PO BOX 1380
CLEVELAND, MS 38732
Phone number (662) 846-2520
Located within a hospital No
Type of ownership For profit - Corporation
Owner operates multiple homesYes
Accept Medicare or Medicaid Medicaid
Continue Care Retirement CommunityNo
Resident and family councils Both
Certified number of beds 35
Total number of residents 34
Perc of occupied beds 97
Sprinkler status Yes
Number of Facility Reported Incidents0
Number of Substantiated Complaints0
Number of Fines0
Total Amount of Fines$0
Total Number of Penalties0
Total Number of Penalties0
Ratings Summary: BOLIVAR MEDICAL CENTER LTC
Overall rating 4
4
Nursing Home Staffing 4
4
Registered Nurses only 4
4
Health Inspections 3
3
Quality Measures 3
3
Nursing Home Staffing Info: BOLIVAR MEDICAL CENTER LTC
National AverageMississippi AverageBOLIVAR MEDICAL CENTER LTC
Overall staff rating NA NA 4
4
Registered Nurses only rating NANA 4
4
Total Number of Residents NA NA 34
Total Number of Nurse Staff Hours per Resident per Day 4.11 hours 4.22 hours 4.1 hours
Total Number of Licensed Nurse Staff Hours per Resident per Day 1.64 hours 1.79 hours 1.65 hours
Registered Nurses Hours per Residents per Day 0.81 hours 0.8 hours 0.72 hours
Licensed Practical or Vacation Nurses Hours per Resident per Day 0.83 hours 0.99 hours 0.93 hours
Certified Nursing Assistants Hours per Residents per Day 2.47 hours 2.44 hours 2.45 hours
Physical Therapy Staffing Hours per Resident Per Day 0.1 hours 0.06 hours 0.0 hours
Health Survey: BOLIVAR MEDICAL CENTER LTC
Heath Survey Summary on 2013-08-16
Total Number of Health Deficiencies 4
Scope and Severity of most Severe Health Deficiency Widespread /Minimal harm or potential for actual harm
Heath Survey Summary on 2012-09-09
Total Number of Health Deficiencies 6
Scope and Severity of most Severe Health Deficiency Widespread /Minimal harm or potential for actual harm
Heath Survey Summary on 2011-11-22
Total Number of Health Deficiencies 5
Scope and Severity of most Severe Health Deficiency Isolated/Minimal harm or potential for actual harm
Health Survey Details: BOLIVAR MEDICAL CENTER LTC
Inspection Results: 08/16/2013
Corrected Deficiency Scope and Severity
09/27/2013 Ensure that each resident who enters the nursing home without a catheter is not given a catheter, unless medically necessary, and that incontinent patients receive proper services to prevent urinary tract infections and restore normal bladder functions. Isolated/Minimal harm or potential for actual harm
09/27/2013 Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. Pattern/Minimal harm or potential for actual harm
09/27/2013 Maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards. Isolated/Minimal harm or potential for actual harm
09/27/2013 Have a program that investigates, controls and keeps infection from spreading. Widespread /Minimal harm or potential for actual harm
Inspection Results: 09/09/2012
Corrected Deficiency Scope and Severity
10/31/2012 Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. Isolated/Minimal harm or potential for actual harm
10/31/2012 Maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards. Widespread /Minimal harm or potential for actual harm
10/31/2012 Store, cook, and serve food in a safe and clean way. Widespread /Minimal harm or potential for actual harm
10/31/2012 Provide care for residents in a way that maintains or improves their dignity and respect in full recognition of their individuality. Pattern/Minimal harm or potential for actual harm
10/31/2012 Assist those residents who need help with eating/drinking, grooming and personal and oral hygiene. Isolated/Minimal harm or potential for actual harm
10/31/2012 Provide housekeeping and maintenance services. Pattern/Minimal harm or potential for actual harm
Inspection Results: 11/22/2011
Corrected Deficiency Scope and Severity
01/06/2012 Develop and implement policies for 1) screening and training employees; and the 2) prevention, identification, investigation, and reporting of any abuse, neglect, mistreatment and misappropriation of property. Isolated/Minimal harm or potential for actual harm
01/06/2012 Ensure services provided by the nursing facility meet professional standards of quality. Isolated/Minimal harm or potential for actual harm
01/06/2012 Give proper treatment to residents with feeding tubes to prevent problems (such as aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, nasal-pharyngeal ulcers) and help restore eating skills, if possible. Isolated/Minimal harm or potential for actual harm
01/06/2012 Have a program that investigates, controls and keeps infection from spreading. Isolated/Minimal harm or potential for actual harm
01/06/2012 Keep accurate, complete and organized clinical records on each resident that meet professional standards. Isolated/Minimal harm or potential for actual harm

Fire Safety Survey: BOLIVAR MEDICAL CENTER LTC
Fire Safety Survey Summary on 2013-08-16
Total Number of Fire SafetyDeficiencies 0
Scope and Severity of most Severe Health Deficiency
Fire Safety Survey Summary on 2012-09-09
Total Number of Fire SafetyDeficiencies 0
Scope and Severity of most Severe Health Deficiency
Fire Safety Survey Summary on 2011-11-22
Total Number of Fire SafetyDeficiencies 0
Scope and Severity of most Severe Health Deficiency
Fire Safety Survey: BOLIVAR MEDICAL CENTER LTC
Not available

Resident Complaints: BOLIVAR MEDICAL CENTER LTC
Not available

Quality Measures: BOLIVAR MEDICAL CENTER LTC
Quality Measures National Average Mississippi Average BOLIVAR MEDICAL CENTER LTC
Overall quality rating NA NA 3
3
Long-Stay Residents
Percent of Long Stay Residents Whose Need for Help with ADLs has Increased 15.4% 18.4% 5.0%
Percent of Long Stay Residents Who Self Report Moderate to Severe Pain 8.3% 11.5% 10.2%
Percent of High Risk Long Stay Residents With Pressure Ulcers 6.1% 7.7% 13.0%
Percent of Long Stay Residents Who Lose Too Much Weight 7.2% 8.3% 7.7%
Percent of Low Risk Long Stay Residents Who Lose Control of Their Bowel or Bladder 43.9% 43.8% %
Percent of Long Stay Residents with a Catheter Inserted and Left in Their Bladder 3.2% 2.5% 3.4%
Percent of Long Stay Residents With a Urinary Tract Infection 6.2% 6.2% 2.2%
Percent of Long Stay Residents Who Have Depressive Symptoms 6.3% 2.2% 0.0%
Percent of Long Stay Residents Who Were Physically Restrained 1.4% 3.5% 12.1%
Percent of Long Stay Residents Experiencing One or More Falls with Major Injury 3.2% 2.8% 4.4%
Percent of Long Stay Residents Assessed and Appropriately Given the Seasonal Influenza Vaccine 92.7% 94.9% 100.0%
Percent of Long Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine 94.3% 97.3% 100.0%
Percent of Long Stay Residents Who Received an Antipsychotic Medication 20.7% 24.5% 31.9%
Short-Stay Residents
Percent of Short Stay Residents Who Self Report Moderate to Severe Pain 19.2% 20.9% %
Percent of Short Stay Residents With Pressure Ulcers That Are New or Worsened 1.2% 1.2% 0.0%
Percent of Short Stay Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine 83.4% 86.8% 100.0%
Percent of Short Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine 82.4% 88.4% 100.0%
Percent of Short Stay Residents Who Newly Received an Antipsychotic Medication 2.6% 3.3% %

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