Lafayette Extended Care

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews, review of Resident Identifier (RI) #64's medical record, the facility's WEEKLY SKIN REPORT FOR THE TIME PERIOD ENDING, 24 HOUR SHIFT REPORT and the policy titled Abuse, Neglect, Misappropriation of Resident Property, Exploitation, and Injuries of Unknown Source, the facility failed to investigate a suspicious injury of unknown source. On 7/17/2019, RI #64 was observed to have a red and blue/green large bruise that was rectangular and covered most of the breast area from the nipple up and the chest wall. This deficient practice affected RI #64, one of one sampled resident identified by the facility as having an injury of unknown source. Findings include: The facility's policy titled Abuse, Neglect, Misappropriation of Resident Property, Exploitation, and Injuries of Unknown Source with an effective date of 11/28/2016, documented . PURPOSE: To ensure the safety and well-being of each resident, the facility will promote and protect the rights of each resident. POLICY: . INJURIES OF UNKNOWN…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews, review of Resident Identifier (RI) #64's medical record and the facility's policy titled Abuse, Neglect, Misappropriation of Resident Property, Exploitation, and Injuries of Unknown Source, the facility failed to timely report an injury of unknown source to the State Agency. On 7/17/2019, RI #64 was observed to have a red and blue/green large bruise that was rectangular and covered most of the breast area from the nipple up and the chest wall. This injury of unknown source was not reported to the State Agency until 1/21/2020. This deficient practice affected RI #64, one of one sampled resident identified by the facility as having an injury of unknown source. Findings include: The facility's policy titled Abuse, Neglect, Misappropriation of Resident Property, Exploitation, and Injuries of Unknown Source with an effective date of 11/28/2016, documented . PURPOSE: To ensure the safety and well-being of each resident, the facility will promote and protect the rights of each resident. POLICY: .…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interviews and review of Resident Identifier (RI) #43's medical record, the facility failed to ensure RI #43 was not ordered and administered a PRN (as needed) antipsychotic medication, Haldol, for greater than 14 days, without documented rationale in the resident's medical record for the continued use of the PRN antipsychotic medication. This deficient practice affected RI #43, one of five sampled residents reviewed for unnecessary medications. Findings include: RI #43 was readmitted to the facility 8/27/2019. RI #43 has a medical history to include diagnoses of: Dementia with behavioral disturbance, Mood Disorder, Psychotic Disorder with delusions and Unspecified Psychosis. RI #43's PHYSICIAN ORDERS dated 8/28/2019, documented Haldol 2 mg (milligram) po (by mouth) prn (as needed) q6hrs (every six hours) for agitation. In an interview on 1/16/2020 at 4:42 PM, Employee Identifier (EI) #2, the Director of Nursing acknowledged RI #43's order for Haldol had not been renewed since it was ordered on 8/28/2019. When asked if the physician gave a rationale to continue use beyond…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and review of the facility policy titled Labeling and Dating Foods . the facility failed to ensure all frozen items were sealed, labeled and dated in the walk in freezer. During the entrance tour of the kitchen on 12/18/18, an unlabeled and undated clear plastic bag of breaded okra was open and exposed the okra to the air in the walk in freezer. This had the potential to affect 65 residents who received meals from the kitchen. Findings include: Review of a facility policy titled Labeling and Dating Foods . and dated 2016 revealed the following: Guideline: All foods stored will be properly labeled according to the following guidelines. Procedure: . 3. * Date marking for freezer storage food items . Once a package is opened, it will be re-dated with the date the package was opened and shall be used by the safe food storage guidelines . During the entrance observation of the facility kitchen on 12/18/18 at 9:15 AM, the walk-in freezer was observed with the Certified Dietary Manager, Employee Identifier (EI) #3. In the walk-in freezer was an unlabeled…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews and record review, the facility failed to ensure Resident Identifier (RI) #22's suprapubic urinary catheter and tubing was shielded from the view of other residents and visitors. This effected one of two residents with suprapubic catheter. Findings include: RI #22 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses of Cervical Spinal Cord injury. A review of the December 2018 Physician's Orders with an order date 11/28/18 stated, . CHANGE SUPRA PUBIC CATH (CATHETER) Q (EVERY) MONTH ON THE 13TH (20 FRENCH (FR) CATH W(WITH)/30 ML (milliliters) H2O (water) BULB) . A review of RI #22's Care Plan for FOLEY CATHETER dated 12/31/16 revealed the presence of a suprapubic catheter. On 12/19/18 at 1:29 p.m. the surveyor observed RI #22's suprapubic catheter hanging on the bed frame without a covered bag to shield it from the view of other residents or visitors. On 12/19/18 at 3:06 p.m. an interview was conducted with Employee Identifier (EI) #4, Certified Nursing…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure Resident Identifier (RI) #31's prescribed diet was followed. This affected one of four residents whose diets were reviewed. Findings Include: RI # 31 was admitted to the facility on [DATE] and readmitted on [DATE], with diagnoses including Type 2 Diabetes with Diabetic Autonomic (poly) Neuropathy, Gastroparesis, and Dependence on Renal Dialysis. A review of RI #3's December 2018 Physician Orders dated 12/7/2018, revealed a regular diet with double eggs and cheese with breakfast and no tomatoes, no potatoes and no bananas. An observation was made on 12/18/2018 at 6:00 p.m. RI #31's meal tray was observed for intake amount. RI #31's meal tray was noted to have hashbrowns. RI #31 said she/he did not eat them because they told her/him she/he could not have them. Employee Identifier (EI) #2, Director of Nursing (DON) was present and also observed RI #31's tray. On 12/19/2018 at 1:53 p.m., the surveyor conducted an interview with EI #2.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review and interviews, the facility failed to ensure: (1) the amount of fluid allowed for Resident Identifier (RI) #35, a resident on dialysis and fluid restriction, was documented on the care plan; and (2) a care plan was developed for RI #15's no use of straws. These deficient practices affected RI #15 and #35, two of 19 sampled residents whose plans of care were reviewed. Findings Include: (1) RI #35 was readmitted to the facility on [DATE], with diagnosis to include End Stage Renal Disease and Chronic Kidney Disease. The Quarterly Minimum Data Set (MDS) assessment, with an Assessment Reference Date (ARD) of 09/03/17, revealed RI #35 had a Brief Interview for Mental Status score of 3 indicating severely impaired cognition. A review of RI #35's careplan titled Risk for complications related to Renal Failure requiring Dialysis did not specify the amount of fluids allowed for each discipline. The care plan failed to designate the amount of fluid restriction allowed. A review of RI…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interview and record review, the facility failed to ensure the Physician's Orders for Resident Identifier (RI) #15 to not have a straw was followed. This deficient practice affected RI #15, one of 19 residents whose Physician Orders were reviewed. RI #15 was admitted to the facility on [DATE], with the diagnosis of Dysphagia, Oropharyngeal Phase. A review of RI #15's Plan of Treatment for Outpatient Rehabilitation, with an onset date of 04/23/16, documents: . 20. INITIAL ASSESSMENT . 0 (No) straws c (with) orders for Glucerna c meals . RI #15's Weekly Progress Note, with summary dates from 04/29/16 - 05/05/16, documented: . GOAL: . (2). Patient will tolerate thin liquids c 0 s/s (signs/symptoms) aspiration . Current: . via (by way of) cup rim - NO STRAWS . RI #15's February 2018 Physician Orders documented: . NO STRAWS. ALL THIN LIQUID FROM CUP RIM . On 01/31/18 at 8:57 a.m., the surveyor observed a no straws please sign posted over RI #15's bed. On 02/01/18 at 12:00 p.m., the surveyor…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review and interviews, the facility failed to monitor the amount of fluid for Resident Identifier (RI) #35, a resident receiving Dialysis and on a 1500 cc (centimeter) fluid restriction. This affected RI # 35, one of three residents sampled for dialysis. Findings Include: RI #35 was readmitted to the facility on [DATE], with diagnosis to include End Stage Renal Disease, Chronic Kidney Disease and Vascular Dementia. The Quarterly Minimum Data Set (MDS) assessment, with an Assessment Reference Date (ARD) of 09/03/17, revealed RI #35 had a Brief Interview for Mental Status score of 3 indicating severely impaired cognition. RI #35's February 2018 Physician Orders reveals an order for a 1500 cc (centimeter) fluid restriction. RI #35 was receiving hemodialysis Monday, Wednesday and Friday. A review of RI #35's chart, MAR (Medication Administration Record), care plan nor the CNA (Certified Nursing Assistant) [NAME] revealed documentation of the daily amount of fluids RI #35 was receiving.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation and interviews, the facility failed to ensure 62 stock Bisacodyl Suppositories, with the expired date of 12/2017, were not stored in the refrigerator in the medication room. This deficient practice had the potential to affect all residents in the facility with a Physician's Order for Bisacodyl Suppositories. Findings Include: On 02/01/18 at 2:49 p.m., the surveyor made an observation of the medication room on the South Unit with Employee Identifier (EI) #7, a Licensed Practical Nurse. The surveyor observed a box of 62 stock Bisacodyl suppositories with an expiration date of 12/2017. The surveyor asked EI #7 should the expired suppositories be in the refrigerator. EI #7 said no. The surveyor asked EI #7 who was responsible for ensuring expired medications were not stored in the refrigerator. EI #7 said all of the nurses. The surveyor asked EI #7 what could be the result of a resident receiving an expired medication. EI #7 said they could have a reaction to or not get the full benefits of the medication. On 02/01/18 at 5:46 p.m., the surveyor conducted an…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations and interviews the facility failed to ensure: (1) Resident Identifier (RI) #20's nebulizer mask was stored properly; and (2) a Certified Nursing Assistant, Employee Identifier (EI) #8, did not touch Resident Identifier (RI) #56's cornbread with her bare hands while assisting RI #56 with the lunch meal 01/31/18. These deficient practices affected RI #20, one of two residents observed with a nebulizer mask, and RI #56 one of two residents observed being assisted with meals. Findings Include: (1) RI #20 was admitted to the facility on [DATE], and readmitted on [DATE], with a diagnosis of Chronic Obstructive Pulmonary Disease. RI #20's February 2018 Physician Orders documented: . ALBUTEROL - IPRATROPIUM 2.5 MG (milligram) - 0.5 MG 3 ML (milliliters) INHALATION SOLUTION. TID (three times a day) PRN (as needed) SOB (shortness of breath) . On 01/31/18 at 9:37 a.m., the surveyor observed RI #20's nebulizer mask lying on top of dresser drawer. The nebulizer mask was not in a covering at this time.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.