Lake Village Rehabilitation and Care Center

Number of residents sampled: Number of residents cited: Based on observation, record review, interview and facility guidance review, the facility failed to ensure the medication error rate was less than five percent during the medication administration observation of two (Residents #51 and #58) of four residents who received medications from two Licensed Practical Nurses (LPNs). This surveyor observed 25 opportunities for medication administration and two of the 25 medications were not administered in accordance with the physician's orders, resulting in a medication error rate of eight percent. The findings include: Review of a Medication Administration guidance, not dated, from an in-service given on 02/17/2026, conducted by the Director of Nursing (DON) revealed, included in the six rights of medication was the right dosage and to check the label three times, comparing the label with the order and if the medication was a tablet or caplet, to pour the correct number in the cap and then into the medication cup. Resident #51: On 03/05/2026 at 8:33 AM, after preparing medications for…

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 record review, interviews and facility policy review, it was determined that the facility failed to have the medical care of each resident supervised by a Physician for three (Resident #3, Resident #6, Resident #20) of three residents reviewed for unnecessary medications and antibiotic stewardship. The findings include:Review of the facility's undated policy titled Antibiotic Stewardship indicated the medical director provides oversight to team functions and responsible for program outcomes, provides clinical guidance and enforcement, and provides monitoring of patients receiving selected microbials. The policy also indicated the Antibiotic Stewardship Team, core members, included at a minimum, an infection preventionist, physician and a pharmacist, along with any administrative, developmental and IT support. Review of a facility policy titled, Consultant Pharmacist Services Provider Requirements dated 01/01/2015, indicated A written or electronic response of report of findings and recommendations resulting from the activities as described is given to the attending…

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.

Number of residents sampled: Number of residents cited: Based on observation, record review, interview and facility policy review the facility failed to ensure Enhanced Barrier Precautions (EBP) were implemented during tracheostomy (trach) care for one (Resident #1) of one resident reviewed for tracheostomy care. The findings include: On 03/06/2026 at 9:22 AM, this surveyor observed Registered Nurse (RN) # 3 provide trach care to Resident #1. RN #3 did not put on a gown before or during the trach care. Review of March 2026 Physician's Orders (PO) for Resident #1, revealed an order for EBP related to trach and gastrostomy tube with a revision date of 02/08/2026. The PO also revealed an order with a start date of 06/05/2025 to change the inner cannula every day. Review of a quarterly Minimum Data Set, with an Assessment Reference Date of 02/04/2026 for Resident #1 revealed a Staff Assessment for Mental Status score of 3, which indicated Resident #1 had severe cognitive impairment, never or rarely made decisions, and received tracheostomy care. Review of a Care Plan, with a revision…

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, record review and interview, the facility failed to ensure foods in the pantry were dated to maintain freshness and prevent potential cross contamination. This failed practice had the potential to affect 52 residents who received meals from the kitchen according to the list provided by the Director of Nursing (DON) dated 09/03/2024 (Total Census 55). The findings are: 1. On 09/05/2024 at 9:06 AM, a shelf above the food processer next to the stove had bottles of spices. A container of onion powder with a build-up dried matter on the open, and a container of salt with the lid open were found on the shelf. The Dietary Manager (DM) was asked how spices are supposed to be stored. The DM indicated that the lids are supposed to be closed. 2. On 09/05/2024 at 9:14 AM, the following observations were made in the dry storage panty: a. One 20 liter clear dry storage container with a blue lid with a label indicating corn meal was observed to the left upon entry into the pantry. No date indicating when it was placed in the container, or a date of when it should be used by,…

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, record review, and policy review, the facility failed to ensure the medication error rate was less than five percent (%). 31 opportunities of medication administration were observed and 2 of the 31 medications were not administered in accordance with physician's orders, resulting in a medication error rate of 6.45%. The findings are: On 09/05/2024 at 8:26 AM, Registered Nurse (RN) #3 was observed retrieving Resident #53's medication from the medication cart for the 8:00 AM medication pass. She retrieved a box of Famotidine tablets, 10 milligrams (mg) strength, removed two tablets from the box and placed them in a pill cup. Once she gathered the medication, she administered the medication to Resident #53. Resident #53's Order Summary dated 09/05/2024 was reviewed and indicated an order for Famotidine 20 mg tablets and give two by mouth one time a day for 40 mg daily. On 09/05/2024 at 4:24 PM, (RN) #3 was interviewed and asked to look at the box of Famotidine she used to administer medication from to Resident #53. She was asked what the strength of the…

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 interview, record review, and policy review, the facility failed to convey a resident's personal funds to the individual or representative administering the individual's estate within 30 days for 1 (Resident #164) of 3 sampled residents for whom the facility-maintained trust accounts per a list provided by the Business Office Manager (BOM) on [DATE] at 3:00 PM. The findings are: l. Review of the Mortician's Receipt-Record of Death indicated that Resident #164 passed away on [DATE]. 2. A document titled Lake Village Rehabilitation and Care Center Trust-Current Account Balance As of [DATE] documented that a trust account for Resident #164 contained a closing balance of $145.21. 3. On [DATE] at 3:00 PM the Surveyor asked the Business Office Manager (BOM) how long the facility has to return the resident money from trust accounts when a resident passes away or discharges. The BOM indicated one month. 4. On [DATE] at 10:15AM, the Surveyor asked the BOM to identify the date Resident #164 had expired. The BOM…

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 record review, the facility failed to ensure a resident was able to self-hydrate by consistently keeping fluids in reach for 1 (Resident #28) of 1 sampled resident reviewed for accommodation of needs. The findings are: Resident #48 had diagnoses of arthritis in multiple joints (poly osteoarthritis) and the loss of cushioning between the disc in the back (intervertebral disc degeneration) indicated on an Order Summary dated 09/06/2024. A quarterly Minimum Data Set with an Assessment Reference Date of 07/15/2024 was reviewed and indicated Resident #48 had a Brief Interview for Mental Status score of 11, which indicated moderate cognitive impairment and required setup and/or clean up assistance with eating, as the resident had the ability to bring food and/or liquids to the mouth once the meal was placed before the resident. A Care Plan dated 08/19/2024 was reviewed and indicated Resident #48 was at risk for falls and had poly osteoarthritis. Interventions included keeping the resident's personal items within reach and encouraging adequate nutrition…

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 record review and interview, the facility failed to revise the care plan of 1 (Resident #52) sampled resident after the quarterly assessment was completed. The findings include: Review of the quarterly Minimum Data Set (MDS) with the Assessment Reference Date of 7/07/2024 revealed Resident #52 score 5 on a Brief Interview for Mental Status, indicating severely impaired cognition. Resident #52 had a diagnosis of Schizophrenia and depression. Resident #52 was taking an antipsychotic and antidepressant. A Care Plan (revision date 05/21/2024) revealed Resident #52 used an antidepressant medication, but did not reference the use of an antipsychotic medication. A review of the Physician Order portion of Resident #53's electronic health record revealed an order for an antipsychotic intended to treat Schizophrenia, with a start date of 6/27/2024. On 9/06/2024 at 11:33 AM, the Director of Nursing confirmed the care plan did not address Resident #52 taking an antipsychotic medication. On 9/06/2024 at 11:33 AM, the Director of Nursing provided documentation that the facility did not…

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 observations, interviews, and record reviews the facility failed to ensure that 1 (Resident #35) of 2 sampled resident with an indwelling urinary catheter received proper catheter care. The findings include: According to the admission Minimum Data Set (MDS) with the Assessment Reference Date of 8/04/2024, Resident #35 had a Brief Interview for Mental Status score of 03, indicating severe cognitive impairment, and that Resident #35 had an indwelling catheter. A Care Plan (revision date 8/06/2024) revealed Resident #35 had a urinary catheter related to urinary retention, overactive bladder, and benign prostatic hyperplasia (BPH). On 09/03/24 at 02:00 PM, the Surveyor observed Resident #35 sitting in a wheelchair with catheter collection bag hooked to the back of wheelchair. The collection bag was not positioned below the level of the resident ' s bladder to facilitate the flow of urine. On 09/04/24 at 08:44 AM, the Surveyor observed Resident #35 sitting in a wheelchair in the common area. The Surveyor noted that catheter tubing was wrapped around the resident's right ankle…

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, record review, the facility failed to ensure a glucometer was cleansed after being used to check a fingerstick blood sugar for 1 (Resident #2) of 1 sampled resident who was reviewed for glucometer checks. On 09/05/2024 at 4:36 PM, Licensed Practical Nurse (LPN #2) was observed gathering a glucometer machine and other items. She sanitized her hands, put on a clean pair of gloves, took the items to Resident #2's room and placed them on the bedside table. She informed the resident she was about to check the resident's blood sugar. She cleansed the ring finger of the resident's left hand, performed other steps and collected a blood sample from Resident #2's finger using the test strip in the glucometer machine. After the results were displayed on the glucometer machine, LPN #2 discarded the used items, placed hand sanitizer in her hands, rubbed her hands together and picked up the glucometer machine. She rubbed her hands over the front and back of the glucometer machine for less than five seconds and placed the glucometer machine in the top right drawer…

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 record review, the facility failed to remove dented cans from food circulation; label and date leftover food items in the refrigerator; and date opened spice containers to ensure food is used or discarded prior to the use by date. The failed practices had the ability to affect 42 residents (Resident Census: 44), who received meals from the kitchen. The findings are: 1. On 10/02/23 at 10:47 AM, the following spices were on a shelf in the kitchen and did not have an opened date: i) Whole Celery Seed ii) Ground Allspice iii) Mediterranean Style Ground Oregano iv) Ground Cinnamon v) Salt vi) Rubbed Sage vii) Celery Salt viii) Ground [NAME] Pepper ix) Ground Ginger x) Dill Weed a. The Surveyor asked Dietary Employee (DE) #2 if there was an opened date on the spices. DE #2 said, I cannot find a date written on these. b. On 10/02/23 at 10:50 AM, the Surveyor asked DE #2 if a 'use by date' was on the unlabeled spices. DE #2 stated No, I usually date the bottle and keep mine for a year. 2. On 10/02/23 at 11:00 AM, observed in the cooler square containers…

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 record review, the facility failed to ensure the Comprehensive Care Plan addressed the use of an anticoagulant for 1 (Resident #45) of 1 sampled resident. The findings are: Resident #45: 1. A Physicians Order dated 09/15/23 noted Resident #45 was to receive Apixaban 5 milligrams two times a day for an anticoagulant. 2. The Care Plan, last reviewed on 9/25/23, did not address anticoagulant use and/or precautions. 3. On 10/04/23 at 3:20 PM, LPN #1 confirmed she did not find anticoagulants on Resident #45's Care Plan.