Courtyard of Natchitoches

Inspectors wroteBased on interview and record review the facility failed to ensure a resident's comprehensive person-centered care plan was reviewed and revised for 1 (#1) of 3 (#2, #3) sampled resident's care plans reviewed. The facility had a total census of 86 according to the Daily Census provided by the facility administrator.

Inspectors wroteBased on interview and record review the facility failed to ensure a resident received the necessary treatment and services to promote healing of a pressure ulcer for 1 (#1) of 3 (#2, #3) residents reviewed for Pressure Ulcer/Injury. The facility had a total census of 86 according to the Daily Census provided by the facility administrator.

Inspectors wroteBased on observation and interview, the facility failed to store food in accordance with professional standards for food service safety by failing to ensure refrigerated food items were covered, labeled, and stored with an open and discard date after opening. This deficient practice had the potential to affect the 87 residents that received meals served from the facility's kitchen.

Inspectors wroteBased on interviews and record reviews, the facility failed to provide education to the resident or resident representative and obtain consent from a resident's responsible party prior to administering the influenza vaccination for 1 (Resident #98) of 6 sampled residents reviewed for influenza vaccines.

Inspectors wroteBased on observations, interviews and record review the facility failed to ensure the interdisciplinary team assessed and determined if a resident was clinically appropriate for self-administration of medication for 1 resident of 1 (Resident #48) sampled residents. Total sample size was 28.

Inspectors wroteBased on observation, record review, and interview the facility failed to ensure the resident's right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences. The facility failed to ensure 1 (Resident #54) of 28 sampled residents was provided a wheelchair appropriate for her size.

Inspectors wroteBased on record review and interview, the facility failed to ensure a resident's drug regimen was free from unnecessary medications by failing to have a documented medical condition and by failing to monitor for side effects and behaviors of psychotropic medications for 1 (Resident #8) of 5 residents reviewed for unnecessary medications.

Inspectors wroteBased on record review and interview, the facility failed to refer a resident with a newly diagnosed mental disorder to the appropriate state-designated authority for Level II PASARR (Preadmission Screening and Resident Review) evaluation and determination for 1 (Resident #11) of 3 residents investigated for PASARR in a final sample of 28 residents. Review of facility policy titled Resident Assessment - Coordination with PASARR Program with review date of 01/2025 read in part. This facility coordinates assessments with the preadmission screening and resident review (PASARR) program under Medicaid to ensure the individuals with a mental disorder, intellectual disability, or a related condition receives care and services in the most integrated setting appropriate to their needs. 6. [...]

Inspectors wroteBased on observation, record review, and interview the facility failed to provide care and services that met professional standards of quality by failing to ensure physician's diet orders were followed for 1 (Resident #48) of 1 sampled residents. Total sample size was 28.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored in a secure manner by failing to ensure medications were not left at the bedside for 1 (Resident #48) resident of 28 sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to honor and accommodate food preferences for 2 (Resident #5 and Resident #29) of the 7 residents reviewed for dining. The deficient practice had the potential to affect 87 residents who consumed meals from the kitchen. Review of facility policy titled Promoting/Maintaining Resident Self-Determination dated 04/2025 read in part. It is the practice of this facility to protect and promote resident rights by facilitating resident self-determination through support of resident choice. The facility will ensure that each resident has the opportunity to exercise his/her autonomy regarding those things that are important in his/her life such as interest and preferences. 9. The facility will accommodate the resident preferences to the extent possible and as agreed upon by the resident sponsor and physician. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the privacy and confidentiality of medical records for 1 (Resident R5) of 5 (Resident #1, Resident #2, Resident #3, Resident #4, and Resident R5) sampled residents. Review of the facility's policy entitled Sanctions for (facility name) to Comply to HIPAA Privacy Standards revised 06/2016 revealed, in part.all workforce members are required to adhere to the HIPPA Privacy Standards and prevent unauthorized disclosure of Protected Health Information (PHI). Workforce members will protect health information from unauthorized disclosure. Leaving PHI in public areas is a violation of HIPPA Privacy Standards. Observation of Hall B on 09/16/2025 at 8:55 a.m. revealed Cart X was unattended, with the electronic medical record (EMR) screen open and Resident R5's PHI visible. [...]

Inspectors wroteBased on observations and interviews, the facility failed to ensure drugs and biologicals were stored in accordance with currently accepted professional principles. The facility failed to ensure Cart X was locked and medications were stored in a safe and secure manner. Review of the facility's policy entitled Medication Storage revised 03/2025 revealed, in part. It is the policy of this facility to ensure all medications housed on our premises will be stored to ensure security. All drugs and biologicals will be stored in locked compartments. During a medication pass, medications must be under the direct observation of the person administering medications or locked in the medication storage area/cart. Observation of Hall B on 09/16/2025 at 8:55 a.m. revealed Cart X was unattended, and unlocked, with 3 of 8 drawers pulled open. [...]

Inspectors wroteBased on interviews, and record reviews, the facility failed to maintain accurate medical records in accordance with accepted professional standards and practices. The facility failed to ensure documentation on the Medication Administration Report (MAR) was accurate for 2 (Resident #2 and Resident #4) of 5 (Resident #1, Resident #2, Resident #3, Resident #4, and Resident R5) sampled residents. Review of the facility's policy entitled Administration of Medicines revised 03/2025 revealed, in part.the facility is to maintain a record of all medications administered. Staff is to time and initial each medication on the MAR after the medication is given. Review of the facility's policy entitled Medication Administration Electronic Documentation revised 03/2025 revealed, in part. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure a resident was free from misappropriation of property/funds for 1 (Resident #1) of 3 (Resident #1, Resident #2, and Resident #3) sampled residents investigated for misappropriation. The facility failed to prevent misappropriation of Resident #1's funds by S7 Rehab Tech.

Inspectors wroteBased on interview and record review, the facility failed to ensure an investigation of an allegation of misappropriation of resident property/funds was thoroughly investigated for 1 (Resident #1) of 3 (Resident #1, Resident #2, and Resident #3) sampled residents reviewed for misappropriation.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to ensure residents were free from physical restraints imposed for the purpose of discipline or convenience for 2 (#1, #3) of 3 (#1, #2, #3) residents reviewed for restraints. The facility failed to ensure: 1. A physician's order was obtained, a consent was signed and a risk assessment was completed for a Geri-chair for Resident #1, 2. A physician's order was obtained, a consent was signed and a risk assessment was completed for a pommel cushion for Resident #3, and 3. A restraint policy was developed.

Inspectors wroteBased on observations, record reviews and interviews, the facility failed to: 1) ensure residents had a physician's order for side rails, 2) obtain informed consent from the resident or resident's representative for side rail use, and/or 3) assess residents for the risk of entrapment from bed rails and 4) ensure a policy was developed for the use of bed rails prior to the installation of bed rails for 3 (#1, #2, #3) of 3 (#1, #2, #3) residents reviewed for bed rails.

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure 1 (#1) out of 2 (#1, #2, #3) sampled residents with pressure ulcers received necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing.

Inspectors wroteBased on record review and interview, the facility failed to ensure all medical records regarding the resident's code status consistently reflected the resident's current wishes for 1 (#2) of 3 (#1, #2, and #3) sampled residents reviewed for advance directives.

Inspectors wroteBased on record review and interview, the facility failed to ensure a resident's change in condition was immediately reported for 1 (#1) of 3 (#1, #2, & #3) sampled residents, as evidenced by S4CNA and S5CNA failing to timely notify the nurse when Resident #1's leg made an audible popping sound while being repositioned by staff.

Inspectors wroteBased on record review and interview, the facility failed to use a mechanical lift, as determined necessary by the resident's person centered plan of care, during a transfer from bed to wheelchair for 1 (Resident #1) of 3 (Resident #1, Resident #2, and Resident #3) sampled residents.

Inspectors wroteBased on observation, interview, and record review the facility failed to keep the residents' equipment in good repair. The facility failed to repair wheelchair arm rest cushions for 5 (#19, #40, #47, #49, #67) out of 44 total sampled residents.

Inspectors wroteBased on observation, interview, and record review the facility failed to meet the nutritional needs of residents in accordance with established national guidelines. The facility failed to follow the menu in regard to portion size to ensure nutritional adequacy of the meal for 10 ( #10, #25, #34, #41, #51, #52, #78, #85, #92, and #295) out of 13 (#2, #10, #25, #34, #35, #41, #50, #51, #52, #78, #85, #92, and #295) residents who received pureed meals served by the facility kitchen.

Inspectors wroteBased on record review and interview, the facility failed to issue a Notice of Medicare Non-Coverage (NOMNC) to a resident or his/her responsible party prior to the discontinuation of Medicare Part A services for 3 (#33, #44, & #197) of 3 residents reviewed for Beneficiary Notification.

Inspectors wroteBased on observation, record review, and interview the facility failed to develop the resident's comprehensive plan of care for 1 (#37) of 44 sampled residents by failing to develop a Hospice Care Plan for Resident #37.

Inspectors wroteBased on interview and record review the facility failed to revise the care plan to include new fall interventions after a resident fell attempting to get in bed for 1 (#54) of 3 (#13, #54 and #59) resident's care plans reviewed.

Inspectors wroteBased on record review and interview the facility failed to ensure services were provided to meet professional standards of practice for 1 (#28) of 44 sampled residents. The facility failed to ensure physician's orders for Resident #28 were followed.

Inspectors wroteBased on record review and interview, the facility failed to ensure that a resident maintained acceptable parameters of nutritional status for 2 (#11, #195) of 5 (#2, #11, #37, #77, & #195) residents reviewed for nutrition by failing to follow or implement registered dietitian's recommendations.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure that nurse aides are able to demonstrate competency in skills necessary to care for residents' needs, as identified through observation of delayed call light response for 1 (#67) of 44 sampled residents. The facility failed to ensure timely call light response for Resident #67.

Inspectors wroteBased on observation, interview and record review, the facility failed to honor and accommodate resident food allergies, intolerances, and preferences by failing to ensure 1 Resident (#2) was not provided a supplement with milk containing products. This deficient practice had the potential to affect the 94 Residents that resided at the facility.

Inspectors wroteBased on observation and interview, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety by failing to ensure refrigerated food items were covered, labeled, and stored with an open date after opening. This deficient practice had the potential to affect the 92 Residents that received meals served in the kitchen.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure a resident maintained acceptable parameters of nutritional and hydration status consistent with the resident's comprehensive assessment and plan of care, for 1 (#1) of 3 (#1, #2, & #3) sampled residents reviewed for hydration and nutrition. The facility failed to: 1. Ensure Resident #1 received nutritional supplements as ordered; 2. Ensure the RD's (Registered Dietician) dietary recommendation to increase Resident #1's calories and protein through a nutritional supplement was implemented; and 3. Ensure Resident #1's meal intake was documented for each meal, as care planned.

Inspectors wroteBased on record review and interview, the facility failed to ensure a resident who was unable to carry out ADLs received the necessary services to maintain good oral hygiene for 1 (#1) of 3 (#1, #2, & #3) sampled residents reviewed for ADLs.

Inspectors wroteBased on record review and interview, the facility failed to protect the resident's right to be free from verbal abuse by staff for 2 (#2, #4) of 4 (#1, #2, #3, & #4) residents reviewed for abuse.

Inspectors wroteBased on interview and record review, the facility failed to ensure there was sufficient staff with appropriate competencies and skill sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. The facility failed to ensure that resident calls for help were answered timely, and that the need was met when a resident called for help. This deficient practice had the potential to affect all 97 residents residing in the facility.

Inspectors wroteFACILITY Based on observation and interview, the facility failed to ensure medications were stored under proper temperature controls for 2 (Medication Refrigerator A, Medication Refrigerator B) of 2 medication refrigerators observed out of a total of 3 medication refrigerators.

Inspectors wroteBased on record review and interview the facility failed to ensure the resident's right to formulate an advanced directive was properly reflected in the resident's record for 2 (#19, #57) of 3 (#19, #52,#57) residents reviewed for advance directives. The facility failed to ensure all records regarding code status consistently reflected the resident's wishes.

Inspectors wroteBased on record review and interview, the facility failed to consult with the resident's physician timely when there was a change in the resident's physical condition after a recent fall, for 1 (#12) of 4 (#12, #18, #33, #93) residents reviewed for accidents.

Inspectors wroteBased on record review and interview, the facility failed to make prompt efforts to document and resolve grievances for 1 (#84) of 1 resident reviewed for grievances.

Inspectors wroteBased on interview and record review, the facility failed to provide care and services that met professional standards of quality, by failing to promptly assess a resident after she fell and hit her head, for 1 resident (#18) in a total sample of 25 residents.

Inspectors wroteBased on observations, interviews and record review, the Facility failed to ensure that Residents who were unable to carry out ADLs (Activities of Daily Living) received the necessary services to maintain good grooming and personal hygiene. The Facility failed to provide trimmed fingernails to dependent Residents for 1 (Resident #67) of 5 (Resident #67, Resident #1, Resident #39, Resident #21 and Resident #84) Residents sampled for ADL's. Total sample size was 24.

Inspectors wroteBased on observation, interview and record review the facility failed to provide respiratory care consistent with professional standards for 1 (Resident #63) of 1 Residents reviewed for respiratory care. The facility failed to ensure Resident #63's respiratory equipment was properly changed, labeled and stored. Total sample size was 24.

Inspectors wroteBased on record review and interview, the facility failed to ensure residents who use psychotropic drugs received gradual dose reductions for 1 (#12) of 5 (#12, #18, #47, #84, #93) residents reviewed for unnecessary medications.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure each resident was free of significant medication errors for 1 (#86) of 4 residents observed during medication administration pass. The facility failed to ensure medication administered to Resident #86 was the correct medication as ordered by the physician. The facility had a total census of 97 residents residing in the facility.