La Belle Manor Care Center

Inspectors wroteBased on interview and record review, the facility failed to accurately code the Minimum Data Set (MDS), a federally mandated assessment completed by staff, according to the Resident Assessment Instrument (RAI) manual for three sampled residents (Resident #4, #8 and #20), in a review of 13 sampled residents. The facility census was 35. Review of the Resident Assessment Instrument (RAI) Manual, version 1.18.11, dated October 2023, showed the following: -Medicare and Medicaid participating long-term care facilities are required to conduct comprehensive, accurate, standardized and reproducible assessments of each resident's functional capacity and health status; -The RAI process has multiple regulatory requirements. [...]

Inspectors wroteBased on interview and record review, the facility failed to develop a comprehensive, person-centered care plan for four residents (Resident #3, #10, #14 and #26), in a review of 13 residents. The facility census was 35. Review of the undated facility policy, Comprehensive Care Plan Policy, showed the following: -A comprehensive care plan is a detailed document outlining a resident's agreed-upon goals of care and the planned activities for their medical, nursing and allied health care. It reflects shared decisions made with the resident, their caregivers and family, about tests, interventions, treatments and other activities needed to achieve these goals. This plan is a dynamic, living document that's updated as the resident's condition changes, ensuring all healthcare team members are informed of the latest critical information; -Key aspects of a comprehensive care plan: a. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to update and revise problems and interventions on resident care plans to reflect current care needs for three residents (Resident #10, #4 and #1) in a sample of 13 residents and failed to include Resident #20's responsible party and Durable Power of Attorney (DPOA) in his/her care planning decision making. The facility census was 35. Review of the undated facility policy, Resident Plan of Care, showed the following: -It is the policy of the facility to initiate a resident's plan of care on admission, by charge nurse, that is located in the electronic health record; -The MDS Coordinator follows electronic health record for date of plan of care to be completed. The facility did not provide a care plan revisions policy. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide restorative nursing services as recommended to assist one resident (Resident #3), in a review of 13 residents, and two additional residents (Resident #18 and #24), with mobility and/or limited range of motion (ROM) to attain or maintain their highest level of functioning. The facility census was 35. Review of the undated facility policy, Restorative Nursing Program Policy, showed the following: -Non-skilled rehabilitation: Restorative nursing provides non-skilled rehabilitative care with focus on maintaining or improving daily living skills; -Restorative aides and nurses must be trained. Registered nurses (RNs) or licensed practical nurses (LPNs) will provide supervision; -Daily documentation of restorative activities is required. Specific interventions and time spent must be documented; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to assess seven residents (Residents #10, #3, #20, #189, #9, #36, and #35), in a review of 13 sampled residents, for risk of entrapment from bed rails prior to installation, and failed to review the risk and benefits of the bed rails with the resident or resident representative and obtain consent prior to installation. The facility census was 35. Review of the Food and Drug Administration's Guide of Bed Safety, Bed Rails in Hospitals, Nursing Homes and Home Health Care: The Facts, revised April 2010, showed the following: -Patients who have problems with memory, sleeping, incontinence, pain, uncontrolled body movement, or who get out of bed and walk unsafely without assistance, must be carefully assessed for the best ways to keep them from harm, such as falling; [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a medication error rate of less than 5 percent (%). Out of 27 opportunities observed, 10 errors occurred, resulting in a 37.0% error rate, which affected one resident (Resident #10) in a review of of 13 sampled residents and three additional residents (Resident #15, #32 and #28). The facility census was 35. Review of the facility's undated policy, titled Policy for Medication Administration, showed it did not address crushing medications. Review of the facility's undated policy, Insulin Pen Usage, showed before each use, prime the pen to remove air bubbles and ensure a clear needle. Review of the Humalog Kwik pen package insert showed if you do not prime the insulin pen before each injection, you may get too much or too little insulin. [...]

Inspectors wroteBased on observation and interview, the facility failed to timely destroy expired medications. The facility census was 35. 1. Observation of the licensed nurses medication cart on 05/28/25 at 2:30 P.M. showed the following: -One bottle of ketoconazole 2% shampoo labeled for Resident #3, had an expiration date of 12/2022; -One tube of Aspercreme (topical pain relief cream), labeled for Resident #6, had an expiration date of 03/2025; -One bottle of Murine ear drops (wax removal drops), labeled for Resident #2, had an expiration date of 08/2024; -One stock (facility's supply) tube of hydrocortisone 1% cream had an expiration date of 03/25; -One stock bottle of nystatin powder (an antifungal medication) had an expiration date of 09/30/23; -One stock bottle of stoma adhesive had an expiration date of 02/01/25; -One stock tube of Aspercreme had an expiration date of 12/2024. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain two of two ice machines free of a buildup of debris; failed to ensure refrigerated food items were covered, labeled and dated; and failed to ensure trash cans were covered when not in use. The facility census was 35. 1. Review of the facility policy, Ice Handling and Cleaning, dated 2020, showed the following: -Guideline: Ice will be stored and served to residents in a sanitary manner; -Ice will be handled, transported and stored to protect against contamination; -Ice machine will be wiped down daily with sanitizer; -Ice machine will be emptied at least quarterly and thoroughly cleaned with an approved sanitizer to remove any settlement or mineral buildup in the ice discharge area and the floor of the machine. Observation on 5/27/25 at 9:49 A.M. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to implement the facility's policy to address Legionella (a bacterium that can cause a serious type of pneumonia called Legionnaires' Disease (a bacterial disease commonly associated with water-based aerosols) in persons at risk) control that included specific control parameters based on Center for Disease Control and Prevention (CDC) and American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) standards and failed to implement a water management team and parameters for findings related to water monitoring. [...]

Inspectors wroteBased on observation, interview and record review, facility staff failed to develop and consistently implement a regular maintenance program, including routine inspections of bed frames, mattresses and bed rails, to identify areas of possible entrapment for seven residents (Resident #10, #3, #20, #189, #9,#36, and #35), in a review of 13 sampled residents. The facility census was 35. The facility did not have a policy related to risk of entrapment with resident beds. Review of the Food and Drug Administration's (FDA) Guide to Bed Safety, Bed Rails in Hospitals, Nursing Homes and Home Health Care: The Facts, revised April 2010, showed the following: -Between 1985 and 1/1/09, 803 incidents of patients getting caught, trapped, entangled or strangled in beds with rails were reported to the U.S. FDA; -Of those reported, 480 died and 138 had non-fatal injuries; [...]

Inspectors wroteBased on interview and record review, the facility failed to complete a significant change in status assessment (SCSA) Minimum Data Set (MDS), a federally mandated assessment tool required to be completed by facility staff, for two residents (Resident #8 and #20) in a review of 13 sampled residents. This assessment should have been completed within 14 days after the facility determined, or should have determined, there had been a significant change (a decline or improvement in two or more assessed areas of resident status) in the resident's physical or mental condition which had an impact on more than one area of the resident's health status, and required interdisciplinary review and/or revisions of the care plan. The facility census was 35. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one resident (Resident #438), in a review of fifteen sampled residents, received his/her divalproex sodium delayed release (DR) (a medication to treat epilepsy and mood disorders) medication in the proper form, when staff crushed and administered the medication. Further review showed Certified Medication Technician (CMT) A entered an order to crush the resident's medications without consulting the charge nurse, Director of Nursing, or the physician. The facility census was 36. Review of the facility's undated policy, titled Policy for Medication Administration, showed it did not address crushing medications. Review of the facility's policy, Policy for following Physician Orders, revised 08/29/24, showed the policy did not address who could obtain and enter physician orders. 1. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one resident (Resident #10), in a review of 13 sampled residents, and one additional resident (Resident # 15) who received insulin injections, were free from significant medication errors. Staff failed to prime (remove the air from the needle and cartridge) the Humalog Kwik pen (prefilled pen of fast acting insulin (medication injected under the skin used to treat diabetes)) and Fiasp FlexTouch pen (prefilled pen of fast acting insulin) needle as instructed by the manufacturer prior to administration of the medication, potentially affecting the amount of insulin dispensed with each dose. The facility census was 35. Review of the facility's undated policy, Insulin Pen Usage, showed before each use, prime the pen to remove air bubbles and ensure a clear needle. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to post required nurse staffing information, which included the resident census and total actual hours worked by both licensed and unlicensed nursing staff directly responsible for resident care, per shift on a daily basis. The facility census was 35. Review of the facility's undated policy, Posting Daily Staffing, showed the following: -The direct care staff for the facility shall be posted daily across from the nursing desk between the Southeast and Southwest hall; -The charge nurse shall complete this at the beginning of each shift; -The number of each category shall be posted along with the actual hours worked and the census for each shift; -The completed forms shall be given to Director of Nursing to keep for at least 18 months. 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure one resident (Resident #7), of nine sampled residents,was free from physical restraints after the resident presented with verbal behaviors. Staff forced the resident to sit in a wheelchair by physically pushing the resident down into a wheelchair when the resident refused to walk to his/her room. The resident was normally able to ambulate independently. Once in the wheelchair, staff physically removed the resident's hands when the resident held onto the wheels of the chair to prevent staff from moving him/her. Staff placed footrests on the wheelchair when the resident used his/her feet to prevent the chair from moving so that staff could transport the resident to his/her room. The facility census was 41. The facility did not provide a policy on physical restraints upon request. 1. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure one resident (Resident #7) with a developmental delay and learning disability, in a review of nine sampled residents, received person centered interventions to address behaviors affecting others that did not make the resident feel like staff were treating him/her like a child. Staff told the resident to go to his/her room when the resident displayed disruptive behaviors. The staff physically took the resident to his/her room even when the resident refused instead of attempting other interventions to address the resident's behaviors. The facility census was 41. The facility did not provide a policy on providing care and services for residents with behavioral issues upon request. 1. [...]

Inspectors wroteBased on record reviews, document review, and interviews, the facility failed to timely complete the admission Minimum Data Set (MDS) for 3 (Residents #21, #34, and #36) of 5 sampled residents reviewed for resident assessments.

Inspectors wroteBased on record reviews, document review, and interviews, the facility failed to complete quarterly Minimum Data Set (MDS) assessments for 3 (Residents #21, #34, and #36) of 5 sampled residents reviewed for resident assessments.

Inspectors wroteBased on observation, interviews, record reviews, and facility policy review, the facility failed to ensure staff developed a care plan to address the needs of 3 (Residents #21, #36, and #140) of 12 sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the range hood was free of grease and debris; failed to ensure the can opener was clean and free of an accumulation of food debris; and failed to ensure trash cans in the kitchen were covered when not in use. The facility census was 52. 1. Observation on 1/7/19 at 12:29 P.M. showed the range hood had three baffle filters with a heavy buildup of dark fuzzy debris and a moderate buildup of clear and yellow grease. Further observation showed a heavy accumulation of dark fuzzy debris on the fire suppression piping and nozzles under the range hood. Strands of dark fuzzy debris hung off the fire suppression system piping and blew in the breeze of the range hood exhaust system. Review of the range hood sticker on the exterior of the hood on 1/7/19 at 2:59 P.M. [...]

Inspectors wroteBased on interview and record review, the facility failed follow their policy by not notifying the state agency of an injury of unknown origin for one resident (Resident #200), in a review of 13 sampled residents. The facility census was 52. 1. Review of the facility's undated policy Abuse Prevention Policy, showed the facility must ensure all alleged violations of mistreatment, neglect, abuse, injuries of unknown source, and misappropriation of resident property are immediately reported to the facility administrator and to other officials in accordance with state law through established procedures (including the state survey and certification agency). If serious bodily injury to a resident resulted, a report must be made immediately and not later than two hours after forming the suspicion. The facility must report the suspicion and not wait until confirmed with an investigative process. [...]