Lafayette Extended Care

Inspectors wroteBased 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.

Inspectors wroteBased 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.

Inspectors wroteBased 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.

Inspectors wroteBased 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.

Inspectors wroteBased 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.

Inspectors wroteBased 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. [...]

Inspectors wroteBased 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. [...]

Inspectors wroteBased 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 . [...]

Inspectors wroteBased 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. [...]

Inspectors wroteBased 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. [...]

Inspectors wroteBased 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) . [...]

Inspectors wroteBased on observations and interview, the facility failed to ensure the survey results were posted in an area, on a bulletin board near the front door of the facility, which was accessible to all residents. This deficient practice was observed on three of three days of the survey, and had the potential to affect all residents in wheelchairs at the facility.

Inspectors wroteBased on observations and interview, the facility failed to ensure the Daily Nurse Staffing Form consistently included the actual total hours worked by the nursing staff each shift. This was observed on three of three days of the survey, and had the potential to affect all residents residing in the facility. Findings Include: On 01/30/18 at 3:23 p.m., the surveyor observed the Daily Nurse Staffing Form. The form was dated 01/30/2018, the census was 65, and there were no total hours worked for staff on the form for the day, evening or night shifts. On 01/31/18 at 8:27 a.m., the surveyor observed the Daily Nurse Staffing Form. The form was dated 01/31/2018, the census was 64, and there were no total hours worked for staff on the form for the day shift. On 02/01/18 at 9:58 a.m., the surveyor observed the Daily Nurse Staffing Form. [...]