Lafayette Nursing Home

Inspectors wroteBased on record review, interviews and review of a facility policy titled, Activity Programs, the facility failed to ensure an ongoing group activities program was offered on the weekends. This was identified by residents in attendance for resident council on 9/20/22. This affected RI (Resident Identifier) #'s 15,39, and 41, three of five residents who attended resident council on 9/20/22. Findings Include: A review of a policy titled Activity Programs with a revised date of June 2018 documented: .Activity programs are designed to meet the interests and support the physical, mental and psychosocial well-being of each resident. 11.group activities are provided that: b. Are offered at hours convenient to the residents, including evenings, holidays and weekends; . [...]

Inspectors wroteBased on interviews conducted during the initial tour, comments from Resident Council attendees, tray line observation, a review of the facility policy titled Monitoring Food Temperatures for Meal Service, and interviews with staff, the facility failed to consistently serve food at palatable temperatures to residents. This affected 5 of 22 interviewable residents residing in the facility, including RI #25. Findings Include: A review of the facility policy titled, Monitoring Food Temperatures for Meal Service (2016) specified: . Procedure . 3. g. Meals that are served on room trays may be periodically checked at the point of service for palatable food temperatures. Food temperatures of hot foods on room trays at the point of service are preferred to be at 120 degrees F (Fahrenheit) or greater to promote palatability for the resident. [...]

Inspectors wroteBased on observations, interviews and review of facility policies Handwashing/Hand Hygiene and Food Safety Requirements, the facility failed to ensure: 1. facility staff did not transport foods to residents on the halls during an activity, uncovered and using the same glovesbetween resident food distribution, and 2. during incontinent care for Resident Identifier (RI) #10, a Certified Nursing Assistant (CNA) washed her hands between glove changes, two CNAs did not touch clean linens and briefs with soiled gloves, and a CNA did not leave a resident room without washing her hands, enter a linen closet to get a clean brief then return to the resident room. This was observed on 3/10/20 and affected seven of seven residents receiving ice cream and cake during the afternoon activity, and one of one residents observed for incontinent care. Findings Include: 1. [...]

Inspectors wroteBased on observations, interviews and review of Resident Identifier (RI) #44's medical record, the facility failed to develop an individualized care plan for RI #44, a resident totally dependent on staff for all Activities of Daily Living (ADLs), to address RI #44's right leg that was turned outward laterally and rested on the bed, when the resident was placed on bedrest on 10/4/18. The facility further failed to ensure RI #44's use of bilateral heel booties (Posey Heel Pillows), worn daily for the protection and prevention of pressure ulcers, were addressed in RI #44's care plans. These failures to develop and implement interventions to address RI #44's positioning and pressure relief caused RI #44 to develop a facility-acquired Stage IV pressure ulcer on the right outer (lateral) ankle on 11/26/18 that measured 1.8 centimeter (cm) by 1.4 cm with 0.4 cm of depth. [...]

Inspectors wroteBased on observation, interviews, review of Resident Identifier (RI) #44's medical record, the facility's policy titled Prevention of Pressure Ulcers/Injuries and the manufacturer's information for the Posey Heel Pillows/Foot Positioner WOUND PREVENTION, the facility failed to address pressure relief for RI #44's right leg that was turned outward and rested on the bed. RI #44, a resident totally dependent on staff for all Activities of Daily Living (ADLs) and at risk for pressure ulcer development, was placed on bed rest on 10/4/18. When placed on bed rest, there were no changes in RI #44's treatment plan to address the resident's right leg. According to staff interviews, RI #44 wore bilateral heel booties (Posey Heel Pillows) every day. The facility further failed to follow the manufacturer's recommendations to remove the Posey Heel Pillow every two hours and check for skin integrity. [...]

Inspectors wroteBased on interviews and review of the JOB DESCRIPTION DIRECTOR OF NURSING SERVICES and JOB DESCRIPTION ADMINISTRATOR, the facility's Administrator, responsible for the day-to-day operatios of the facility and the Director of Nursing, responsible for the overall operation of the Nursing Service Department, failed to ensure there was a policy to address the use of adaptive devices used to relieve pressure utilized by the facility. The facility's administrative staff futher failed to ensure they were aware of the manufacturer's recommendations for the Posey Heel Pillow applied to Resident Identifier (RI) #44's bilateral lower extremities. Lastly, the administrative staff failed to ensure the staff were educated on the manufacturer's recommendations to remove every two hours to check for skin integrity, proper circulation and range of motion. [...]

Inspectors wroteBased on observations and interviews, the facility failed to provide sufficient nursing staff to consistently meet the needs of the residents. This deficient practice had the potential to affect all 59 residents currently residing in the facility.

Inspectors wroteBased on interview and review of the Lafayette Nursing Home, LLC Facility Assessment, the facility failed to ensure the facility assessment included an evaluation of the overall number of facility staff needed to ensure a sufficient number of qualified staff were available to meet each resident's needs. This deficient practice had the potential to affect all 59 residents currently residing in the facility.

Inspectors wroteBased on interviews and review of the facility's policy titled Quality Assurance and Performance Improvement (QAPI) Committee, the facility failed to ensure the QAPI Committee met quarterly to identify concerns and develop plans of actions to address any concerns identified. This deficient practice had the potential to affect all 59 residents currently residing in the facility.

Inspectors wroteBased on observations, interviews, and review of the facility's policy titled Resident Rights Guidelines for All Nursing Procedures, the facility failed to ensure Employee Identifier (EI) #6 and EI #9, both Certified Nursing Assistants (CNAs) provided personal privacy to Resident Identifier (RI) #9, RI #24, RI #35, RI #40 and RI #58 during incontinence care and/or bathing on 1/13/19. These deficient practices affected five of seven sampled residents reviewed for privacy.

Inspectors wroteBased on observations, interviews and review of the facility's policies titled Laundry and Bedding, Soiled, Diapers/Underpads and Infection Control Guidelines for All Nursing Procedures, the facility failed to ensure soiled linen was not left on the floor. This was observed on one of 13 days of the survey. The facility further to ensure Employee Identifier (EI) #9, a Certified Nursing Assistant (CNA) washed her hands after removing gloves, in between residents and resident care tasks performed. This deficient practice affected Resident Identifier (RI) #8, RI #16, RI #24, RI #25 and RI #40, five of 16 sampled residents.

Inspectors wroteBased on observation, interview and review of the facility's policy titled Medication Storage, Employee Identifier (EI) #10, a Licensed Practical Nurse (LPN) failed to ensure medications were not left on top of the medication cart and the medication cart was locked when out of the nurse's view. This deficient practice was observed on one of 13 days of the survey.

Inspectors wroteBased on observations and interviews, the facility failed to ensure nurse staffing data was posted at the beginning of each shift. This deficient practice was observed on two of 13 days of the survey.