Natchitoches Community Care Center

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 nurse practitioner's orders were transcribed as ordered. The facility failed to transcribe a verbal wound care order for 1 (#2) of 3 (#1, #2, #3) sampled residents.

Inspectors wroteBased on observation and interview the facility failed to follow infection control practices to prevent the development and transmission of infection. The facility failed to ensure staff prepared a clean work area prior to providing wound care and sanitize hands between glove changes for 1 (Resident #2) of 3 (#1,#2, and #3) sampled residents reviewed for infection control.

Inspectors wroteBased on record review and interview, the facility failed to ensure the resident's right to receive mail in a timely manner for 1 (#1) resident out of 3 (#1, #2, & #3) sampled residents reviewed for resident rights.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident was treated with respect and dignity and cared for in a manner that promoted maintenance or enhancement of his or her own quality of life. The facility failed to treat a resident with respect and dignity by failing to adhere to and honor religious dietary preferences for 1 (#1) of 4 (#1, #2, #3, and #4) residents sampled for resident rights.

Inspectors wroteBased on interview and record review, the facility failed to ensure their grievance policy was followed. The facility failed to record a grievance within the appropriate timeframe for 1 (Resident #1) of 4 (Resident #1, Resident #2, Resident #3, and Resident #4) residents sampled for resident rights.

Inspectors wroteBased on interview and record review, the facility failed to ensure the provider documented a clinical rationale for a denial of a psychoactive medication dosage reduction for 1 (#3) of 4 (#1, #2, #3, and #4) sampled residents. The facility failed to ensure the provider documented in the medical record a clinical rationale when the dosage reduction was clinically contraindicated.

Inspectors wroteBased on record reviews and staff interviews, the facility failed to ensure MDS (minimum data set) assessments were accurate for 1 (#3) of 3 (#1, #2 and #3) sample residents. The facility failed to ensure resident #3's MDS accurately reflected her skin conditions and nutritional status at the time of the ARD (assessment reference date).

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure nursing staff provided nursing and related services to assure residents maintained the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by individual plans of care. The facility to notify the Registered Dietician (RD) in a timely manner when 1 (#1) of 2 (#1, #2) residents who received tube feedings order was changed to an equivalent tube feeding.

Inspectors wroteBased on record review and interview, the facility failed to ensure a resident was treated with respect and dignity for 1 (Resident #1) of 3 (Resident #1, Resident #2, & Resident #3) sampled residents.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to be administered in a manner that enabled it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. The facility's Administration failed to ensure an adequate system was in place to ensure RD recommendations for PEG tube feedings were accurately transcribed into the medical record, failed to provide adequate nutrition to maintain weight, and failed to notify the physician when a resident complained of hunger, nausea, and requested to have her tube feeding rate increased for 1 (#26) of a total of 5 (#4, #16, #26, #96, and #98) residents who received nutrition by PEG tube feedings in the facility. [...]

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure services were provided to meet professional standards of quality, by failing to accurately transcribe and implement recommendations from the Registered Dietician, and failing to notify the physician when a resident complained of hunger, nausea, and requested to have her tube feeding rate increased for 1 (#26) of a total of 5 (#4, #16, #26, #96, and #98) residents receiving nutrition by PEG tube feedings in the facility; and failing to perform and document a Comprehensive Skin Assessment for 1 (Resident #19) of 3 (Resident #19, Resident #28, Resident #101) Residents reviewed for Pressure Ulcers. The total Sample Size was 34.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident with a PEG tube maintained acceptable parameters of nutritional and hydration status consistent with the resident's comprehensive assessment for 1 (#26) of a total of 5 (#4, #16, #26, #96, and #98) residents receiving nutrition by PEG tube feedings in the facility. This deficient practice resulted in an Immediate Jeopardy situation for Resident #26 on 07/05/2024 at 3:02 p.m., when S4 RN Clinical Coordinator incorrectly entered a physician's order for a nutritional feeding rate at 25 ml/hr instead of the recommended rate of 45 ml/hr. S19 RD's Progress Notes dated 07/05/2024, revealed recommendations for Diabetisource AC (nutritional feeding) at 45 ml/hr. [...]

Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure that each Resident was treated with respect and dignity in a manner and in an environment that promoted maintenance or enhancement of his or her quality of life for 2 ( #19, and #32) out of 34 sampled residents. The facility failed to: 1. Ensure the privacy of Resident #19 while staff provided wound care. 2. Ensure staff did not stand while assisting Resident #32 during a meal service.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure Residents who are unable to carry out ADLS (Activities of Daily Living) received the necessary services to maintain good grooming and personal hygiene for 2 (#33 and #77) of 7 (#4, #5, #26, #30, #33, #42, and #87) Residents reviewed for ADL's. The facility failed to ensure a Resident (#33) received nail and oral care, and failed to ensure a Resident (#77) received incontinent care. The total Sample Size was 34.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure appropriate care and services had been provided for 1(Resident #19) of 1 resident reviewed for dialysis. The facility failed to ensure a Dialysis Communication Form was completed to include the resident's status prior to sending resident to dialysis facility. The total Sample Size was 34.

Inspectors wroteBased on record review and interview, the facility failed to adequately monitor 1 (#18) resident out of 5 (#1, #18, #58, #71, & #82) reviewed for unnecessary medications. The facility failed to adequately monitor Resident #18 for edema while on a diuretic and for side effects and effectiveness while on an antidepressant.

Inspectors wroteBased on observation and interview, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development of communicable diseases and infections. The facility failed to ensure the following: 1. Staff performed proper hand hygiene during meal service. 2. Staff followed proper infection control practices during wound care. This deficient practice had the potential to affect all residents who reside in the facility. The total resident census was 108.

Inspectors wroteBased on record review and interview, the facility failed to ensure an allegation of physical abuse was reported immediately, but not later than 2 hours after the allegation was made, to the State Survey Agency for 1 (#2) of 3 (#1, #2, & #3) residents reviewed for abuse.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure food served to residents was palatable and at an appetizing temperature for 1 (#2) of 3 (#1, #2, and #3) residents reviewed for dietary services.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure the physician was consulted, and orders were obtained for wound care for 1 (#161) resident out of 3 (#44, #93, #161) residents reviewed for pressure ulcers.

Inspectors wroteBased on observation, record review, and interview the facility failed to provide care and services that meet professional standards of quality, by failing to perform an accurate and thorough weekly skin inspection as ordered for 1 (#93) of 3 (#44, #93, #161) Resident's reviewed for Pressure Ulcers.

Inspectors wroteBased on record review and interview, the facility failed to ensure a resident who required dialysis received such services, consistent with professional standards of practice, and the comprehensive person-centered care plan by failing to administer an ordered medication required related to dialysis for 1 (#90) of 1 resident reviewed for dialysis.

Inspectors wroteBased on observation, record review and interview, the facility failed to maintain accurate reconciliation records of controlled medications for 1 (Hall 1 Nurse Medication Cart) of 2 (Hall 1 Nurse Medication Cart and Hall 2 Nurse Medication Cart) medication carts observed.

Inspectors wroteBased on observation and interview the facility failed to ensure that food was stored in accordance with professional standards for food service. This deficient practice had the potential to affect the 113 residents that received meals prepared by the kitchen.

Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure that each Resident was treated with respect and dignity and in an environment that promoted maintenance or enhancement of his or her quality of life for 1 (Resident #55) of 2 (Resident #55 and Resident #12) Residents sampled for dignity, by failing to ensure she was free of facial hair. Total sample size was 31.

Inspectors wroteBased on record review and interview the facility failed to ensure a resident's right to formulate an advanced directive was properly reflected in the resident's medical record for 1 (#87) of 1 resident reviewed for advance directives. The facility failed to ensure all medical records regarding code status consistently reflected the Resident's wishes to be a DNR (Do Not Resuscitate). The total sample size was 31.

Inspectors wroteBased on interview and record review the facility failed to ensure services were provided according to the resident's plan of care for 1 (#56) of 31 sampled residents. The facility failed to ensure weekly weights were obtained.

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 clean fingernails to dependent Residents for 1 (Resident #12) of 2 (Resident #12 and Resident #76) Residents sampled for ADL's. Total sample size was 31.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide respiratory care consistent with professional standards for 1 (#31) of 1 resident reviewed for respiratory care. The facility failed to ensure respiratory equipment was properly stored. The total survey sample size was 31.