Onyx Care of Farmerville

Inspectors wroteBased on observations and interviews, the facility failed to store food and discard expired items in accordance with professional standards for food service safety. This deficient practice had the potential to effect the 63 residents that received meals prepared in the facility's kitchen.

Inspectors wroteResident #46 Review of the medical record for resident #46 revealed an admission date of 11/15/2022. Resident #46 had diagnoses including cerebral infarction, encephalopathy, cerebral aneurysm, occlusion and stenosis of vertebral artery, dementia, depression and anxiety. Review of the quarterly MDS assessment dated [DATE] revealed Resident #46's BIMS score of 00 which indicated severely impaired cognitive skills for daily decision making. Review of the June 2025 physician orders dated 09/03/2024 revealed an order for Resident #46 to use a geri chair while out of bed due to poor trunk control and reposition every two hours with range of motion and toileting. Review of the current care plan revealed Resident #46 used a geri chair for poor trunk control. [...]

Inspectors wroteBased on record review and interviews, the facility failed to ensure appropriate care and services consistent with professional standards of practice were implemented for 1 of 1 residents (#10) reviewed for dialysis. The facility failed to ensure Resident #10's dialysis access site was assessed and monitored every shift.

Inspectors wroteResident #20 Review of the medical record for sampled Resident #20 revealed an admission date of 09/06/2021. Resident #20 had diagnoses including hemiplegia, hemiparesis, diabetes mellitus, cerebral infarction, depression, and epilepsy. Review of the June 2025 physician orders revealed an order dated 01/31/2025 for bed rails to both side of the bed for increased bed mobility and positioning. Review of the quarterly MDS assessment dated [DATE] revealed Resident #20 had a BIMS score of 15 which indicated intact cognition for daily decision making, and was dependent on staff for toileting, showering and transfers. Review of the current care plan revealed the resident had bed rails to bilateral sides of the bed to assist with bed mobility. [...]

Inspectors wroteBased on interviews and observations, the facility failed to treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes or enhances his or her quality of life for 3 (#1, #39, and #62) of 5 (#1, #39, #40, #62, #65) residents reviewed for dignity. The facility failed to ensure: 1) staff answered call lights in a timely manner (#1, #39) and 2) the Respiratory Therapist informed a resident (#62) of tracheostomy care prior to performing the care.

Inspectors wroteBased on observations and interviews, the facility failed to maintain a safe, clean, comfortable and homelike environment for 1 (#62) of 4 (#38, #47, #48, and #62) residents reviewed for environment. The failed practice was evidenced by Resident #62's tube feeding pump and stand contained spills and splatters and the air conditioner/heating unit contained dust in the vents.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure the Minimum Data Set (MDS) assessment accurately reflected the resident's status for 2 (#4, #55) of 2 residents whose MDS were reviewed for accuracy.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident who was unable to carry out Activities of Daily Living received the necessary services to maintain good grooming and personal hygiene for 2 (#48, #66) of 3 (#56, #57, #66) residents reviewed for Activities of Daily Living (ADL) care.

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure the resident's environment remained as free of accident hazards as is possible by failing to ensure bed rails were properly secured for 2 (#6, #38) of 4 (#6, #20, #33, #38) residents reviewed for accident hazards.

Inspectors wroteBased on record review and interview, the facility failed to ensure it had sufficient nursing staff with the appropriate competencies and skills 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 by having staff fail to follow the physician orders for 1 (#1) of 6 (#1, #10, #13, #18, #33, #62) residents reviewed for unnecessary medications.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure it provided routine drugs to its residents by failing to ensure medications were available for administration at the prescribed time for 2 (#67, #49) of 3 (#67, #49, #42) residents observed for medication pass.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure the physician addressed irregularities identified by the pharmacist for 2 (#33, #1) of 6 (#33, #1, #18, #10, #13, #62) residents whose drug regimens were reviewed. The facility failed to ensure the physician provided a handwritten clinical rationale to deny a gradual dose reduction.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to ensure the medication error rate was not greater than 5% by having a medication error rate of 11%. The facility had 3 medication errors and 27 opportunities.

Inspectors wroteBased on observation and interview, the facility failed to ensure garbage had been disposed of properly. The facility census was 74 and the deficient practice had the potential to effect all residents.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to ensure it maintained an infection control program designed to provide a safe, sanitary and comfortable environment. The facility failed to dispense medications in a sanitary manner for 2 (#67, #49) of 3 (#67, #49, #42) residents observed during the medication pass and the facility failed to store nebulizers in a sanitary manner for 1 (#1) of 3 (#1, #57, #62) residents reviewed for respiratory care.

Inspectors wroteBased on observations, record reviews and interviews, the facility failed to maintain all mechanical, electrical, and patient care equipment in safe operating condition by having wheelchairs in need of repair for 3 (#38, #47, #48) of 4 (#38, #47, #48, #62) residents reviewed for environment.

Inspectors wroteI. Based on record reviews and interviews, the facility failed to ensure that 1 (#5) of 3 (#4, #5, #6) residents environment remained free of accident hazards by failing to ensure assistive devices (side rails) were in good repair. This deficient practice resulted in an Immediate Jeopardy situation on 12/11/2024 at approximately 9:35 a.m. when resident #5 fell from his bed while using his right ¼ side rail to assist with care. Resident #5's side rail was attached to a bed extender that flared approximately 45 degrees away from the bed which resulted in the fall. Resident #5 obtained a closed fracture of the left distal femur and had open reduction and internal fixation surgery (ORIF) with hardware on 12/12/2024. The facility implemented corrective actions which were completed prior to the State Agency's investigation entry on 01/13/2025. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure a resident with pressure ulcers received the necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection, and prevent new ulcers from developing for 1 (#4) of 3 (#4, #5, and #6) residents investigated for pressure ulcers. The facility failed to 1) observe and report signs and symptoms of an unstageable pressure ulcer development on the sacrum area for resident #4 and 2) failed to treat a stage 4 pressure wound according to physician orders for resident #4.

Inspectors wroteBased on record reviews and interview, the facility failed to ensure the agency Certified Nursing Assistant (CNA) and agency Licensed Practical Nurse (LPN) had documented training and competency demonstrations for all skills related to their expected roles for 2 (S5CNA and S4LPN) out of 5 (S4LPN, S5CNA, S8CNA,S14,CNA,S15CNA) personnel files reviewed.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure residents remain as free of accident hazards as possible for 1 (#31) of 4 (#31, #32, #39, and #276) residents reviewed for accidents. The facility failed to ensure staff provided proper transfer using a mechanical lift for resident #31 on 04/01/2024 and 04/10/2024. The facility also failed to ensure a thorough investigation was completed by the facility on 04/01/2024 by failing to identify the 2 Certified Nurse Aids (CNAs), who were involved in the improper transfer of resident #31 using a mechanical lift.

Inspectors wroteBased on record review and interview, the facility failed to ensure a Registered Nurse (RN) provided services of 8 consecutive hours a day on 11/05/2023, 02/03/2024, 02/10/2024, and 05/12/2024.

Inspectors wroteBased on record review and interview the facility failed to ensure resident's drug regimens were free from unnecessary psychotropic medications for 1 (#323) of 5 (#39,#47,#48,#276,#323) residents reviewed for unnecessary medications. The facility failed to ensure a psychotropic medication was used only when there was an acceptable diagnosis documented in the medical record for resident #323.

Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure a resident who is unable to carry out activities of daily living receives the necessary services to maintain good grooming and personal hygiene for 1 (#15) of 1 (#15) residents sampled for activities of daily living.

Inspectors wroteBased on record review and interview the facility failed to ensure nursing staff had 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 a resident's (#44) medications were not left unattended at his bedside.

Inspectors wroteBased on record reviews and interview, the facility failed to ensure the State Adverse Actions Website checks were completed for Certified Nursing Assistants (CNA) initially upon hire and monthly thereafter for 1(S7CNA) of 6 (S6CNA, S7CNA, S14CNA, S15CNA, S16CNA and S17CNA) personnel files reviewed.

Inspectors wroteBased on record review and interview the facility failed to protect the resident's rights to be free from verbal abuse by staff when she used profanity and cursed at the resident. The incident involved 1 (#2) of 4 (#1, 2, 3, 4) sampled residents reviewed for abuse.

Inspectors wroteBased on record review and interviews, the facility failed to provide pain management consistent with professional standards of practice for 1 (#3) of 4 (#1, #2, #3, and #4) sampled residents. The facility failed to ensure pain medication was available in the facility for resident #3 as ordered.

Inspectors wroteBased on observation, and interviews, the facility failed to ensure that housekeeping and maintenance services were provided to maintain a sanitary, orderly, and comfortable interior by failing to maintain equipment and provide routine cleaning in the facility laundry area. This had the potential to affect 66 residents that resided in the facility.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to have a written order for the specific type of restraint in use and provide ongoing re-evaluation of the need for the physical restraint for 1 (#61) of 3 (#28, #30, and #61) sampled residents reviewed for restraints.

Inspectors wroteBased on record review and interview the facility failed to ensure each resident`s medication regimen was free from unnecessary medication by failing to adequately monitor drug levels for 2 (#10, 24) of 5 (#3, 5, 10, 24, 63) residents reviewed for unnecessary medications that required drug levels to be monitored.