Ouachita Nursing and Rehabilitation Center

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure food items stored in the dry food storage were covered or sealed to prevent potential cross contamination; expired dairy product and food items were promptly removed and discarded on or before the expiration date, and dietary staff washed their hands, before handling clean equipment or food items for one of one meal observed.

Inspectors wroteBased on record review, facility document review, interview, and facility policy review, it was determined that the facility failed to protect a cognitively impaired resident with known sexual behaviors from sexual activity with a staff member for one (Resident #14) of three residents reviewed for abuse and neglect.

Inspectors wroteBased on interviews, record review, and facility document review, it was determined that the facility failed to identify sexual behaviors on a resident’s comprehensive care plan as a behavior resulting in no goals, interventions, or plan for safe sexual activity, assessed competency for consent, redirection from other residents, and protection from unethical staff for 1 (Resident #14) of 8 residents reviewed for comprehensive person-centered care plans.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure care plan interventions were consistently implemented for 1 (Resident #1) of 4 (Residents #1, #2, #3, and #4) sampled residents whose care plans were reviewed for continuity of care.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure the dietary staff washed their hands and changed their gloves before handling food items to prevent the potential for cross contamination for the residents who received meals from 1 of 1 kitchen, ensure leftover foods were not used to maintain food quality; food items stored in the refrigerator/freezer were covered, sealed, and foods were dated when opened to ensure first in, first out usage to prevent potential for food bone illnesses: ceiling vents and lights were maintained in clean, sanitary conditions for food preparation These failed practices had the potential to affect 76 residents who received meals from the Kitchen.

Inspectors wroteBased on observation, record review and interview, the facility failed to prevent the misappropriation of narcotics for 2 Residents (Resident #72 & #74) to prevent possible complications of pain management. This failed practice had the potential to affect all residents taking narcotics in the facility.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure meals were prepared and served according to the planned written menu to meet the nutritional needs of the residents for 2 of 2 meals observed. This failed practice had the potential to affect 5 residents who received pureed diets and 15 residents who received mechanical soft diets from 1 of 1 kitchen.

Inspectors wroteBased on observation and interview, the facility failed to ensure that pureed food items were blended to a smooth, lump free consistency to minimize the risk of choking or other complications for those residents who required pureed diets for 2 of 2 meals observed. The failed practice had the potential to affect 5 residents who received pureed diets.

Inspectors wroteBased on observations, interview, record review, document review and policy and procedure review, it was determined the facility failed to ensure hand hygiene and gloves were changed during perineal care for 2 residents (Resident #14 and Resident #52) of 2 residents observed for perineal care. This failed practice had the potential to affect 7 residents who required assistance with perineal care. The facility failed to ensure hand hygiene was performed during clean laundry delivery, before and after entry into room [ROOM NUMBER]. The facility failed to ensure doors for 3 (Resident #18, #28, #54) on droplet precautions remained closed, and COVID positive residents wore the appropriate protection when leaving the room. The Facility failed to ensure staff followed droplet precautions to prevent cross contamination and the spread of disease affecting all 78 residents in the building.

Inspectors wroteBased on observation and interview, the facility failed to ensure privacy and dignity was maintained for 1 Resident (Resident #14) of 1 Resident observed during activity of daily living care. This failed practice had the potential to affect 78 residents currently residing in the facility.

Inspectors wroteBased on observations and interview it was determined that the facility failed to ensure Resident #178's personal and medical information was protected from potential unauthorized persons.

Inspectors wroteBased on observations and interviews, the facility failed to ensure a sink was properly attached to a bathroom wall, for one bathroom sink of two sinks observed. This failed practice had the potential to affect 1 Resident who had access to room [ROOM NUMBER].

Inspectors wroteBased on record review and staff interview, the facility failed to ensure a referral for Pre-admission Screening and Resident Review (PASRR) was made for one (Residents #72) sampled resident reviewed for PASARR. Specifically, the facility failed to ensure Resident #72's PASRR Level 1 pre-screening was completed prior to admission.

Inspectors wroteBased on observations, interviews, record review and review of facility policy and procedures, the facility failed to provide perineal care in accordance with professional standards of care, for 2 (Resident #14 and Resident #52) of 2 residents observed. This failed practice had the potential to affect 7 residents residing in 300 hall who required assistance with perineal care.

Inspectors wroteBased on observation, interview, record review and policy review, the facility failed to follow manufacturer guidance to transfer a Resident from the wheelchair to the bed and from the bed back to the wheelchair for 1 Resident (Resident #14) of 1 Resident observed during a transfer. This failed practice had the potential to affect 3 residents (Resident #14, #42, and #45) who are transferred using a sit to stand lift.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure peg tubes were flushed with the appropriate amount of tap water as ordered by the physician to prevent peg tube complications in 1 (Resident #53) of 2 Residents that received tube feeding, and flushes.

Inspectors wroteBased on observation and interview, the facility failed to ensure medications were stored and labeled in accordance with state laws and accepted standards of pharmacy practice, failed to ensure nasal spray was administered appropriately for 1 (Resident #178), and failed to ensure medications were secured in 1 medication cart of 2 medication carts observed. This failed practice had the potential to affect 47 residents residing in the facility with the ability to ambulate independently or propel in a wheelchair independently.

Inspectors wroteBased on observation, and interview, the facility failed to ensure expired food items were promptly removed and discarded on or before the expiration or use by dates, foods were dated and/or utilized prior to their expiration date, equipment was sanitized between clean and dirty tasks to minimize the potential for food borne illness for residents who received meals from 1 of 1 kitchen, food was prepared and served in a manner to minimize the risk of food borne illness and staff did not consume personal beverages while in the kitchen. The failed practice had the ability to affect 73 residents who receive their meals from one of one kitchen according to a list provided by the Infection Preventionist, LPN on 05/25/23 at 3:38 PM.

Inspectors wroteBased on interview, and record review, the facility failed to ensure resident funds were placed in an interest-bearing account and the interest earned was prorated per individual on the basis of actual earnings or their end-of quarter balance. The failed practice had the ability to affect 11 sampled residents (Residents #1, #5, #8, #10, #15, #40, #50, #52 #60, #62 and #176) who had trust accounts managed by the facility according to a list provided by the Business Office Manager (BOM) on 05/25/23 at 9:51 AM.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure meals were prepared and served according to the planned written menu to meet the nutritional needs of the residents for one of one meal observed. The failed practice had the ability to affect 74 residents who received their meals from 1 of 1 kitchen according to a list provided by the Infection Preventionist (IP) #1 on 05/25/23 at 3:38 PM.

Inspectors wroteBased on observation, and interview, the facility failed to utilize standard precautions when processing clean laundry and failed to process clean laundry in a manner to maintain cleanliness. The failed practice had the ability to affect 77 residents according to the Census by Hall provided by the Administrator on 05/22/23 at 10:25 AM.

Inspectors wroteBased on observation, and interview, the facility failed to maintain a safe environment for 4 (Rooms #206, #207, #208 and #209) rooms and failed to avoid utilizing power strips to operate medical devices for 1 (Rooms #209) of 9 (Rooms #201, #202, #203, #204, #205, #206, #207, #208 and #209) resident rooms on Hall 2.

Inspectors wroteBased on observation and record review, it was determined that the facility failed to ensure resident dignity was maintained by failure to cover urinary catheter collection devices for 1 (Resident #37) of 1 (sampled resident who had an indwelling urinary catheter.

Inspectors wroteBased on interview, record review, and review of the Centers for Medicare and Medicaid Services Resident Assessment Instrument Manual 3.0, the facility failed to accurately record the assessment for 1 (Resident #50) of 24 (Residents #1, #5, #8, #10, #13, #15, #25, #26, #28, #37, #40, #49, #50, #51, #52, #60, #62, #68, #72, #73, #74, #75, #176 and #278) sampled residents.

Inspectors wroteBased on observation, record review, and interview, the facility failed to review and revise the Care Plan to meet the residents' needs for 1 (Resident #68) of 6 (Residents #25, #27, #40, #52 and #176) sampled residents whose care plans were reviewed. This failed practice had the potential to affect 12 residents who had weight loss in the last 3 months per a list provided by the Director of Nursing (DON) on 05/25/23 at 10:02 AM.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure adequate nail care was provided for 1 (Resident #62) of 15 (Residents #8, #15, #25, #26, #37, #40, #49, #50, #51, #52, #60, #62, #68, #176 and #278) sampled residents who relied on the facility for assistance with nail care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure sufficient treatment and services were provided to prevent a decreased range of motion for 1 (Resident #1) of 24 (Resident #1, #5, #8, #10, #13, #15, #25, #26, #28, #37, #40, #49, #50, #51, #52, #60, #62, #68, #72, #73, #74, #75, #176 and #278) sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medications were stored in a sanitary environment in 1 of 1 medication storage room to prevent potential cross contamination. This failed practice had the potential to affect 1 resident (Resident #72) who had medications stored in the refrigerator as documented on a list provided by the Director of Nursing (DON) on 05/26/23.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a Physician's Order for a dietary supplement was followed for 1 (Resident #8) of 7 (Residents #8, #15, #28, #50, #60, #62 and #68) sampled residents who received a dietary supplement according to a list provided by the Director of Nursing (DON) on 05/25/23 at 10:02 AM.