Broadway Nursing: Unlicensed Staff Treated 87 Residents - LA
The unlicensed worker at Broadway Nursing and Rehabilitation Center failed the National Council Licensure Examination for Practical Nurses but continued working as an LPN from November 20, 2024, until she was suspended on January 24, 2025. Federal inspectors cited the facility for immediate jeopardy violations, finding a likelihood of serious injury, harm, or death from the unlicensed care.
Administrator S1Administrator directed the promotion himself. On February 12, he told inspectors he ordered Human Resources specialist S7TMS to change the worker's status from CNA to LPN, and he directed Director of Nursing S2DON to let the worker perform LPN duties.
"He should have verified S5Unlicensed Personnel had a valid Louisiana Practical Nurse license before allowing her to perform care and services as a Louisiana Practical Nurse," the inspection report stated.
The worker signed a Licensed Staff job description on November 22, 2024, two days after her official promotion. She had never passed the licensing exam required to work as an LPN in Louisiana.
Nobody checked.
Human Resources specialist S7TMS told inspectors she was responsible for verifying licensure when staff were hired and when position changes occurred. She officially changed the worker's status on November 20 but didn't contact the Louisiana State Board of Practical Nurse Examiners until January 24, 2025 — more than two months later.
The state board's email response came five days later: the worker "did not have an active Practical Nurse License in the state of Louisiana."
Director of Nursing S2DON described the arrangement as training. She said the unlicensed worker would "observe and provide nursing care under supervision of another licensed nurse." But S2DON admitted she should have called the state licensing board to verify the worker had a Louisiana nursing license before allowing her to provide LPN services to residents.
The facility's own Professional Licensure Verification Policy required all employees with professional licenses to be verified upon hire and as required through the appropriate licensure board. The Administrator's job description made him responsible for adopting and enforcing rules and for the healthcare and safety of patients.
Those policies weren't followed.
On February 17, Administrator S1Administrator acknowledged to inspectors there was a likelihood of serious injury, serious harm, serious impairment or death from having unlicensed personnel providing nursing services. Chief Operations Officer S6COO made the same admission the same day.
The facility identified 87 residents who received care and services from the unlicensed worker during her two-month tenure as a supposed LPN. Electronic medical records showed she provided nursing care throughout the facility until her suspension.
The worker was terminated on January 29, 2025, five days after her suspension.
Broadway Nursing implemented corrective actions before federal inspectors arrived. The facility in-serviced the Administrator on January 24, the Director of Nursing on January 29, and the Human Resources specialist on January 30 on licensure verification and reporting wrongdoing.
A regional RN conducted cognitive resident interviews on January 30 regarding medication administration concerns and other nursing issues. The facility started a facility-wide audit of all nurses on January 24 to ensure active licenses were in place.
Staff received in-service training on reporting wrongdoing by January 31. The facility completed audits of electronic medical records for residents who received care from the unlicensed worker to ensure no harm occurred, according to the inspection report.
The facility's monitoring plan requires the Human Resources specialist to verify licensure before nurses are hired or change roles. The Director of Nursing will receive copies for double verification. A Corporate Compliance Officer will audit weekly for three months, then annually.
Federal inspectors found the corrective actions were completed before their investigation, classifying the violations as past noncompliance. But the immediate jeopardy designation reflects the severity of unlicensed personnel providing nursing services to vulnerable residents.
The inspection reviewed 50 personnel files for active and current licensure. Only one employee lacked proper licensing — the worker who had been promoted without verification.
Broadway Nursing's Administrator reported to a Regional Director and was responsible for the healthcare and safety of patients and others, according to his job description. The Director of Nursing was supposed to assist with interviewing, evaluating and selecting new personnel. The Human Resources Manager was responsible for maintaining all personnel files in compliance with local and federal laws.
The system failed at every level. The Administrator ordered the promotion without license verification. The Director of Nursing allowed unlicensed nursing care. The Human Resources specialist processed the position change without confirming the worker could legally perform the job.
For more than two months, 87 residents received nursing care from someone who had never passed the exam required to provide it. The facility's own policies required license verification. State law required proper licensure. Federal regulations demanded compliance.
None of it happened until a Human Resources specialist finally made a phone call in January, two months too late.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for The Broadway Nursing and Rehabilitation Ctr from 2025-02-17 including all violations, facility responses, and corrective action plans.
Additional Resources
- View all inspection reports for The Broadway Nursing and Rehabilitation Ctr
- Browse all LA nursing home inspections
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 13, 2026 · Our methodology
THE BROADWAY NURSING AND REHABILITATION CTR in LOCKPORT, LA was cited for violations during a health inspection on February 17, 2025.
Federal inspectors cited the facility for immediate jeopardy violations, finding a likelihood of serious injury, harm, or death from the unlicensed care.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.
Frequently Asked Questions
- What happened at THE BROADWAY NURSING AND REHABILITATION CTR?
- Federal inspectors cited the facility for immediate jeopardy violations, finding a likelihood of serious injury, harm, or death from the unlicensed care.
- How serious are these violations?
- Violation severity varies from minor documentation issues to serious safety concerns. Review the inspection report for specific deficiency codes and scope. All violations must be corrected within required timeframes and are subject to follow-up verification inspections.
- What should families do?
- Families should: (1) Ask facility administration about specific corrective actions taken, (2) Request to see the follow-up inspection report verifying corrections, (3) Check if this represents a pattern by reviewing prior inspection reports, (4) Compare this facility's ratings with other nursing homes in LOCKPORT, LA, (5) Report any new concerns directly to state authorities.
- Where can I see the full inspection report?
- The complete inspection report is available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request a copy directly from THE BROADWAY NURSING AND REHABILITATION CTR or from the state Department of Health. The report includes specific deficiency codes, facility responses, and correction timelines. This facility's federal provider number is 195583.
- Has this facility had violations before?
- To check THE BROADWAY NURSING AND REHABILITATION CTR's history, visit Medicare.gov's Care Compare and review their inspection history, quality ratings, and staffing levels. Look for patterns of repeated violations, especially in critical areas like abuse prevention, medication management, infection control, and resident safety.