Jena Nursing and Rehabilitation Center: Missed Meds - LA
The resident, identified in the inspection report as Resident #59, was admitted to Jena Nursing and Rehabilitation Center in July 2025. His diagnoses included end-stage renal disease, Type 2 diabetes with complications, depression, anxiety, bipolar disorder, and Parkinsonism. He was fully cognitively intact, scoring a perfect 15 on a standardized cognition assessment.
His dialysis center prescribed Sevelamer Carbonate 800mg, brand name Renvela, to be taken before meals. The drug binds phosphorus in the digestive tract, preventing it from entering the bloodstream. For a dialysis patient with already elevated phosphorus, going without it carries real consequences. The dialysis center's registered dietitian had ordered two tablets with meals and one with snacks specifically because his April 2026 lab work showed his phosphorus was running high.
The last doses he received were on April 17, 2026. After that, nothing.
Inspectors reviewing his electronic medication administration records on June 3 found the same letter, H for hold, filling box after box across April, May, and into June. He missed every dose from April 18 through April 30. He missed every dose in May. He missed every dose from June 1 through at least June 12, when inspectors were still on-site.
Forty-seven days. Not a single tablet.
The registered dietitian at the dialysis center told inspectors the medication had been filled on March 27 and again on April 20, and that the resident should not have run out. She said the dialysis center sends the medication back with the resident after appointments and that the facility knew to call dialysis directly for refills.
An LPN at the facility told inspectors she had called the nursing home's own pharmacy about getting a refill. The pharmacy told her they don't normally fill Sevelamer Carbonate because dialysis handles it, but said they could fill it if the facility needed them to.
Nobody followed up. The prescription sat on hold.
The director of nursing, identified as S2 DON, told inspectors during an interview at 3:23 p.m. on June 3 that she did not know the resident had gone without the medication since April 18. She said she had been under the impression the drug could only be refilled through dialysis. Then she confirmed what the records already showed: the facility should have ordered it through their own pharmacy the moment the dialysis supply ran out, and they did not.
The communication sheets from the dialysis center covering April through early June showed no new orders had come through. Nobody at the facility appears to have escalated the problem when the medication kept going on hold week after week.
The facility's own medication administration policy, reviewed with a date of March 1, 2026, stated plainly that if a medication is ordered but not present, staff should check whether it was misplaced and then call the pharmacy to obtain it. The policy existed. The gap existed. They coexisted for a month and a half.
Federal inspectors rated the violation as causing minimal harm or potential for actual harm, affecting a small number of residents. It was cited under the regulatory standard requiring facilities to provide pharmaceutical services ensuring the accurate acquiring, receiving, and administration of medications.
Resident #59 went to dialysis throughout those weeks. His phosphorus was flagged as elevated in April. The dietitian was monitoring him. The orders were in the system. And still, every morning before breakfast, before lunch, before dinner, the record just says H.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Jena Nursing and Rehabilitation Center, LLC from 2026-06-03 including all violations, facility responses, and corrective action plans.
Download the official CMS inspection PDF from Medicare.gov
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: September 19, 2026 · Our methodology
Jena Nursing and Rehabilitation Center, LLC in Jena, LA was cited for violations during a health inspection on June 3, 2026.
The resident, identified in the inspection report as Resident #59, was admitted to Jena Nursing and Rehabilitation Center in July 2025.
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.