Maison Du Monde Living Center

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

and had stolen her pop. S11LPN stated she informed S1ADM (Administrator) of the incidents on 12/06/2025 and 12/07/2025 at the times that they occurred.

On 01/28/2026 at 2:31 p.m., a phone interview was conducted with S12CNA (Certified Nursing Assistant) regarding the incident on 12/06/2025 between Resident #2 and Resident #81. S12CNA stated on 12/06/2025, Resident #2 was wheeling herself down the hall, Resident #81 walked out of her room, and both residents were in the hall at the same time. Resident #81 stated something about Resident #2 stealing her pop. S12CNA stated that when she was separating the residents and wheeling Resident #2 back to her room, she hit Resident #81 on her leg.

On 01/28/2026 at 3:53 p.m., an interview and record review were conducted with S1ADM. S1ADM confirmed he was notified by S3SSD (Social Service Director) and S11LPN of the physical altercations between Resident #2 and Resident #81 at the times they occurred on 12/06/2025 and 12/07/2025. S1ADM stated the incidents resulted in no injury to both residents.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

01/29/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Maison Du Monde Living Center

4000 Rodeo Road Abbeville, LA 70510

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review and interview, the facility failed to complete a discharge summary for 1 (Resident #123) of 3 closed records reviewed.Findings:A review of the facility's policy titled, Discharge Summary and Plan, with

a last reviewed date of 04/09/2025, read in part, When the facility anticipates a resident's discharge to private residence, another nursing care facility, a discharge summary and post discharge plan will be developed which will assist the resident to adjust to his or her new living environment. The discharge summary will include a recapitulation of the resident's stay at this facility and a final summary of the resident's status at the time of discharge. A copy of the following will be provided to the resident and receiving facility and a copy will be filed in the resident's medical records: c. discharge summary.A review of Resident #123's record revealed she was admitted to the facility on [DATE REDACTED] and discharged from the facility

on 11/07/2025. Further review of the record revealed no documentation of a discharge summary completed for Resident #123.On 01/28/2026 at 2:06 p.m., a record review and interview was conducted with S3SSD (Social Services Director). S3SSD confirmed Resident #123 was discharged from the facility on 11/07/2025. S3SSD further confirmed that a discharge summary was not completed for Resident #123.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

01/29/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Maison Du Monde Living Center

4000 Rodeo Road Abbeville, LA 70510

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0685 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

application fee for the hearing aids program. Resident stated I don't have that kind of money!. You can't ask them to waive that fee? SSD spoke to . at [ENT] office and explained that resident stated she did not have

the money for the application fee. stated that if resident couldn't pay the fee, she would not be able to participate in the program.also stated that resident was referred . for assistance with hearing devices.

S3SSD stated that evidently she did know about the referral to the community provider to obtain hearing aids for Resident #6. S3SSD could not explain why she did not follow up with the community provider after not receiving communication from them regarding the resident's hearing aids or for an appointment from February 2025 to now. S3SSD was asked if she was responsible for providing residents with assistance or resources to obtain hearing aids or other assistive devices, and she stated Yea I guess.

Event ID:

Facility ID:

If continuation sheet