Acadia St. Landry Guest House

F-F812

On [DATE REDACTED] at 8:35 AM, an tour of the facility's kitchen revealed surfaces with an accumulation dust, dirt, food residue and other debris and expired food items. In addition, a meal was served at temperatures that were not within an appropriate range during distribution of hall trays.

Review of the facility's State of Louisiana Department of Health, Office of Public Health, Retail Food Notice of Violations dated [DATE REDACTED] at 12:30 PM, read in part: Non-Critical Items: Description of Violations: Non-food contact surfaces of equipment have an accumulation of dust, dirt, food residue and other debris. Food carts are not clean. Floors are not clean. (Corrected). Floors along the walls under the dishwashing machine and

in the dishwashing room are not clean. (Repeated)

Review of the facility's State of Louisiana Department of Health, Office of Public Health, Retail Food Notice of Violations dated [DATE REDACTED] at 10:00 AM, read in part: Non-food contact surfaces of equipment have an accumulation of dust, dirt, food residue and other debris. Inside the microwave oven and seasoning cabinet are not clean. (Repeat). Floors are not clean. Floors are not clean along the walls under the shelves in the walk in cooler, walk in freezer and the dishwashing area (Repeat).

On [DATE REDACTED] at 4:30 PM, an interview was conducted with S1ADM (Administrator). S1ADM confirmed the presented findings in the kitchen.

On [DATE REDACTED] at 9:43 AM, an interview was conducted with S1ADM. He stated he was unaware of any inspection performed by OPH (Office of Public health) since 2023. S1ADM stated that S17DM had been notified of the results but had not relayed those results to him. He stated that S17DM (Dietary Manager) was responsible for all activities in the kitchen, including ensuring cleanliness, however, he had total oversite of

the kitchen.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 20 of 23 195564 Department of Health & Human Services Printed: 09/08/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 195564 B. Wing 02/12/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Acadia St Landry Nursing & Rehabilitation Center 830 S. Broadway Church Point, LA 70525

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 0880 Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 47965 potential for actual harm Based on observation, interview, and record review, the facility failed to establish and maintain an infection Residents Affected - Many prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections by failing to ensure contact precautions were followed for 1 (#74) of 4 (#21, #27, #74 and #273) residents on contact precautions.

Findings:

On 02/13/2025, a review of the facility's policy titled Application of Transmission-Based Precautions with a revised date of 11/05/2024, read in part .Contact Precautions: Intended to prevent transmission of infectious agents that are spread by direct or indirect contact with the resident or the resident's environment. Staff caring for residents on Contact Precautions should wear gown and gloves for all interactions that may involve contact with the resident or potentially contaminated areas in the resident's environment.

Resident # 74 was admitted to the facility on [DATE REDACTED] with diagnoses which included, but were not limited to urinary tract infection, and benign prostatic hyperplasia with lower urinary tract symptoms.

A review of Resident #74's quarterly MDS dated [DATE REDACTED] revealed he had an indwelling catheter.

A review of Resident #74's care plan revealed a focus area dated 01/28/2025 for Contact Isolation precaution. Interventions included in part, signs placed outside of resident's room to alert staff visitors to check with nurse before entering room and proper PPE (Personal Protective Equipment) required before entering room.

On 02/10/2025 at 10:20 AM, an observation was made of Resident #74's room. A large sign was observed

on the door that read in part: Contact Precautions Everyone Must .Providers and staff must also: Put on gloves before room entry. Discard gloves before room exit. Put on gown before room entry. Discard gown

before room exit .

During an interview with S7ResCNA (Restorative Certified Nursing Assistant) on 02/10/2025 at 10:20 AM, S7ResCNA stated that Resident #74 was at therapy. When asked if the resident still went to therapy while on contact precautions, she stated He has been going to therapy. S7ResCNA opened the resident's door and confirmed he was not in the room.

On 02/10/2025 at 10:28 AM, an observation was made of the therapy room. S21PTTech (Physical Therapy Tech) was pushing the resident in his wheelchair and was not wearing gown or gloves. S21PTTech stated

she was taking the resident back to his room. When asked stated she was unaware he was on Contact Precautions.

On 02/10/2025 at 11:06 AM S22CNA (Certified Nursing Assistant) was observed in Resident #74's room without gown or gloves. She was pushing the resident in his wheelchair towards his door. S3IP (Infection Preventionist) confirmed S22CNA did not have a gown or gloves on while in the resident's room.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 21 of 23 195564 Department of Health & Human Services Printed: 09/08/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 195564 B. Wing 02/12/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Acadia St Landry Nursing & Rehabilitation Center 830 S. Broadway Church Point, LA 70525

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 0880 On 02/10/2025 at 11:09 AM, Resident #74's was asked who took him to therapy in the morning, and he stated S7ResCNA took him to therapy. Level of Harm - Minimal harm or potential for actual harm During an interview with on 02/10/2025 at 10:58 AM with S3IP, she confirmed Resident #74 was on Contact Precautions. She stated that he had ESBL (Extended spectrum beta-lactamase) in his urine and was on Residents Affected - Many antibiotics. S3IP stated the resident should not have gone to therapy due to risk of contamination.

During a follow-up interview with S7ResCNA on 02/11/2025 at 10:50 AM, stated that she was aware the resident was on Contact Precautions but confused it for enhanced barrier. S7ResCNA stated she should not have taken the resident out his room because he was on Contact Precautions.

During an interview with S23OT (Occupational therapist) on 02/11/2025 at 2:10 PM, she stated Resident #74 received physical, occupational and speech therapy. She stated that therapy staff never goes to his room to get him, so they were unaware that he was on contact precautions and were not using gown or gloves. She further stated that the infection preventionist usually makes them aware, but she did not.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 22 of 23 195564 Department of Health & Human Services Printed: 09/08/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 195564 B. Wing 02/12/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Acadia St Landry Nursing & Rehabilitation Center 830 S. Broadway Church Point, LA 70525

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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 47965 potential for actual harm Based on observation and interview, the facility failed to ensure that residents who were capable of using call Residents Affected - Few bells were able to reach the call bell for 1 (#60) of 39 sampled residents.

Findings:

Resident #60 was admitted to the facility on [DATE REDACTED] with diagnoses which included, but were not limited, to major depressive disorder and repeated falls.

A review of Resident #60's quarterly MDS (Minimum Data Set) dated 10/30/2024, revealed in Section GG that she had no upper extremity impairments.

On 02/10/2025 at 9:46 AM, an observation was made of Resident #60 in her room. The resident was lying in her bed and her call bell was on the night stand at the foot of her bed. The call bell was outside of the resident's reach. When asked, Resident #60 stated that she did not know where her call bell was.

During an observation and interview with S18LPN (Licensed Practical Nurse) on 02/10/2025 at 9:50 AM, she confirmed the resident's call bell was out of Resident #60's reach. S18LPN stated Resident #60 was capable of using her call bell, and it should have been pinned to the resident's bed where she can reach it and not placed on the night stand at the foot of bed where the resident was unable to reach it.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 23 of 23 195564