Deerfield Nursing And Rehabilitation Center

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

shift on 07/30/2025 and was assigned to provide care for Resident #7. S9CNA revealed she assisted Resident #7 with eating dinner meal in the dining room around 4:30 p.m. S9CNA revealed around 5:00 p.m.

after Resident #7 finished eating she transferred Resident #7 in her geri chair back to her room. S9CNA reported she backed Resident #7's in her geri chair where the geri chair was at the foot of the bed. S9CNA reported she positioned the geri chair perpendicular to the foot of the bed toward the right side where the geri chair was facing the entrance door of the room. S9CNA reported when she left the room to assist other residents, Resident #7 was sitting in the geri chair. S9CNA reported around 5:25 p.m. she went back to round on Resident #7 and observed Resident #7 was sitting on her buttocks on the floor on the left side of

the bed. S9CNA reported she was leaning against the left side of the bed and pulling against the left bed rail using her left hand attempting to get up. S9CNA reported she immediately went and notified S8LPN.

S9CNA revealed S8LPN told her to go get help and S8LPN went to assess Resident #7. S9CNA revealed when she returned to Resident #7's room Resident #7 was still sitting on the floor and S8LPN was assessing her for injuries. Then S8LPN and S9CNA assisted her up into the bed. S9CNA reported at the time of the incident she was not aware she should have not left Resident #7 in the geri chair in her room unattended. On 09/17/2025 at 2:17 p.m. a telephone interview with S8LPN revealed she worked the day shift (7a.m. -7p.m.) on 07/30/2025 and was assigned to provide care for Resident #7. S8LPN revealed she was at the nurses' station and S9CNA came and informed her around 5:25 p.m. that Resident #7 was on

the floor in her room. S8LPN reported she was aware that Resident #7 should not be left in her room in geri chair unattended. S8LPN reported she reminded S9CNA not to leave Resident #7 in her room in geri chair unattended after Resident #7's fall on 07/30/2025. On 09/22/2025 at 4:15 p.m. an interview with S1Administrator revealed S9CNA should have not left Resident #7 in her room unattended when she was

in the geri chair on 07/30/2025.

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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

09/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Deerfield Nursing and Rehabilitation Center

522 Main Street Delhi, LA 71232

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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

documentation of the daily checks to make sure all exit door were secured and wander guard systems functioned properly revealed no issues.On 09/11/2025 at 11:25 a.m. an interview with S1Administrator revealed the QA team reviewed their wandering and elopement policy. S1Administrator revealed S2DON, herself, and the weekend RN would be verifying that the exit doors alarms are checked daily by the ward clerk Monday through Friday and on Saturday and Sunday by the weekend RN.S1Administrator revealed

they plan on conducting random weekly elopement drills for 1 month then monthly for 3 months.

S1Administrator reported she and the DON will be responsible for conducting the elopement drill.

S1Aministrator reported she and S2DON will monitor that the QA tool sign in sheet verifying the kitchen doors are being locked daily according to the newly implemented process. S1Administrator reported findings will be reported to in the daily QA meeting Monday through Friday.

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

09/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Deerfield Nursing and Rehabilitation Center

522 Main Street Delhi, LA 71232

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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

side of the bed and she attempting to get up. S8LPN revealed Resident #7 was alert and oriented to name.

Resident #7 was not able to tell her what had happened and how she ended up on the floor. S8LPN reported she took Resident #7's vital signs and assessed her for injuries. S8LPN reported she noticed a small purplish bruise on her right arm behind her elbow and a small purplish bruise to her left calf. Resident #7 did not have any open wounds or skin tears noted. S8LPN reported Resident #7 denied pain. S8LPN reported she initiated neuro checks. S8LPN reported she asked Resident #7 if she hit her head and she said no. S8LPN reported Resident #7 was able to performed rang of motions to bilateral upper and lower extremities without voicing any pain showing any signs of pain. S8LPN reported they assisted her up to lay down on the bed. S8LPN reported again asked Resident #7 if she was hurting anywhere and she pointed towards her stomach. S8LPN reported she pulled her shirt up and assessed her stomach and chest area and there was no redness or bruising noted. Resident #7 then passed gas. S8LPN reported Resident #7 denied any pain after passing gas. S8LPN reported she looked to make sure of when her last time she had

a bowel movement and reported there were no issue with her bowel movements. S8LPN reported she notified the MD and Resident #7's responsible party. S8LPN reported Resident #7 was not sent out to the hospital for further evaluation. On 09/23/2025 at 2:18 p.m. a telephone interview with S8LPN reported she was not aware that she should have sent Resident #7 out to the emergency room for evaluation and treatment after having the unwitnessed fall on 07/30/2025 and not being able to explain what happened due to her Alzheimer's disease. S8LPN revealed she had not received in-service training on the facility's Accidents and Incidents - Investigation and Reporting policy with a revised date of 06/09/2025 prior to Resident #7's fall on 07/30/2025. On 09/23/2025 at 2:40 p.m., an interview with S1Administrator confirmed S8LPN should have sent Resident #7 out to the hospital after her unwitnessed fall on 07/30/2025 according to the facility's policy. S1Administrator confirmed S8LPN did not have documented evidence that she received in-service training on the facility's updated Accidents and Incidents - Investigation and Reporting policy with a revised date of 06/09/2025, prior to Resident #7's fall on 07/30/2025.

Event ID:

Facility ID:

If continuation sheet