Legacy Nursing And Rehabilitation Of Franklin

F-F692.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 8 of 9 195388 Department of Health & Human Services Printed: 09/13/2025 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 195388 B. Wing 08/09/2024

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

Legacy Nursing and Rehabilitation of Franklin 1907 Chinaberry Street Franklin, LA 70538

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 0835 In an interview on 08/07/2024 at 3:55 p.m., S5LPN indicated she was responsible for Resident #1 on the day shift on 07/12/2024. S5LPN indicated the nursing staff had difficulty getting Resident #1 to eat lunch and Level of Harm - Immediate dinner. S5LPN indicated Resident #1 was nonverbal and unable to communicate his wants and needs to jeopardy to resident health or staff. S5LPN indicated she did not feel it was necessary to notify Resident #1's physician or responsible safety party that he had not eaten well on 07/12/2024.

Residents Affected - Few In an interview on 08/06/2024 at 4:41 p.m., Resident #1's daughter/responsible party indicated she had not been notified by the facility of Resident #1's decline in oral intake on 07/12/2024 or 07/13/2024. Resident #1's daughter/responsible party indicated had she been made aware on 07/12/2024 and 07/13/2024 she would have gone to the facility to check on her father and she could have ensured that his needs were addressed.

In an interview on 08/07/2024 at 2:00 p.m., S4Quality Improvement (QI) Nurse indicated she was responsible for notifying the physician of any significant weight changes and recommendations made by the Registered Dietitian. S4QI Nurse further indicated she was not aware of the Registered Dietitian's recommendation for Resident #1 to receive Twocal 2 ounces twice daily for 60 days by staff. S4QI Nurse confirmed she did not notify Resident #1's physician of the above mentioned recommendation and should have.

In an interview on 08/08/2024 at 2:03 p.m., Resident #1's physician confirmed he was not notified of the Registered Dietitian's recommendation on 04/14/2024 of Twocal 2 ounces twice daily for 60 days. Resident #1's physician further indicated Resident #1 was severely dehydrated when he was hospitalized on [DATE REDACTED]. Resident #1's physician further indicated Resident #1's level of dehydration was so severe Resident #1 had to have very poor oral intake for a minimum of a week, and the level of Resident #1's dehydration did not happen in 3 days.

In an interview on 08/08/2024 at 4:39 p.m., S3Prior Director of Nursing (DON) stated Resident #1 had a very good appetite and required double portions due to a history of taking food from other peoples plates. S3Prior DON indicated if Resident #1 became unable or unwilling to eat, then this would have been a significant change for him, and the nursing staff should have immediately notified the physician.

In an interview on 08/09/2024 at 12:19 p.m., S2DON confirmed the nursing staff did not notify Resident #1's physician and responsible party timely on 07/12/2024 and/or 07/13/2024 of Resident #1's decline in oral intake, and confirmed this resulted in an immediate jeopardy situation.

In an interview on 08/09/2024 at 12:19 p.m., S1Administrator confirmed the nursing staff did not notify #1's physician and responsible party timely on 07/12/2024 and/or 7/13/2024 of Resident #1's decline in oral intake and confirmed this resulted in an immediate jeopardy situation.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 9 of 9 195388