St. Helena Parish Nursing Home

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

facility for a little over a month. He stated the facility notified him of the incident between Resident #1 and #2 on 08/01/2025. He stated he was told there was a gentleman resident in the common area with Resident #1, and he rubbed her between her legs. He stated he was told it was not skin to skin, but it was still inappropriate touching. He stated Resident #1 was confused. He stated if Resident #1 was cognitive,

she would have been very upset that someone touched her inappropriately. On 08/27/2025 at 8:10 a.m., an

interview was conducted with S12NP. He stated he was familiar with Resident #2. He stated at the beginning of the year, Resident #2 was in the IOP program and received group therapy and individual counseling for Bipolar and Depression. He stated Resident #2 responded well to the program and his symptoms of Bipolar and Depression improved with medication changes. He stated Resident #2 completed his treatment at the beginning of the year and was discharged from the program. He stated he was not notified Resident #2 was having increased inappropriate sexual behaviors in May 2025. He stated if Resident #2's behaviors had become a problem, he would have expected staff to notify him to address the behaviors. He stated he was not notified by the facility Resident #2 sexually abused Resident #1 on 08/01/2025. He stated he had not evaluated Resident #1 or #2 since the incident, and stated he needed to.

On 08/26/2025 at 2:25 p.m., an interview was conducted with S2DON. She stated both she and S6SW arranged IOP for the facility residents. S2DON confirmed S12NP was not notified of Resident #2's increase

in sexual behaviors in May 2025 per his care plan intervention, and should have been. She further confirmed S12NP had not been notified of the incident between Resident #1 and #2, and Resident #1 had not been assessed for psychosocial abuse.

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

08/28/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

St. Helena Parish Nursing Home

32 North 2nd Street Greensburg, LA 70441

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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many

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

all residents. Minimizing Liability Risk: Training staff and adhering to best practices can help reduce the risk of liability associated with admitting sex offenders. 5. Reporting Suspected Abuse. If any abuse is suspected or occurs, it is essential to follow established reporting protocols, including notifying the nursing home administrator, attending physician, medical director, responsible party, local law enforcement, state licensing and certification agencies, and possible Adult Protection Services (APS). 6. Staff Training and ResourcesTrain staff on Sex Offender Management: Ensure staff receive training on how to manage and interact with residents who are registered sex offenders, including recognizing and responding to potential risks. Utilize Resources: Leverage resources available to guide best practices in sex offender treatment and management. 7. Discharge ConsiderationsPotential for discharge: discharge a resident appropriately upon discovering a sex offense conviction after admission, assuming prior notification wasn't received. Review of facility in-service sheet revealed on 08/05/2025, S9CNA received the following in-service conducted by S1ADM:Anytime there is any sign of abuse please, SEPARATE, SEPARATE, SEPARATE before reporting! Be sure to report immediately after separation. The administrator only has 2 hours to report the incident.

However, do not wait to report immediately! Review of the facility's in-service sheet revealed on 08/27/2025, staff received the following in-service conducted by S1ADM: Adult, Disable Person, or Elderly Abuse-Recognition and Reporting Policy. Review of the facility's in-service sheet revealed on 08/27/2025, S1ADM received the following in-services conducted by S18CEO: Regulatory sex offender checks completed for all by S2DON, residents/potential residents to be monitored by the administrator for 30 days, and upon notification of a potential resident utilizing the audit tool.Effect

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

08/28/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

St. Helena Parish Nursing Home

32 North 2nd Street Greensburg, LA 70441

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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record reviews and interviews, the facility failed to coordinate assessments with the resident's Pre-admission Screening and Resident Review (PASRR) Level II by failing to incorporate PASRR Level II determinations and recommendations into a resident's transitions of care for 1 (#2) of 3 (#2, #3, and #Resident R6) residents reviewed for sexual behaviors.Review of Resident #2's clinical record revealed he was admitted to

the facility on [DATE REDACTED] with diagnoses including, Bipolar Disorder and Depression. Review of Resident #2's Form 142 revealed he was approved for admission by Level II authority for a temporary period of 03/04/2025 - 03/03/2026. Review of Resident #2's PASRR Level II Evaluation Summary and Determination Notice dated 03/11/2025 revealed the Level II authority had approved 365 days for nursing facility placement and the following to occur: 1. Psychiatric Evaluation for assessment and medication management. 2. Referral for Dementia Testing/Evaluation by a Neurologist or Neuropsychologist. 3.

Community Based Service via Mental Health Rehab Services to be rendered at NF Community Psychiatric Supportive Services and Psychosocial Rehab Individual counseling to occur by a licensed mental health professional. Review of Resident #2's clinical record revealed the last time he received a psychiatric evaluation was on 01/16/2025. Further review revealed none of the PASRR Level II recommendations listed above had been completed since 03/11/2025. An interview was conducted with S2DON on 08/27/2025 at 12:14 p.m. S2DON reviewed Resident #2's Level II Determination Notice dated 03/11/2025 and confirmed

the PASRR level II recommendations mentioned above were not implemented, and should have been.

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

08/28/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

St. Helena Parish Nursing Home

32 North 2nd Street Greensburg, LA 70441

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

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

offender. She stated she was not initially trained to care plan residents for being sex offenders. She confirmed Residents #2 and #3's care plans were developed to reflect their sex offender status after the incident occurred between Residents #1 and #2. On 08/26/2025 at 2:25 p.m., an interview was conducted with S2DON. She stated she was unaware Resident #2 and Resident #3 were registered sex offenders until

after the incident occurred between Resident #1 and #2 on 08/01/2025. S2DON stated if she would have known Resident #2 was a registered sex offender, she would have been more aggressive with initiating interventions for him, which could have made staff more aware of Resident #2's behaviors. She stated if S4CP was aware Residents #2 and #3 were registered sex offenders, they should have been care planned for being sex offenders prior to the incident between Residents #1 and #2 on 08/01/2025. 2. Review of Resident #2's Clinical Record revealed he was admitted to the facility on [DATE REDACTED] with diagnoses, which included Bipolar Disorder and Depression. Further review revealed Resident #2 was a registered sex offender. Review of Resident #2's Care Plan created on 02/26/2025 revealed the following, in part: Problem:

The resident has a behavior problem: excessive masturbating and staying completely naked at all times when in room/makes sexual comments towards staff at times. Interventions: Explain/reinforce why behavior is inappropriate and/or unacceptable to the resident; intervene as necessary to protect the rights and safety of others; 05/15/2025: Intensive Outpatient Program (IOP) to be notified of increase in inappropriate sexual behavior. Review of an email dated 05/16/2025 at 10:34 a.m. from S4CP to S6SW revealed the following, in part:I couldn't remember if you were in the meeting when S2DON said it or not, but S2DON said she wants S12NP to look at Resident #2 because the Certified Nursing Assistants (CNAs) are saying he's progressively getting worse and worse about making inappropriate sexual comments towards them. Review of Resident #2's Psychiatric Evaluation Notes revealed the last time he was evaluated by S12NP was on 01/16/2025. On 08/26/2025 at 1:10 p.m., an interview was conducted with S4CP. She stated the intervention initiated on Resident #2's care plan on 05/15/2025 for IOP to be notified of his increased inappropriate sexual behaviors was S6SW's responsibility to arrange, and she did not know if it was. On 08/26/2025 at 1:11 p.m., an interview was conducted with S1ADM. He stated S6SW was on vacation and unable to be reached. On 08/27/2025 at 8:10 a.m., an interview was conducted with S12NP. He stated he was not notified Resident #2 was having increased inappropriate sexual behaviors in May 2025. He stated if Resident #2's behaviors had become a problem, he would have expected staff to notify him. On 08/26/2025 at 2:25 p.m., an interview was conducted with S2DON. She stated both she and S6SW arranged IOP for the facility residents. S2DON further confirmed S12NP was not notified of Resident #2's increase in sexual behaviors in May 2025 per his care plan intervention and should have been.

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

08/28/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

St. Helena Parish Nursing Home

32 North 2nd Street Greensburg, LA 70441

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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

8:43:47, S11CNA was observed walking up the hall back to the nurse's station. S11CNA grabbed at S7LPN, who was walking beside her, and pointed towards Residents #1 and #2. S7LPN immediately removed Resident #2's hand from between Resident #1's thighs and separated the residents. S7LPN was observed talking to Resident #1 then she picked up the phone and called someone. 8:48 p.m., Resident #2 was brought to his room. Review of Resident #1's current Care Plan revealed it was not revised after 08/01/2025 to reflect problems, goals, and interventions related to her being a victim of sexual and psychosocial abuse. On 08/26/2025 at 1:10 p.m., an interview was conducted with S4CP. She confirmed Resident #1's care plan was not revised after 08/01/2025 to reflect she was a victim of sexual and psychosocial abuse. She stated Resident #1's care plan should have been revised for staff to observe Resident #1 for any psychosocial or behavioral changes. On 08/26/2025 at 2:25 p.m., an interview was conducted with S2DON. She stated Resident #1's care plan should have been revised after 08/01/2025 to reflect she was a victim of sexual and psychosocial abuse and for staff to observe for any behavioral changes, and it was not.

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

08/28/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

St. Helena Parish Nursing Home

32 North 2nd Street Greensburg, LA 70441

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 0944 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.

Based on record reviews and interview, the facility failed to ensure staff was provided Quality Assurance and Performance Improvement (QAPI) training for 5 (S7LPN, S8LPN, S9CNA, S10CNA, and S11CNA) of 5 (S7LPN, S8LPN, S9CNA, S10CNA, and S11CNA) personnel files reviewed. Review of S7LPN's personnel file revealed a hire date of 07/26/2024. Further review of S7LPN's personnel file revealed no documented evidence, and the facility presented no documented evidence, S7LPN received QAPI training as required.

Review of S8LPN's personnel file revealed a hire date of 12/01/2023. Further review of S8LPN's personnel file revealed no documented evidence, and the facility presented no documented evidence, S8LPN received QAPI training as required. Review of S9CNA's personnel file revealed a hire date of 04/16/2025.

Further review of S9CNA's personnel file revealed no documented evidence, and the facility presented no documented evidence, S9CNA received QAPI training as required. Review of S10CNA's personnel file revealed a hire date of 03/29/2022. Further review of S10CNA's personnel file revealed no documented evidence, and the facility presented no documented evidence, S10CNA received QAPI training as required.

Review of S11CNA's personnel file revealed a hire date of 12/11/2024. Further review of S11CNA's personnel file revealed no documented evidence, and the facility presented no documented evidence, S11CNA received QAPI training as required. On 08/28/2025 at 10:20 a.m., an interview was conducted with S1ADM. He stated there was no documentation any staff had completed QAPI training.

Event ID:

Facility ID:

If continuation sheet