F 0636 Resident #60

Level of Harm - Minimal harm or Review of Resident #60's Discharge-return anticipated Minimum Data Set (MDS) with an Assessment potential for actual harm Reference Date (ARD) of 04/20/2025, revealed a complete by date of 05/04/2025. Further review of the MDS revealed the MDS had a status of in progress. Residents Affected - Some

On 05/21/2025 at 12:56 p.m., an interview was conducted with S13MDS. She reviewed Resident #57's Quarterly MDS assessment. She further reviewed Resident #24, #29, #37 and #60's Discharge Assessments. She confirmed status for all aforementioned assessments as being in progress and had not been completed in required timeframe. She stated Quarterly and Discharge MDS assessments should be completed within 14 days and were not.

On 05/21/2025 at 2:10 p.m., an interview was conducted with S2RNSUP. She reviewed Resident #57's Quarterly MDS assessment. She further reviewed Resident #24, #29, #37 and #60's Discharge Assessments. S2RNSUP confirmed status for all aforementioned assessments as being in progress and had not been completed in required timeframe. S2RNSUP stated Quarterly and Discharge MDS assessments should be completed within 14 days and were not.

47191

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 2 of 25 195526 Department of Health & Human Services Printed: 08/26/2025 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 195526 B. Wing 05/21/2025

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

Heritage Healthcare of Hammond 1300 Derek Drive Hammond, LA 70403

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 0637 Assess the resident when there is a significant change in condition

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 46975 potential for actual harm 47191 Residents Affected - Few Based on record review and interview the facility failed to complete a significant change MDS within 14 calendar days after determining there was a significant change in residents status for 2 of 20(#6 and #29) sampled resident's.

Findings:

Resident #6

Review of Resident #6's Significant Change MDS with an ARD of 03/06/2025 revealed an admitted [DATE REDACTED].

Further Review of Resident #6's Significant Change MDS with an ARD of 03/06/2025 revealed assessment was completed on 03/26/2025.

Resident #29

Review of Resident #29's Significant Change MDS with an ARD of 05/05/2025 revealed an admitted [DATE REDACTED].

Further review of Resident #29's clinical record revealed a Significant Change MDS with an ARD of 05/05/2025 with a submission status of in progress.

On 05/21/2025 at 12:56 p.m. an interview was conducted with S13MDS. She reviewed Resident #6 and Resident #29 most recent significant change assessments. S13MDS confirmed Resident #6 Significant Change assessment dated [DATE REDACTED] was not completed within required timeframe. S13MDS confirmed Resident #29 Significant Change assessment dated [DATE REDACTED] was still in progress and assessment was not completed within required timeframe. S13MDS confirmed Resident #6 and Resident #29 significant change assessments should have been completed within 14 days and were not.

On 05/21/2025 at 2:10 p.m. an interview was conducted with S2RNSUP. She reviewed Resident #6 and Resident #29 most recent significant change assessments. S2RNSUP confirmed Resident #6 Significant Change assessment dated [DATE REDACTED] was not completed within required timeframe. S2RNSUP confirmed Resident #29 Significant Change assessment dated [DATE REDACTED] was still in progress and assessment was not completed within required timeframe. S2RNSUP confirmed Resident #6 and Resident #29 significant change assessments should have been completed within 14 days and were not.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 3 of 25 195526 Department of Health & Human Services Printed: 08/26/2025 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 195526 B. Wing 05/21/2025

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

Heritage Healthcare of Hammond 1300 Derek Drive Hammond, LA 70403

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 0655 Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 47191

Residents Affected - Few Based on record review and interview the facility failed to ensure a baseline care plan was developed within 48 hours of admission to the facility for 1 (#290) of 20 sampled residents.

Findings:

Review of Resident #290's medical record revealed an admitted [DATE REDACTED] with diagnoses which included Type II Diabetes Mellitus, Atrial Fibrillation and Major Depressive Disorder.

Review of Resident #290's medical record revealed a baseline care plan was initiated on 05/19/2025.

On 05/21/2025 at 12:56 p.m. an interview was conducted with S19MDS. She reviewed Resident #290's care plan and confirmed she initiated it on 05/19/2025. S19MDS confirmed baseline care plans should be implemented within 48 hours of admission and Resident #290's was not.

On 05/21/2025 at 2:10 p.m. an interview was conducted with S2RNSUP. She reviewed Resident #290's baseline care plan and confirmed it was initiated on 05/19/2025. S2RNSUP confirmed she would expect all residents to have a baseline care plan within 48 hours of Admission. S2RNSUP confirmed Resident #290's baseline care was not implemented in a timely manner and should have been.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 4 of 25 195526 Department of Health & Human Services Printed: 08/26/2025 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 195526 B. Wing 05/21/2025

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

Heritage Healthcare of Hammond 1300 Derek Drive Hammond, LA 70403

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 0677 On 5/20/2025 at 10:50 a.m., an interview was conducted with S17CNA. She stated she was working 6:00 a. m.-2:00 p.m. today, but usually worked the 2:00 p.m.-10:00 p.m. shift. She stated the shower aids on the Level of Harm - Minimal harm or halls were responsible for giving the resident's baths/showers. She stated when the shower aid was pulled to potential for actual harm the floor, the floor CNA would try to get baths completed if possible. She stated she had never given Resident #240 a bath/shower. Residents Affected - Few

On 05/20/2025 at 1:51 p.m., an interview was conducted with S18SA. She stated she was scheduled Monday-Friday from 6:00 a.m.-2:00 p.m. as the shower aid. She stated she got pulled to the floor usually 3 days a week. She stated when she was pulled, if she did not volunteer to stay until the next shift and bathe/shower residents, staff would attempt to call someone in, if not, residents would not get a bath. She stated she was responsible for bathing/showering the residents on Hall B. She stated Resident #240 required a bed bath because he could not stand on his own to get in the shower. She stated his bath days were Tuesdays, Thursdays, and Saturdays. She reviewed Resident #240's bath flowsheet dated May 2025 and confirmed since he was admitted , no baths had been documented. She stated she wiped him off the day after he was admitted , but had not given him a bath since then.

On 05/21/2025 at 9:04 a.m., an interview was conducted with S16CNA. She stated she was assigned to Resident #240 from 6:00 a.m.-2:00 p.m. She stated the shower aid completed Resident #240's baths. She stated on days like today, when they were short staffed and pulled the shower aid to work the floor, the floor CNA was responsible for giving baths/showers. She stated she had never given Resident #240 a bath since

he had been admitted . She reviewed Resident #240's bathing flowsheet and verified he was admitted on [DATE REDACTED] and there had been no baths charted as being given, and only 1 refusal charted on 05/15/2025.

On 05/21/2025 at 2:45 p.m., an interview was completed with S1ADM and S2RNSUP. S1ADM reviewed Resident #240's bathing flowsheet and confirmed no baths had been documented as given since he was admitted , and only 1 refusal had been documented. S2RNSUP stated she had 2 CNA's bathe Resident #240 on Saturday 05/17/2025 so she knew he received a bath that day. S1ADM and S2RNSUP were unable to confirm Resident #240 received a bath before 05/17/2025. They stated any refusals or baths given should have been documented.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 6 of 25 195526 Department of Health & Human Services Printed: 08/26/2025 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 195526 B. Wing 05/21/2025

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

Heritage Healthcare of Hammond 1300 Derek Drive Hammond, LA 70403

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 0684 Review of Resident #240's TAR dated May 2025 revealed no documentation the following wound care was provided on 05/09/2025: Abrasion to left knee, abrasion to right great toe, laceration to left knee, laceration to Level of Harm - Minimal harm or right forearm, and surgical incision to LBKA. potential for actual harm

Review of Resident #240's Nurse's Note revealed no documentation regarding a refusal or why wound care Residents Affected - Few was not completed on 05/09/2025.

On 05/20/2025 at 8:31 a.m., an interview was conducted with Resident #240. He stated he was supposed to receive wound care daily. He stated he could not recall specific days, but there had been days where he did not receive wound care.

On 05/21/2025 at 10:00 a.m., an interview was conducted with S12TN. She stated she worked Monday-Friday as the wound care nurse. She stated when she was pulled to the floor or was unavailable, one of the ADON's would complete wound care. She stated Resident #240 had dressing changes ordered daily. She stated on 05/09/2025 she had a doctor's appointment at noon and left early. She stated she did not perform Resident #240's wound care treatments and notified S4ADON she was unable to complete them.

On 05/21/2025 at 12:28 p.m., an interview was conducted with S4ADON. She stated she was notified S12TN left early on 05/09/2025 and did not complete Resident #240's wound care. She stated Resident #240 had a lot of pain that day and she notified S14NP. She stated S14NP said it was ok to hold the dressing change for 05/09/2025. She stated she did not chart his wound care treatment was held on 05/09/2025 and should have.

On 05/21/2025 at 2:07 p.m., an interview was conducted with S14NP. She stated she was not notified on any day since Resident #240's admission that he was in too much pain to receive wound care treatment, or gave an order for wound care to be held. She stated she expected staff to provide wound care to Resident #240 daily as ordered.

On 05/21/2025 at 2:45 p.m., an interview was completed with S1ADM. She reviewed Resident #240's TAR for May 2025 and verified the wound care for 05/09/2025 was not documented as completed. She confirmed wound care treatments should be completed per doctor orders, unless a resident was in too much pain. She further confirmed if wound care was not completed because a resident was in pain, it should be documented.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 8 of 25 195526 Department of Health & Human Services Printed: 08/26/2025 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 195526 B. Wing 05/21/2025

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

Heritage Healthcare of Hammond 1300 Derek Drive Hammond, LA 70403

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 0725 On 05/21/2025 at 2:45 p.m., an interview was conducted with S1ADM. She stated staffing was determined by census. She was made aware of the staffing observations on 05/19/2025. She stated she did not expect a Level of Harm - Minimal harm or resident to stay soiled for 51 minutes before being changed. She stated CNA's should make rounds every 2 potential for actual harm hours, and residents should be assisted back to bed timely. She was notified of S7LPN not being aware Resident #32 refused dialysis on 05/19/2025 because she stated she was pulled in a thousand directions. Residents Affected - Some She stated it was an issue if the nurse did not know her resident refused dialysis and was at the facility for 3-4 hours, when she thought she was out of the facility.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 25 195526 Department of Health & Human Services Printed: 08/26/2025 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 195526 B. Wing 05/21/2025

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

Heritage Healthcare of Hammond 1300 Derek Drive Hammond, LA 70403

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 0732 Post nurse staffing information every day.

Level of Harm - Potential for 45270 minimal harm Based on observations and interviews, the facility failed to ensure nurse staffing data was posted on a daily Residents Affected - Many basis at the beginning of each shift and readily accessible to residents and visitors. This deficient practice had the potential to affect any of the 82 residents residing in the facility.

Findings:

On 05/18/2025 at 9:32 a.m., an observation was made of the bulletin board on Hall A. The form titled Daily Staffing Reporting Form dated 05/16/2025 was observed.

On 05/18/2025 at 9:38 a.m., an interview was conducted with S4ADON. She stated she was responsible for posting the nurse staffing data information Monday through Friday. She stated on Friday's she completed the nurse staffing data forms for Saturday, Sunday and Monday. She stated there were no staff on the weekend who were responsible for updating the nurse staffing data forms and was not aware it was required.

On 05/18/2025 at 10:00 a.m., an interview was conducted with S2RNSUP and S3ADON. S2RNSUP and S3ADON stated S4ADON was responsible for posting the nurse staffing data information. S2RNSUP and S3ADON observed the bulletin board on Hall A and confirmed the posted form Daily Staffing Reporting Form was dated 05/16/2025.

On 05/18/2025 at 10:20 a.m., an interview was conducted with S1ADM. She observed the bulletin board on Hall A and confirmed the posted form Daily Staffing Reporting Form was dated 05/16/2025.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 25 195526 Department of Health & Human Services Printed: 08/26/2025 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 195526 B. Wing 05/21/2025

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

Heritage Healthcare of Hammond 1300 Derek Drive Hammond, LA 70403

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 0761 Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately Level of Harm - Minimal harm or locked, compartments for controlled drugs. potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 45270 Residents Affected - Few Based on observations, interviews, and record review, the facility failed to ensure medications were stored and labeled properly in accordance with current accepted professional principles. The facility failed to ensure medications for Resident #190 were labeled properly, not expired and not available for administration.

Findings:

Resident #190

Review of Resident #190's Clinical Record revealed she was admitted to the facility on [DATE REDACTED] with diagnoses of Unspecified Elevated [NAME] Blood Cell Count, Acute Kidney Failure, and Chronic Kidney Disease Stage 4.

Review of Resident #190's current Physician Orders revealed the following, in part:

Order date: 05/16/2025 Cefazolin Sodium Injection Solution Reconstituted 1 gram use 1 gram intravenously one time a day every Tuesday, Thursday, and Saturday to be given at dialysis related to Unspecified Acute Kidney Failure.

On 05/19/2025 at 9:45 a.m., an observation was made of Med a room with S2RNSUP and S3ADON. A large clear plastic bag was observed containing seven pre-packaged intravenous infusions of Cefazolin 1g/50 ml for Resident #190. Further review revealed the manufacturer expiration date of 04/2025 on the seven packages, but was labeled with an expiration date of 05/16/2026 from the facility's pharmacy.

On 05/19/2025 at 9:46 a.m., an interview was conducted with S3ADON and S2RNSUP. S3ADON and S2RNSUP observed the seven pre-packaged intravenous infusions of Cefazolin 1g/50 ml for Resident #190 and confirmed the manufacturer expiration date on the packages were dated 04/2025, but were labeled with

an expiration date of 05/16/2026 from the facility's pharmacy. S3ADON and S2RNSUP confirmed the medication was received from the facility's pharmacy on 05/16/2025, was expired, not labeled accurately and was available for use.

On 05/19/2025 at 9:50 a.m., a telephone interview was conducted with the facility's Pharmacist. He was made aware of the above findings. He confirmed expired medications should not have been filled and delivered to the facility.

On 05/19/2025 at 1:50 p.m., an interview was conducted with S10CRN. S10CRN stated she observed the seven pre-packaged intravenous infusions of Cefazolin 1g/50 ml for Resident #190 and confirmed the manufacturer expiration date on the packages were dated 04/2025, but were labeled with an expiration date of 05/16/2026 from the facility's pharmacy. S10CRN confirmed the medications were expired when received from the facility's pharmacy on 05/16/2025.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 25 195526 Department of Health & Human Services Printed: 08/26/2025 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 195526 B. Wing 05/21/2025

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

Heritage Healthcare of Hammond 1300 Derek Drive Hammond, LA 70403

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 0812 On 05/18/2025, at 12:05 p.m., an observation was made of one enclosed meal cart brought into the kitchen by S8DM. A microwave was observed secured to the top of the enclosed meal cart and was placed at the Level of Harm - Minimal harm or end of the food line for loading by S8DM. The top of the enclosed meal cart and microwave were noted to be potential for actual harm unclean with food debris and dried substances. Four additional enclosed meal carts with microwaves were observed with S8DM and were noted to be soiled with food debris and dried substances on the top of the Residents Affected - Some carts and inside and outside of the microwaves.

On 05/18/2025 at 12:08 p.m., an interview was conducted with S8DM. She stated kitchen staff were responsible for cleaning the enclosed meal carts and microwaves after each meal service. She confirmed the 5 enclosed meal carts and microwaves were not clean and should have been.

52121

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 18 of 25 195526 Department of Health & Human Services Printed: 08/26/2025 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 195526 B. Wing 05/21/2025

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

Heritage Healthcare of Hammond 1300 Derek Drive Hammond, LA 70403

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 0814 Dispose of garbage and refuse properly.

Level of Harm - Minimal harm or 52121 potential for actual harm Based on observations and interviews, the facility failed to ensure garbage and waste were properly Residents Affected - Few contained in the outdoor trash dumpster.

Findings:

On 05/18/2025 at 8:45 a.m., an observation was made of the facility's outdoor trash dumpster with S9CK.

The outdoor trash dumpster was observed containing several bags of trash with the lid open.

On 05/18/2025 at 8:50 a.m., an interview was conducted with S9CK. She observed the outdoor dumpster lid and stated it should have been closed by the night shift kitchen staff. She stated the dumpster lid was open upon arrival for her shift. She attempted to close the dumpster lid with a broom stick, but was unsuccessful.

She further stated she thought the dumpster lid may be broken.

On 05/18/2025 at 9:47 a.m., an interview was conducted with S8DM. She was made aware of the above finding. She stated the dumpster lid was not broken, but was hard for staff to close. She confirmed the outdoor trash dumpster lid should be kept closed at all times.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 19 of 25 195526 Department of Health & Human Services Printed: 08/26/2025 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 195526 B. Wing 05/21/2025

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

Heritage Healthcare of Hammond 1300 Derek Drive Hammond, LA 70403

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 0842 On 05/20/2025 at 2:48 p.m., an interview was conducted with a staff member from Resident #32's Dialysis Center. She stated Resident #32 did not show up to dialysis yesterday. She stated the clinic called the facility Level of Harm - Minimal harm or and was notified Resident #32 was not going to dialysis because she was not feeling well. potential for actual harm Resident #60 Residents Affected - Few

Review of Resident #60's Clinical Record revealed he was admitted to the facility on [DATE REDACTED] with diagnoses which included Mycobacterial Infections.

Review of Resident #60's Admission MDS with an ARD of 04/18/2025 revealed a BIMS of 15, which indicated he was cognitively intact.

Review of Resident #60's current Physician Orders revealed the following, in part:

Start date: 05/10/2025-Primaxin IV. Use 500 mg every 6 hours

Review of Resident #60's MAR dated May 2025 revealed the administration status for the 0600 dose of Primaxin on 05/16/2025 was blank.

On 05/20/2025 at 3:17 p.m., an interview was conducted with S11LPN. She confirmed she worked the morning of 05/16/2025 and gave Resident #60 the 0600 dose of Primaxin. She was made aware the 0600 Primaxin was not documented as administered. She stated medications should be documented as given when administered.

On 05/21/2025 at 2:45 p.m., an interview was conducted with S1ADM. She reviewed Resident #32's MAR and confirmed it was documented the resident went to dialysis, which was inaccurate. She reviewed Resident #60's MAR and confirmed when a nurse administered medication, it should be documented as administered.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 21 of 25 195526 Department of Health & Human Services Printed: 08/26/2025 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 195526 B. Wing 05/21/2025

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

Heritage Healthcare of Hammond 1300 Derek Drive Hammond, LA 70403

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 Review of Resident #76's clinical record revealed an admitted [DATE REDACTED] with diagnoses, which included Non-Pressure Chronic Ulcer Left Foot, Pressure Ulcer of Sacral Region, and Pressure Ulcer Left Heel Stage Level of Harm - Minimal harm or 3. potential for actual harm

Review of Resident #76's Physician Orders revealed the following: Residents Affected - Some Order Date- 08/14/2024- Enhanced Barrier Precautions: utilize gown and gloves during high contact care activities for Residents with chronic wounds or indwelling devices.

On 05/19/2025 at 4:30 p.m., an observation was made of S3ADON performing wound care to Resident #76 wounds. S3ADON gathered supplies outside of resident's room with visible EBP signage posted on outside of door. S3ADON proceeded by entering room, performed hand hygiene and applied gloves. S3ADON failed to adhere to Enhanced Barrier Precautions and apply a gown prior to providing direct care to wounds.

On 05/20/2025 at 3:10 p.m., an interview was conducted with S3ADON. She stated Resident #76 was on EBP related to wounds and currently had an indwelling device in place. She confirmed she failed to apply gown prior to providing direct care to Resident #76's wounds and should have.

On 05/21/2025 at 9:25 a.m., an interview was conducted with S2RNSUP. She was made aware of the above findings. She stated she expected staff to properly don PPE when a resident is on EBP. S2RNSUP confirmed staff were required to don gown and gloves when performing wound care and catheter care. S2RNSUP confirmed EBP should have been followed prior to providing direct care to wounds and catheter care.

47191

52121

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 25 of 25 195526