Based on interview and record review the Facility failed to ensure that a Resident maintained acceptable parameters of nutritional status, such as usual body weight or desirable weight range for 1 (#69 ) of 3 (#39, #45, #69) sampled Residents reviewed for nutrition. Total sample size 26. The facility failed to ensure Resident #69 received ordered nutritional supplements with meals, assistance or encouragement with eating, and accurate documentation of meal intake.

Review of Resident #69's medical record revealed she was admitted to the facility on [DATE REDACTED], with diagnoses that included: Aphasia, Alzheimer's disease, Depressive Disorder, Cognitive Communication Deficit, Vitamin B12 Deficiency, and Dementia.

Review of Resident #69's Quarterly MDS, with ARD of 04/02/2025, revealed she had a BIMS score of 3 (indicating severe cognitive impairment). The MDS revealed Resident #69 was independent with eating.

Review of Resident #69's current care plan, revealed in part .Resident #69 has a potential for a nutritional problem. Interventions included in part . Monitor/ document/ report PRN if I exhibit signs and symptoms of dysphagia, pocketing, choking, coughing, drooling, holding food in mouth, or refusing to eat. Resident #69 has unplanned/unexpected weight loss r/t poor food intake. Interventions included in part . Monitor and

record my food intake at each meal; Offer my supplements as ordered. Resident #69 has an ADL self-care performance deficit r/t dementia and generalized muscle weakness. Interventions included in part . Eating: I am independent with set up assist.

Review of Resident #69's weights revealed the following which represented a significant weight loss: 12/9/2024 = 136.4 pounds 1/6/2025 = 136.0 pounds 2/10/2025 = 137.5 pounds (14.3 pound/10.2% weight loss in 3 months) 3/7/2025 = 136.6 pounds 4/10/2025 = 131.2 pounds 5/9/2025 = 123.2 pounds (8 pound/ -6.10 % weight loss in 1 month)

Review of Resident # 69's medical record revealed Resident #69 was weighed monthly until triggered for weight loss. Resident #69 is currently weighed weekly.

08/27/2025 Department of Health & Human Services Centers for Medicare & Medicaid ServicesPrinted: N o. 0938-0391 STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION NAME OF PROVIDER OR SUPPLIER(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY COMPLETED (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIESSTREET ADDRESS, CITY, STATE, ZIP CODE B. Wing (Each deficiency must be preceded by full regulatory or LSC identifying information) 05/14/2025

The Columns Rehabilitation and Healthcare Center 3025 Fourth Street Jonesville, LA 71343 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Review of Health Status Note dated on 05/08/2025, revealed in part .Speech therapy evaluated Resident #69 with new recommendation for mighty shakes.

Review of progress note titled Weight Change dated 05/09/2025, revealed in part . Resident #69 assessed by Speech Therapy regarding difficulty swallowing. Resident #69's weight assessed due to decreased appetite and meal intake. Speech therapist recommended mighty shakes with meals. Current weight 123. 2lbs, 8lbs weight loss in 30 days.

Review of Physician Orders dated on 05/09/2025, revealed in part .Mighty shakes or Magic cup with meals three times a day.

Review of Dietician Progress note dated 05/11/2025, revealed in part . Trigger for significant weight loss noted. Current weight 123.2 pounds (8 pound loss in one month). Mighty Shakes added three times a day with meals and Megace added for appetite on 05/10. Continue to monitor.

Lunch observation on 05/12/2025 at 12:25 p.m., revealed in part .Resident #69 sitting in the dining room.

Observed Resident #69 not eating. Encouragement or assistance not provided by staff. Observation of the tray revealed entree untouched and no mighty shake for lunch.

Review of meal intake report dated 05/12/2025 at 01:02 p.m. revealed in part . S11 CNA documented intake of 76-100 % for lunch.

Breakfast observation on 05/13/2025 at 09:10 a.m., revealed in part .Resident #69 exiting her room with the therapist. Observation of tray revealed meal set-up was not performed. Observed untouched food on breakfast tray and mighty shake not provided with meal. On 05/13/2025 at 9:20 a.m., observed CNA removing breakfast tray from Resident #69's room.

Review of meal intake report dated 05/13/2025 at 12:49 p.m. revealed in part . S15 CNA documented meal intake of 51-75 % for breakfast.

Interview on 05/13/2025 at 01:50 p.m. with S15 CNA, revealed Resident #69 does not require feeding assistance but does require meal set up. S15 CNA, revealed meal set up included: Removing cover from plate, opening beverage carton and utensils. S15 CNA confirmed she documented Resident #69's meal intake for breakfast.

Lunch observation on 05/13/2025 at 11:47 a.m., revealed in part . Resident #69 sitting in the dining room.

Observed Resident #69 not eating. Observation of tray revealed mighty shake served with lunch. Observed resident drink approximately fifty percent of shake. On 05/13/2025 at 12:11 p.m., observed S7 CNA assist resident from dining room back to Resident #69's room. Observed lunch tray which revealed, untouched entree. Encouragement or assistance not offered by staff.

Review of meal intake report dated 05/13/2025 at 12:49 p.m. revealed in part . S15 CNA documented meal intake of 76-100 % for lunch.

Interview on 5/13/2025 at 01:40 p.m. with S7 CNA, revealed Resident #69 is independent with eating but requires meal set up. S7 CNA, revealed meal set up included: Removing cover from plate, open beverage and utensils.

08/27/2025 Department of Health & Human Services Centers for Medicare & Medicaid ServicesPrinted: N o. 0938-0391 STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION NAME OF PROVIDER OR SUPPLIER(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY COMPLETED (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIESSTREET ADDRESS, CITY, STATE, ZIP CODE B. Wing (Each deficiency must be preceded by full regulatory or LSC identifying information) 05/14/2025

The Columns Rehabilitation and Healthcare Center 3025 Fourth Street Jonesville, LA 71343 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Interview on 05/13/2025 at 02:20 p.m. with S9 LPN, revealed Resident #69 requires cueing and encouragement during meals. S9 LPN confirmed that CNAs are responsible for documenting meal intake and are to notify nurse when a resident does not eat.

Interview on 05/13/2025 at 02:32 p.m. with S10 RN clinical support, revealed weights are obtained weekly for residents with significant weight loss. Significant weight loss is reported to Registered Dietician and Physician. S10 RN clinical support confirmed CNAs should have notified nurse of Resident #69's decrease in PO intake. S10 RN clinical support confirmed weight loss was not identified until it became significant.

Breakfast observation on 05/14/2025 at 08:36 a.m., revealed in part .breakfast tray on bedside table not set up and food remained untouched.

Observation and interview on 05/14/2025 at 09:10 a.m., revealed in part . S11 CNA removing breakfast tray from Resident #69's room. Mighty shake was not observed on breakfast tray. S11 CNA confirmed Resident #69 did not receive a mighty shake with breakfast and should have.

Interview on 05/14/2025 at 09:10 a.m. with S12 LPN, confirmed Resident #69 did not receive a mighty shake with breakfast and should have.

Interview on 05/14/2025 at 12:30 p.m. with S2 DON, confirmed Resident #69 did not receive nutritional supplements as ordered and should have. S2 DON confirmed inaccurate meal intake documentation. S2 DON confirmed that Resident #69 should have been assisted/ encouraged by staff during meals. 08/27/2025 Department of Health & Human Services Centers for Medicare & Medicaid ServicesPrinted: N o. 0938-0391 STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION NAME OF PROVIDER OR SUPPLIER(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY COMPLETED (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIESSTREET ADDRESS, CITY, STATE, ZIP CODE B. Wing (Each deficiency must be preceded by full regulatory or LSC identifying information) 05/14/2025

The Columns Rehabilitation and Healthcare Center 3025 Fourth Street Jonesville, LA 71343 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 locked, compartments for controlled drugs.

Based on observations and interviews, the facility failed to ensure drugs and biologicals were stored in accordance with currently accepted professional principles. The facility failed to ensure:

1. 1. Nursing carts were free of loose pills for 1 (Cart A) of 2 (Cart A and Cart B) carts reviewed, and
2. 2. Nursing carts were free of expired supplies for 1 (Cart B) of 2 (Cart A and Cart B) carts reviewed.

Review of the facility's policy entitled Storage of Medication Requiring Refrigeration revised on 09/01/2024 revealed, in part .the facility must provide safe and effective storage of all drugs and biologicals consistent with professional standards of practice. Staff should remove any expired medications from active stock and discard according to facility policy.

Interview with S19 CQI on 05/14/2025 at 12:23 p.m. confirmed the facility's policy entitled Storage of Medication Requiring Refrigeration was used for all medications in the facility, not just refrigerated medications.

Observation of Cart A on 05/13/2025 at 1:45 p.m., with oversight from S9 LPN, revealed 2 unidentified and loose tablets in the bottom of the 2nd drawer of the cart. S9 LPN confirmed there were 2 unidentified and loose tablets in the 2nd drawer of Cart A, that should not have been.

Observation of Cart B on 05/14/2025 at 1:00 p.m., with oversight from S18 Treatment Nurse, revealed 17 Lubricating Jelly 3 gram packages with an expiration date of 03/2019, 8 Skin Protectant Cream with Lanolin 0.18 ounce packages with an expiration date of 09/2024, 1 Lubricating Jelly 3 gram package with an expiration date of 04/12/2022, and 1 Skin Protectant Ointment 5 gram package with an expiration date of 05/2024. S18 Treatment Nurse confirmed the expired supplies were in Cart B, and should not have been. 08/27/2025 Department of Health & Human Services Centers for Medicare & Medicaid ServicesPrinted: N o. 0938-0391 STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION NAME OF PROVIDER OR SUPPLIER(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY COMPLETED (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIESSTREET ADDRESS, CITY, STATE, ZIP CODE B. Wing (Each deficiency must be preceded by full regulatory or LSC identifying information) 05/14/2025

The Columns Rehabilitation and Healthcare Center 3025 Fourth Street Jonesville, LA 71343 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

Based on observation and interview, the facility failed to ensure menus were followed in order to meet the nutritional needs of residents who required a puree diet. The facility failed to follow the recipe in regard to portion size to ensure the nutritional adequacy of the meal for all 10 residents who received a puree diet.

In an interview during the initial kitchen tour at 8:50 a.m. on 05/12/2025, S3 Dietary Manager stated the facility had 10 residents being served a puree diet.

In an observation on 05/12/2025 at 10:30 a.m., S4 [NAME] used a 2 ounce ladle and put 6 scoops of lima beans into the blender to puree. S4 [NAME] then added 2 scoops of liquid from the lima beans to the blender. S4 [NAME] blended them together and placed them in a pan for the steam table.

Review of the recipe for lima beans provided by S3 Dietary Manager revealed for 10 servings, 1 and 1/4 quart (40 ounces) of beans should have been pureed.

In an interview on 05/12/2025 at 11:00 a.m., S4 [NAME] confirmed she put 6 scoops of lima beans into the blender with a 2 ounce ladle.

In an interview on 05/12/2025 at 11:05 a.m., S3 Dietary Manager confirmed S4 [NAME] did not follow the recipe and did not put enough lima beans in the blender to puree, but should have. 08/27/2025 Department of Health & Human Services Centers for Medicare & Medicaid ServicesPrinted: N o. 0938-0391 STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION NAME OF PROVIDER OR SUPPLIER(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY COMPLETED (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIESSTREET ADDRESS, CITY, STATE, ZIP CODE B. Wing (Each deficiency must be preceded by full regulatory or LSC identifying information) 05/14/2025

The Columns Rehabilitation and Healthcare Center 3025 Fourth Street Jonesville, LA 71343 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food

in accordance with professional standards.

Based on observation and interview, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety by failing to ensure:

3. 1. Food was not open to air while stored in the pantry; and
4. 2. Food serving scoop was not left inside sugar bin in direct contact with resident food items.

This deficient practice had the potential to affect 84 residents who received meals served from the kitchen.

An observation on 05/12/2025 at 9:00 a.m. revealed the serving scoop was inside the bulk storage container of sugar lying on top of and in direct contact with the sugar. In an interview at that time, S3 Dietary Manager confirmed the scoop should not be in the sugar bin touching the sugar.

An observation on 05/12/2025 at 9:05 a.m. revealed a package of fish breading in the pantry that was open to air. In an interview at that time, S3 Dietary Manager confirmed the fish breading in the pantry was open to air and should not be. 08/27/2025