Allen Oaks Nursing And Rehab Center

F-F689

Review of the facility's policy titled, Elopements dated 12/2007 revealed in part . Staff shall promptly report any resident who tries to leave the premises or is suspected of being missing to the Charge Nurse of Director of Nursing.

Review of the facility's policy titled, Accidents and Incidents-Investigating and Reporting dated 07/2017 revealed in part . All accidents or incidents involving residents, employees, visitors, vendors, etc., occurring

on our premises shall be investigated and reported to the Administrator.

Interview on 08/16/2024 at 2:15 p.m. with S2 DON revealed Resident #Resident R7 went out the X Hall front door, unsupervised by staff on 06/25/2024 and 08/03/2024. S2 DON confirmed the facility did not complete an incident report on 06/25/2024. S2 DON revealed the facility had not investigated Resident #Resident R7's elopement incidents as there was no incident to investigate.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 16 195584 Department of Health & Human Services Printed: 09/12/2025 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 195584 B. Wing 08/19/2024

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

Allen Oaks Nursing and Rehab Center 909 East 6th Avenue Oakdale, LA 71463

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 Interview on 08/16/2024 at 2:25 p.m. with S2 DON revealed the facility had not implemented any further interventions to Resident #Resident R7's plan of care following elopements on 06/25/2024 and 08/03/2024. S2 DON Level of Harm - Immediate revealed no new in-services related to elopement were done as a result of Resident #Resident R7's elopements. S2 jeopardy to resident health or DON revealed he did not consider these incidents an elopement because Resident #Resident R7 did not leave the safety facility grounds.

Residents Affected - Few Interview on 08/16/2024 at 3:19 p.m. with S2 DON revealed the facility did not have a policy related to training staff on risk for elopement, how to respond after an elopement, or a policy specific to Elopement/Wandering Assessments.

Interview on 08/16/2024 at 6:50 p.m. with S1 ADM revealed she was aware of Resident #Resident R7's elopements that occurred on 06/25/2024 and 08/03/2024, and the facility did not complete incident reports or in-servicing because the facility did not feel the incidents were elopements. S1 ADM confirmed the facility had not updated Resident #Resident R7's plan of care with further interventions following elopements to prevent the likelihood of elopement, but should have.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 16 195584 Department of Health & Human Services Printed: 09/12/2025 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 195584 B. Wing 08/19/2024

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

Allen Oaks Nursing and Rehab Center 909 East 6th Avenue Oakdale, LA 71463

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 Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or 45213 potential for actual harm Based on interview and record review, the facility failed to maintain an infection prevention and control Residents Affected - Few program designed to provide a safe, sanitary, and comfortable environment and help to prevent the development of communicable diseases and infections for 1 (Resident #1) of 12 (Resident #1, Resident #2, Resident #3, #Resident R1, #Resident R2, #Resident R3, #Resident R4, #Resident R5, #Resident R6, #Resident R7, #Resident R8, and #Resident R9) sampled residents. The facility failed to ensure the following:

1. Staff provided proper perineal care for Resident #1.

2. Staff did not stand on Resident #1's mattresses to provide care.

3. Proper disposal of soiled linens and briefs in Resident #1's room.

Findings:

Review of the facility's policy titled Perineal Care dated 02/2018 read in part .The purposes of this procedure are to provide cleanliness and comfort to the resident, to prevent infections and skin irritations, and to observe the resident's skin condition. b. Wash perineal area, wiping from front to back. e. Wash the rectal area thoroughly, wiping from the base of the labia towards extending over the buttocks. 9. Discard disposable items into designated containers.

Review of Resident #1's medical record revealed an admitted on 03/24/2021 with diagnoses which included: Altered Mental Status, Dementia, Pseudobulbar Affect, Muscle Weakness, Difficulty in Walking, Anxiety Disorder, and Major Depressive Disorder.

Review of Resident #1's Significant Change MDS with an ARD of 05/01/2024 revealed a BIMS score of 00, indicating severe cognitive impairment. Resident #1's MDS revealed she had the ability to express her ideas and wants which could be understood. Resident #1's MDS stated she required moderate assistance with upper body dressing, lower body dressing and personal hygiene; maximal assistance with bathing; and she was dependent on staff for toileting hygiene.

Review of Resident #1's Care Plan with a Target Date of 08/30/2024 revealed in part . ADL self-care performance. Interventions: Camera in room provided per family. Encourage the resident to participate to the fullest extent possible with each interaction. Praise all efforts at self-care.

Review on 08/12/2024 of video camera footage of Resident #1's room dated 07/19/2024 at 1:47 a.m. revealed S3 CNA providing perineal care to Resident #1 while standing on the mattress that is on the floor by

the side of Resident #1's bed. S3 CNA turned Resident #1, removed the disposable incontinent brief from under her, and put it on the mattress on the side of Resident #1's bed.

Review on 08/12/2024 of video camera footage of Resident #1's room dated 07/23/2024 at 7:52 p.m. revealed S3 CNA standing on the mattress on the floor next to Resident #1's bed. The mattress has areas that were wet where S3 CNA is standing. S3 CNA then climbed into Resident #1's bed and stood on the mattress at the head of the bed to pull her up. S3 CNA then walked on the mattress to get off of the bed.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 16 195584 Department of Health & Human Services Printed: 09/12/2025 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 195584 B. Wing 08/19/2024

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

Allen Oaks Nursing and Rehab Center 909 East 6th Avenue Oakdale, LA 71463

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 on 08/12/2024 of video camera footage of Resident #1's room dated 07/23/2024 at 11:02 p.m. revealed S3 CNA and S4 CNA were providing perineal care to Resident #1. S3 CNA and S4 CNA rolled Level of Harm - Minimal harm or Resident #1 on her left side and S3 CNA cleansed from her buttocks downward to her labia. S4 CNA potential for actual harm grabbed the disposable incontinent brief from under Resident #1 and tossed it on the floor.

Residents Affected - Few Interview on 08/12/2024 at 10:45 a.m. with S1 ADM revealed she reviewed video video footage on 07/29/2024 where S3 CNA got on Resident #1's bed to pull her up in bed. S1 ADM confirmed S3 CNA should have never stood on Resident #1's bed. S1 ADM revealed S3 CNA reported she did not want to have to pick up the floor mattress and raise the bed to pull her up.

Telephone interview on 08/15/2024 at 10:52 a.m. with S3 CNA revealed she would have had to move the mattress next to Resident #1's bed and lower the bed but she was in a rush. S3 CNA confirmed she should not have stood on Resident #1's bed to pull her up.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 16 of 16 195584