Highland Place Rehab And Nursing Center

F-F600

During a phone interview on 01/28/2025 at 3:45 p.m., S5 RN (Registered Nurse) reported no facility employee remained with Resident #2 after the incident on 12/27/2024 and Resident #2 did not receive one-on-one care after the incident. S5 RN confirmed Resident #2 remained in the room with Residents #1, #6 and #7 after the allegation of the sexual abuse was made. S5 RN reported before she left at the end of her shift around 7:00 a.m. Resident #2 remained in the same room with Residents #1, #6 and #7.

During an interview on 01/28/2025 at 4:00 p.m., S6 ADON (Assistant Director of Nursing) reported she became aware of the incident around 3:00 a.m. on 12/27/2024 by S5 RN. S6 ADON reported when she checked on Resident #1 the morning of 12/27/2024, she saw Resident #1 coming out of the doorway of his room and Resident #2 was still in the room in the bed. S6 ADON reported Resident #2 did not say or do anything. S6 ADON reported she could not find documentation Resident #2 was placed with one-on-one monitoring after the incident.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 16 of 20 195350 Department of Health & Human Services Printed: 09/09/2025 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 195350 B. Wing 02/04/2025

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

Highland Place Rehab and Nursing Center 1736 Irving Place Shreveport, LA 71101

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 During an interview on 01/29/2025 at 9:07 a.m. S2 DON reported Resident #2 should have been placed with one-on-one care after the incident and that would have been found in Resident #2's notes or the shift report Level of Harm - Immediate notes. S2 DON was unable to provide any documentation that Resident #2 was placed on one-on-one jeopardy to resident health or monitoring after the incident occurred. safety

During an interview on 01/30/2025 at 10:30 a.m. S5 RN confirmed there was no other staff in the resident Residents Affected - Some room when she left at the end of her shift at 7:00 a.m. on 12/28/2024. S5 RN further reported at the end of her shift, Resident #1 had returned to the shared resident room and was in his bed, Resident #2 was in his bed and the other 2 residents remained in bed.

During an interview on 01/29/2025 at 9:26 a.m. S1 Administrator reported on 12/27/2024 at 8:00 a.m. Resident #1 came to her office and reported Resident #2 had exposed himself to him during the early morning hours. S1 Administrator confirmed she was not notified of the incident until Resident #1 told her. S1 Administrator reported she should have been notified immediately and called S5 RN to find out the details about the incident with Resident #1 and Resident #2. S1 Administrator confirmed Resident #1 and Resident #2 were in the same room with Resident #6 and Resident #7 until Resident #1 was moved later in the day on 12/27/2024.

During an interview on 01/29/2025 at 12:50 p.m., S1 Administrator confirmed the facility did not have documentation of Resident #2 receiving one-on-one supervision after the incident on 12/27/2024 involving Resident #1 and Resident #2.

During an interview on 01/30/2025 at 9:56 a.m. S2 DON reported he was responsible for overseeing all staff are trained on the abuse/neglect policy including recognizing signs, investigations, protection, and reporting procedures.

During an interview on 01/30/2025 at 9:56 a.m. S1 Administrator acknowledged she was responsible for providing oversite of the facility's abuse/neglect policy including reporting timeframes, one on one monitoring and making sure staff was educated on the necessary steps to ensure the safety and well-being of all resident.

The facility's Plan of Removal:

Resident #1 was the victim at the time of the event on 12/27/024 at 2:38 a.m. The perpetrator, Resident #2, was discharged from the center on 12/27/2024 at 6:08 p.m. Roommates, Resident #6 and Resident #7 had

the potential to be affected since they were in the room at the time of the event and afterwards until the aggressor was discharged . Resident and staff interviews started 01/30/2025 and are in progress to identify any other residents who may have the potential to be affected.

1. Any allegation of abuse - the center must follow the abuse/neglect policy to protect residents, effective 01/30/2025.

2. If an abuse allegation is made, the abuse aggressor will be place on one-on-one with the behavior monitoring which will continue until cleared by a medical provider or until discharged , effective 01/20/2025.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 17 of 20 195350 Department of Health & Human Services Printed: 09/09/2025 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 195350 B. Wing 02/04/2025

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

Highland Place Rehab and Nursing Center 1736 Irving Place Shreveport, LA 71101

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 3. The Administrator and DON are responsible for ensuring that all aspects of the abuse/neglect policy are carried out and that all components, such as one-on-one documentation and behavior monitoring, are Level of Harm - Immediate implemented, effective 01/30/2025. jeopardy to resident health or safety 4. Administrator and Director of Nursing (DON) have been educated on abuse/neglect, the abuse/neglect policy to indicate reporting timeframes, and following all administration and reporting requirements for Residents Affected - Some abuse/neglect and the follow-up of handling abuse/neglect allegations. This education occurred on 01/30/2025 by the RN, Chief Nursing Officer.

5. Residents #6 and #7 have had trauma assessments completed on 01/30/2025 by the Social Services Director.

Education started immediately on 01/30/2025 (see attached) to include 100% of staff and contract staff. This education will include the abuse/neglect policy with timeframes and will include initiation of the one-on-one with behavior monitoring form.

The mode of education will be verbal in person via staff meeting as well as a voice and text message communication blast.

The voice and text message blast communication were sent out by the Regional Administrator. The in-person staff meetings for education were/is being completed by the following staff members: RN, Director of Nursing; Associate Director of Nursing; and RN, Assistant Director of Nursing.

All education was initiated on 01/30/2025 and will continue daily until 100% is achieved. No one will work until this education has been validated as received.

All new hires will receive this education prior to working.

Ad hoc QAPI (Quality Assurance and Performance Improvement) was held on 01/31/2025 at 5:30 p.m. with Nursing Home Administrator, Director of Nursing, Management Nurses, Department Heads, Medical Director, and a floor staff licensed nurse and certified nursing assistant to discuss the systemic changes of facility practice.

Starting the week of 02/03/2025, the center social service director or designee will interview five residents weekly for four weeks to ask about abuse and follow up. The abuse interview monitoring process will continue after the initial four weeks monthly for three months. The results of these audits will be brought to

the quality assurance/performance improvement committee to ensure all processes are followed and to ensure continued compliance. If it is determined that processes are not followed, the center will perform a 100% re-education of all staff and follow up directly with the responsible at the time of the incident.

Administrative oversight of the process will be completed by the Nursing Home Administrator and the Director of Nursing. As of 01/30/2025 and ongoing, the Regional Director Clinical Operations will provide oversight of the Nursing Home Administrator and Director of Nursing administrative oversight by reviewing and providing feedback on allegations of abuse and providing further supervision and training as needed.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 18 of 20 195350 Department of Health & Human Services Printed: 09/09/2025 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 195350 B. Wing 02/04/2025

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

Highland Place Rehab and Nursing Center 1736 Irving Place Shreveport, LA 71101

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 Date Facility Asserts the Likelihood for Serious Harm to Any Recipient No Longer Exists: 01/30/2025.

Level of Harm - Immediate jeopardy to resident health or safety

Residents Affected - Some

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 19 of 20 195350 Department of Health & Human Services Printed: 09/09/2025 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 195350 B. Wing 02/04/2025

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

Highland Place Rehab and Nursing Center 1736 Irving Place Shreveport, LA 71101

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 Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 30669

Residents Affected - Few Based on record reviews and interviews, the facility failed to ensure medical records were accurately documented for 1 (Resident #2) of 7 (Resident #1, #2, #3, #4, #5, #6, and #7) sampled residents. The facility failed to have documentation of a physician's discharge order.

Findings:

Review of Resident #2's record revealed an admitted [DATE REDACTED] and a discharge date of [DATE REDACTED].

Review of Resident #2's medical record revealed the following diagnoses which included but not limited to: Pain in left wrist, chronic viral hepatitis C, cognitive communication deficit, cannabis use, unspecified.

Review of Resident #2's MDS (Minimum Data Set) revealed a BIMS (Brief Interview of Mental Status) of 06 indicated severe impaired cognition.

Review of Resident #2's physician orders failed to reveal a discharge order to the hospital on 12/27/2024.

During an interview on 01/20/2025 at 3:20 p.m. S6 ADON (Assistant Director of Nursing) reported she could not locate the discharge order for Resident #2. S6 ADON reported she was responsible for taking the order and misplaced the verbal order from the physician. S6 ADON acknowledged there was not a system in place for taking verbal orders.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 20 of 20 195350