**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record reviews, the facility failed to ensure a resident was assessed quarterly for 1 (#37) of 4 (#30, #37, #43, and #124) residents sampled for medication administration. The facility failed to ensure 1) Resident #37 was assessed quarterly for self-administration of medications, 2) a specific order was obtained for self-administration of medications for Resident #37, and 3) the care plan for Resident #37's included self-administration of medications with the specified medications to be self-administered.Findings:Review of the facility's Self-Administration of Medication, undated, Policy and Procedure revealed the following, in part:It is the policy of this facility that each resident has the right to self-administer medications, but is the responsibility of the interdisciplinary team to determine that it is safe prior to the resident exercising that right.2. If the resident wishes to self-administer medications, the Interdisciplinary Team (IDT) must assess the resident's overall ability to safely administer his/her own medications.3. To assess whether the resident is able to self-administer medications, the criteria on the Assessment for self-administration of medications form will be used. If the Interdisciplinary Team determines that the resident is unable to self-administer medications, because this would be a danger to the resident or to others, then the Interdisciplinary Team may not grant the right to self-administer medications. If the right is granted, a specific order to self-administer must be obtained which includes how, when, and for what reason the medication can be used.4. When a resident self-administers medication, he/she will be reassessed at least quarterly for continued safety of this practice. The IDT will complete this assessment using the Assessment for self-administration of medications. If in the IDT's professional judgment, the resident is unable to safely self-administer his medication, the medical doctor will be contacted to discontinue the order for self-administration.7. Self-administration of bedside medications must be careplanned, including the specific order, granting of approval by IDT, and monitoring for compliance.Review of the record for Resident #37 revealed an admission date of 09/08/2024 with diagnoses including bilateral primary osteoarthritis of knee, cellulitis of unspecified part of limb, acute upper respiratory infection, dysphagia, pulmonary embolism, and chronic obstructive pulmonary disease.Review of Resident #37's Quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed resident's Brief Interview for Mental Status (BIMS) score was 15 indicating no cognitive impairment.During medication administration observation with S4Licensed Practical Nurse (LPN) on 08/06/2025 at 8:15 a.m. revealed Resident #37 had a Ventolin (Albuterol) inhaler and Nasonex (nasal spray) at his bedside. Resident #37 administered his nasal spray 1 spray in each nostril. S4LPN confirmed these 2 medications are kept in resident's room and are self-administered by the resident. An interview on 08/06/2025 at 8:15 a.m. with Resident #37 confirmed he has his Albuterol inhaler and nasal spray at his bedside, resident confirmed he does self-administer these medications as ordered. Resident #37 confirmed he uses his Albuterol inhaler 2 puffs every 6 hours as needed and his nasal spray 1 spray in each nostril daily.Review of Resident #37's August 2025 Physician's Orders revealed an order dated 01/15/2025 for a Ventolin Hydrofluoroalkane (HFA) Inhalation Aerosol Solution 108 (90 base) micrograms/actuate (Albuterol Sulfate) 2 puffs inhale orally every 6 hours as needed for wheezing related to chronic obstructive pulmonary disease. Further review revealed an order dated 07/18/2024 for Nasonex 24 hour nasal suspension 1 spray in both nostrils one time a day for acute upper respiratory infection. Resident #37's Physician's Orders did not specify that each of these medications were to be kept at bedside and self-administered by the resident.Review of Resident #37's Assessment for Self-Administration of Medications dated 01/15/2025 revealed resident was determined to be safe and able to self-administer medications but did not identify the specific medications that the resident was determined to be safe to administer.Review of the July and August 2025 Medication Administration Records (MAR) for Resident #37 revealed the 2 medications listed above do not specify that each of these medications are kept at the bedside and should be administered by the resident.Review of Resident #37's current care plan revealed no documentation identifying that resident was determined to be safe to self-administer any of his medications.An interview on 08/06/2025 at 10:05 a.m. with S5LPN revealed that Resident #37 does have his nasal spray and Albuterol inhaler at his bedside and self-administers these 2 medications. S5LPN confirmed that Resident #37's physician's orders did not identify that these 2 medications were to be self-administered by Resident #37. S5LPN reported she completed the Assessment for Self-Administration of Medications on 01/15/2025 for Resident #37 but has not completed this assessment quarterly.An interview on 08/06/2025 at 2:35 p.m. with S2Director of Nursing (DON) confirmed the facility failed to ensure Resident #37 was assessed for self-administration of medications quarterly. S2DON confirmed the facility failed to ensure documentation of self-administration of bedside medications including specific order and monitoring for compliance was added to Resident #37's care plan. S2DON confirmed the facility failed to ensure Resident #37's physician's orders included a specified order to self-administer medications including how, when, and for what reason the medications can be used.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure a resident with a new diagnosis of schizophrenia was referred to the appropriate state agency for Preadmission Screening and Resident Review (PASARR) Level II evaluation as required for 1 (#12) of 2 (#12, #13) residents reviewed for PASARR requirements. Findings:Record review revealed Resident #12 was admitted to the facility on [DATE] with diagnoses of hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting left dominate side, depression, gastroesophageal reflux disease without esophagitis, dysphagia following unspecified cerebrovascular disease, muscle wasting and atrophy both thighs, generalized muscle weakness, need for assistance with personal care, other abnormalities of gait and mobility, and other lack of coordination. Further review revealed Resident #12 was diagnosed with schizoaffective disorder, bipolar type, on 04/01/2025.Review of Form142 (Louisiana Department of Health and Hospitals Medicaid Program Notice of Medical Certification) revealed Resident #12 was approved for Medicaid/Private medical eligibility services effective 02/21/2022. Further review of the Form 142 revealed a Level II decision was not required on 03/02/2022. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 9 which indicated Resident #12 had moderate cognitive impairment for daily decision making. Review of section N revealed Resident #12 received antipsychotic medication and antidepressant medication. Review of the active August 2025 Physician Orders revealed an order dated 04/01/2025 for Risperdal 0.5 milligram (mg) tablet give 1 tablet by mouth two times daily for schizoaffective disorder, bipolar type.On 08/05/2025 at 9:49 a.m., during an interview with S2Director of Nursing (DON), surveyor requested the PASARR Level II for Resident #12 and the facility's policy for obtaining a PASARR II.Review of Resident #12's record revealed no documented evidence that a Level II PASARR was completed after Resident #12 was diagnosed with schizoaffective disorder, bipolar type, on 04/01/2025. On 08/05/2025 at 3:25 p.m., an interview with S2DON confirmed a PASARR Level II screening had not been submitted to the appropriate state agency for Resident #12 after the new diagnoses of schizoaffective disorder, bipolar type, on 04/01/2025.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews and interview the facility failed to ensure drugs and biologicals were stored properly by having medications at resident's bedside for 1 (#71) of 1 resident reviewed for medication storage. Findings: Review of the facility's Medication Storage in the Facility policy (undated) revealed the following in part: Policy: Medications and biologicals are stored safely, securely, and properly following manufacturer's recommendations or those of the supplier. The medication supply is accessible only to licensed nursing or medical personnel and pharmacy personnel. 2. Only licensed nurses, the consultant pharmacist, and those lawfully authorized to administer mediations are allowed access to medications. Review of the medical record for Resident #71 revealed an admission date of 01/09/2025. Resident #71 had diagnoses that included altered mental status, hypertensive heart disease, depression, reflux, heart failure, atrial fibrillation, rhabdomyolysis, dementia, muscle wasting, and cognitive communication deficit.Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #71 had a Brief Interview for Mental Status (BIMS) score of 12 which indicated intact cognition for daily decision making. Review of the current care plan for Resident #71 revealed impaired cognitive function/dementia or impaired thought processes related to dementia. Further review of the care plan revealed to administer medications as ordered, communicate with the resident/family/caregivers regarding resident's capabilities and needs. The resident needed specific supervision assistance with all decision making. On 08/04/2025 at 9:00 a.m. observation of Resident #71 revealed she was in the room lying in bed, and one bottle of Tums (antacid) and one bottle of Systane complete eyedrops (eye lubricant) was located on top of Resident #71's refrigerator beside her bed. At that time an interview with Resident #71 revealed she thought a friend had brought her the medications and she will take the medications when needed. On 08/05/2025 at 8:45 a.m. observation of Resident #71 revealed she was lying in bed, and one bottle of Tums and one bottle of Systane complete eyedrops was noted on top of the refrigerator beside her bed.Review of the Resident #71's August 2025 physician's orders revealed no documented evidence of an order for Tums or Systane eyedrops. On 08/05/2025 at 8:55 a.m. S2Director of Nursing (DON) was notified of medications at Resident #71's bedside. At that time observation of Resident #71's room with S2DON revealed Resident #71 had a bottle of Tums and a bottle of Systane eyedrops located on top of the refrigerator in her room. S2DON confirmed Resident #71 did not have a physician's order for the medications and the medications should not be stored at Resident #71's bedside available for use.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure that licensed nurses assessed resident's needs for 1 (#14) of 1 (#14) resident sampled for urinary catheter or urinary tract infections (UTI). The failed practice was evidenced by Resident #14 being diagnosed with a UTI on 12/23/2025 with no record of assessments or interventions in the medical record by licensed nursing staff on 12/24/2024 or 12/25/2025 directly related to her diagnoses of a UTI. Findings:Resident #14Record review revealed Resident #14 was originally admitted to the facility on [DATE] and had a readmission from a hospital on [DATE]. Review of the most recent quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #14 had a Brief Interview of Mental Status (BIMS) score of 15 which indicated she had no cognitive impairment. Review of diagnoses revealed Resident #14 had been diagnosed with type 2 diabetes mellitus, history of UTI, and chronic kidney disease.Further review of the medical record revealed the following nurses progress notes:12/23/2024 at 11:10 Lab / Radiology NoteNote Text: Lab results from 12/20 urinalysis (UA) - UA blood 3+, UA protein 2+, UA nitrite Positive, UA leukocytes 3+, UA white blood cells 40-50, UA red blood cells 40-50, UA bacteria 3+; Urine culture results from 12/20 greater than 2 organisms recovered, non-predominant. Greater than 10,000 colony units per milliliter. Please submit another sample if clinically indicated. Results given to S3Nurse Practitioner (NP).12/26/2024 at 10:48 General Nurses Note Note Text: received order per S3NP for Ciprofloxacin 500 milligrams 1 pill by mouth twice daily x 7 days for UTI. Further review of nurses progress notes revealed no documented evidence of Resident #14 being assessed for signs or symptoms of a UTI on 12/24/2024 or 12/25/2025. On 08/06/2025 at 9:13 a.m. an interview with Resident #14 was conducted in the day area. Resident #14 was alert and oriented. Resident #14 reported she went to the hospital on the day after Christmas (12/26/2024). Resident #14 reported that she got sick and was confused that evening so they sent her to the hospital. Resident #14 reported she received intravenous fluids and antibiotics at the hospital for over a week. Resident #14 reported she felt achy all over on Christmas Eve (12/24/2024) and Christmas day (12/25/2024). Resident #14 reported she did not get antibiotics for her Urinary Tract Infection (UTI) until the evening of 12/26/2024. On 08/06/2025 at 10:01 a.m., an interview with S3NP revealed she was aware of the abnormal UA and was monitoring symptoms but was waiting for clarification of culture results to start antibiotics since 2 organisms were growing. She reported Resident #14 was stable until the night of 12/26/2024. On 08/06/2025 at 11:25 a.m., an interview with S2Director of Nursing (DON) was conducted in her office. S2DON confirmed there was no record of nursing assessments in the progress notes or temperatures recorded on 12/24/2024 or 12/25/2025 to specifically monitor the severity of the urinary tract infection identified on 12/23/2024 for Resident #14.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure a resident who was unable to carry out activities of daily living received the necessary services to maintain good grooming and hygiene for 1 (#56) of 1 (#56) resident reviewed for activities of daily living. Findings: Record review revealed resident #56 was admitted to the facility on [DATE] with diagnoses including cerebrovascular accident, congestive heart failure, edema, and glaucoma. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] for resident #56 revealed a brief interview of mental status could not be completed due to memory problems, and severely impaired cognitive skills for daily decision making. Further review of the MDS data revealed resident #56 was dependent on staff for activities of daily living care which included personal hygiene. On 07/08/2024 at 1:55 p.m., observation revealed resident #56 had long fingernails with jagged edges to both hands. The right hand was noted to be contracted. On 07/09/2024 at 11:43 a.m., an observation with S5Certified Nurse Aide (CNA) was conducted in the room of resident#56. S5CNA confirmed resident #56`s fingernails were long and jagged to both hands. S5CNA confirmed resident #56 was dependent on staff for activities of daily living (ADL) care. S5CNA partially opened resident #56`s contracted right hand and there was a foul odor coming from his right hand. On 07/10/2024 at 8:32 a.m., observation of resident #56 was conducted in his room with S5CNA. Both hands still had long jagged fingernails and the right hand was contracted. A foul odor was noted when S5CNA partially opened resident #56`s contracted right hand. On 07/10/2024 at 08:32 a.m., S2Director of Nurses (DON) was informed resident #56 had long jagged nails and his contracted right hand had an odor. S2DON agreed resident #56`s nails should have been trimmed and his contracted right hand should not have an odor.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations and interviews, the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice for 1 (#73) of 2 (#71 & #73) residents reviewed for positioning. The facility failed to address the positioning needs for resident #73. Findings: Review of the record for resident #73 revealed the resident was admitted on [DATE] with diagnoses of Down syndrome, myocardial infarction, atrial fibrillation, diabetes, muscle wasting and atrophy, congestive heart failure, incontinence without sensory awareness, and hypertension. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had modified independent cognitive skills for daily decision making. The resident's mobility device was a wheelchair. The resident required partial/moderate assistance with toilet hygiene and dressing and the resident required substantial/maximal assistance with personal hygiene and shower/bathe. The resident was always incontinent of bowel and bladder. The resident had no speech and was rarely/never understood. An interview with S4Certified Nursing Assistant (CNA) on 07/10/2024 at 12:30 p.m. revealed resident #73 used his wheelchair for mobility daily. Observation on 07/08/2024 at 11:56 a.m. revealed resident #73 was up in his wheelchair in the day area on his hall and his feet were not touching the floor. Resident #73 was unable to be interviewed. Observation on 07/08/2024 at 1:20 p.m. revealed resident #73 was up in his wheelchair in the dining room and his right foot was not touching the floor. Observation on 07/09/2024 at 11:26 a.m. and 3:37 p.m. revealed resident #73 was up in his wheelchair in the dining room. His feet were not touching the floor. Observation on 07/10/2024 at 8:05 a.m. revealed the resident was propelling his wheelchair down the hall using his upper body and his feet were not touching the floor. Observation on 07/10/2024 at 11:37 a.m. revealed the resident up in his wheelchair in the dining room. His right foot was not touching the floor and part of his left foot was touching the floor. An interview with S2Director of Nurses on 07/10/2024 at 2:45 p.m. confirmed resident #73 should have support for his lower extremities.

Based on observation, record review and interview the facility failed to ensure drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable. The facility failed to date multi dose insulin pens when first used for 6 (#33, #39, #50, #100, #104, #225) of 6 (#33, #39, #50, #100, #104, #225) insulin pens observed without a date and by not discarding 1 (#225) of 1 (#225) insulin pens within 28 days after the first use. Findings: On 07/10/2024 at 3:07 p.m. observation of Hall A medication cart revealed the following insulin pens were not dated upon first use: Resident #33: Novolog and Basaglar (Lantus) pens were not dated when first used. Resident #39: Novolog and Basaglar (Lantus) pens were not dated when first used. On 07/10/2024 at 3:15 p.m., an interview with S3Licensed Practical Nurse (LPN) confirmed the insulin pens should have been dated when first used and were not for resident #33 and resident #39. On 07/10/2024 at 3:25 p.m. observation of Hall B medication cart revealed the following insulin pens were not dated upon first use: Resident #50: Lantus pen was not dated when first used. Resident #100: Lantus pen and Novolog pen were not dated when first used. Resident #104: Lantus pen was not dated when first used. Resident #225: Lantus pen was not dated when first used. Further observation of Hall B medication cart revealed resident #225's Lispro Kwik Pen was dated 09/06/2023. On 07/10/2024 at 3:40 p.m., an interview with S3LPN confirmed the insulin should have been dated when first used for resident #50, #100, #104, and #225, and the insulin for resident #225 dated 09/06/2023 should have been discarded. On 07/10/2024 at 4:35 p.m., an interview with S2Director of Nurses (DON) confirmed the facility's written policy and procedure for insulin guidelines did not have any instructions regarding dating of insulin when it is first used, however it is standard practice to date the insulin when it is first used.

Based on observations and interviews, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. The facility failed to ensure random and personal items were not stored in the laundry department. Findings: On 07/08/2024 at 3:00 p.m., an observation of the laundry department revealed the following items were observed on a shelf that was designated for clean mops: 1-large pair of scissors, 1-insulated pink colored drinking glass, 4-sharpies, 1-pair of ear pods, and 1-pair of eye glasses. Further observation revealed the following: 1-large hand held tape dispenser and a purse were stored on a shelf with clean clothing. 1-long cord and cell phone charger was stored on a table that was designated for folding resident clean clothing and linens. The cell phone charger and cord was laying on top of and in direct contact with the table top. 1-gray tote bag was on the floor between a large and small washing machines. After the observation was completed, S6Laundry Worker revealed the cell phone cord/charger were her personal belongings. S6Laundry Worker reported that the gray tote bag belonged to S7Laundry Worker. On 07/08/2024 at approximately 3:15 p.m., an observation of the laundry department with S1Administrator and S8Laundry Supervisor was conducted. S1Administrator confirmed the items listed above should not have been kept in laundry room.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Findings Resident #40 Review of the medical record for resident #40 revealed an admission date of 06/02/2023 with diagnoses including dysphagia, cellulitis, chronic systolic heart failure, type 2 diabetes mellitus, permanent atrial fibrillation, and chronic pain. Review of the current physician's orders revealed an order dated 06/12/2023 to flush peg tube with 100 cubic centimeters (cc) of water every 4 hours. Review of the June 2023 and July 2023 Medication Administration Record (MAR) revealed peg tube flushes were administered 4 times per day, instead of 6 times per day as ordered. Review of the current care plan revealed resident #40 had a peg tube. Further review of the care plan revealed an intervention dated 06/12/2023 to flush peg tube with 100 cc's water every 4 hours. An interview on 07/19/2023 at 1:15 p.m. with S4Licensed Practical Nurse (LPN) revealed that resident #40 had an order dated 06/12/2023 to flush peg tube with 100 cc's water every 4 hours, which would be 6 times per day. S4LPN confirmed that the June 2023 and July 2023 MAR had documented evidence that peg tube was flushed with 100 cc's of water 4 times per day, instead of 6 times per day as ordered. An interview on 07/19/2023 at 1:40 p.m. with S2Director of Nurses (DON) confirmed that resident #40 had an order dated 06/12/2023 to flush peg tube with 100 cc's of water every 4 hours, which is 6 times per day. S2DON confirmed that the June 2023 and July 2023 MAR revealed the peg tube was flushed with 100 cc's of water 4 times per day, instead of 6 times per day as ordered. Based on observations, record reviews and interviews, the facility failed to ensure a resident fed by enternal means received appropriate treatment and services to prevent complications including but not limited to dehydration and metabolic abnormalities for 2 (#40, #73) of 2 (#40, #73) residents investigated for tube feeding. Findings: Resident #73 On 07/17/2023 at 02:36 p.m., an observation of Resident #73 revealed her tube feeding bag did not have a legible date on the bag or the specific type of tube feeding written on the bag. On 07/17/2023 at 03:01 p.m., an observation was conducted in Resident #73's room with S3 Licensed Practical Nurse (LPN). S3LPN confirmed Resident #73`s tube feeding bag was not labeled correctly. Record review revealed Resident #73 was admitted to the facility on [DATE] with diagnoses that included hemiplegia following stroke, gastrostomy, dysphagia following stroke, and muscle wasting. Most recent minimum data set assessment completed on 05/24/2023 revealed Resident #73 had severe cognitive impairment, dependent on staff for all activities of daily living(ADL) care, and Resident #73 had a feeding tube. Further record review revealed the following active physician order for July 2023: Jevity 1.5 per percutaneous endoscopic gastrostomy (PEG) tube at 35 cubic centimeters/hour. On 07/17/2023 at 03:10 p.m., an observation and interview with S2Director of Nursing (DON) was conducted in the room of Resident #73. S2DON confirmed the tube feeding bag date was not legible and the feeding bag was not labeled to acknowledge the contents. S2DON confirmed the label on the tube feeding bag should have included a legible date and the type of feeding in the bag.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview and record review the facility failed to implement a comprehensive person-centered plan of care to attain or maintain a resident`s highest practicable physical well-being for 1 (#109) of 1 (#109) residents reviewed for the use of a wander guard as a restraint along with the use of compression stockings. Findings: On 07/18/2023 at 12:55 pm, observation revealed Resident #109 was sitting near the front door next to staff. One to two plus edema was noted to both feet. Compression socks were not on Resident #109`s lower extremities. Resident #109 had a wander guard bracelet on her left ankle. On 07/19/2023 at 08:27 am, an observation conducted in Resident #109`s room revealed she was sitting in a chair at a bedside table eating breakfast. Two plus edema was observed to both feet. Resident #109 had a wander guard bracelet on her left ankle. Record review revealed Resident #109 was admitted to the facility on [DATE] with diagnoses that included vascular dementia, heart failure, restlessness, anxiety, and need for assistance with personal care. Review of minimum data set assessment completed on 06/19/2023 revealed a brief interview of mental status (BIMS) score of 4 which indicated severe cognitive impairment. Further review of functional status revealed all ADL (activities of daily living) care required at the minimum, staff supervision for all tasks. Review of active physician orders for July 2023 revealed the following: Compression stockings on in morning Compression stockings off every night Wander guard bracelet Review of the medication administration record for the month of July 2023 revealed the compression stockings were placed on every day as ordered and the wander guard bracelet was recorded as being on her left ankle daily. On 07/19/2023 at 10:49 a.m., an observation and interview was conducted with S2Director of Nursing (DON) in the room of Resident # 109. S2DON confirmed compression stockings were not on as recorded on the medication administration record for 07/19/2023 at 9:00 a.m. S2DON confirmed compression stockings should not be worn over a wander guard bracelet and the physician should be notified of the issue.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, and interviews, the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice and the comprehensive person-centered care plan for 2 (#98 & #120) of 2 residents reviewed for skin conditions. The facility failed to identify skin tears for residents #98 and #120. Findings: Resident #98 Observation on 07/17/2023 at 9:15 a.m. revealed resident #98 was up in her wheelchair in her room. Resident #98 had skin tear and bruise to right forearm approximately an inch long. There was a band-aid above the skin tear. Review of the medical record for resident #98 revealed the resident was admitted on [DATE] with diagnoses of insomnia, fracture 5th metacarpal bone left hand, chronic pain, mild protein - calorie malnutrition, Alzheimer's disease, dysphagia, anxiety and history of falling. Review of the Quarterly Minimum Data Set, dated [DATE] revealed resident #98 had severely impaired cognitive skills for daily decision making. The resident required two person extensive assistance with bed mobility, transfer, and toilet use and one person extensive assistance with personal hygiene. The resident was incontinent of bowel and bladder. The resident was at risk for developing pressure ulcers. Review of the Braden Risk assessment dated [DATE] revealed resident #98 was at a moderate risk of developing pressure ulcers. Review of the careplan revealed a history of a skin tear with the following intervention: full skin evaluation with bath/shower. Review of the Incident & Accident Reports for the past 6 months revealed there was no documentation of the skin tear and bruise on the right forearm observed on 07/17/2023. Review of the Skin Inspection Report revealed skin inspection were performed on 07/17/2023 and 07/18/2023. Further review of the skin assessment revealed the skin recorded as intact. An interview with S5Certified Nursing Assistant (CNA) on 07/19/2023 at 12:45 p.m. revealed she saw the skin tear on resident #98's right forearm on Monday, 07/17/2023. She did not report the skin tear on Monday. S5CNA thought nursing staff already knew about it because there was a band-aid on her arm. An interview with S6Licensed Practical Nurse (LPN) on 07/19/2023 at 12:56 p.m. revealed she was unaware of the skin tear on resident #98's right forearm. S6LPN reported there should be an Incident &Accident Report done for the skin tear. An interview with S2Director of Nursing (DON) on 07/19/2023 at 1:35 p.m. confirmed the skin tear was not identified by the skin assessments on the 07/17/2023 and 07/18/2023. S2DON further confirmed an Incident & Accident Report should be performed for skin tears. Resident #120 Observation on 07/17/2023 at 1:30PM revealed resident #120 was sitting in his wheelchair at the door to his room. Further observation revealed a skin tear on his right forearm approximately one inch in length and small other skin tears to his right arm. The resident also had multiple bruises to his arms. Review of the medical record revealed the resident was admitted on [DATE] with diagnoses of osteoarthritis to right knee, stage IV pressure ulcer to right hip, anxiety, skin changes, constipation, hemorrhoids, dysuria, depression, peripheral vascular disease, Chronic Obstructive Pulmonary Disease, hypertension, reflux, atrial fibrillation, edema, and obesity. Review of the Quarterly Minimum Data Set, dated [DATE] revealed the resident was independent with cognitive skill for daily decision making. The resident required one person supervision for bed mobility, transfer, and toilet use and one person limited assistance with dressing and personal hygiene. The resident was continent of bowel and occasionally incontinent of bladder. The resident was admitted with stage IV pressure ulcer and 1 venous/arterial ulcer. Review of the physician orders for July 2023 revealed the resident received Eliquis 5 milligrams 1 tablet two times a day every day and monitor for abnormal signs and symptoms of bleeding related to anticoagulant therapy every shift. Review of the Medication Administration Record for July 2023 revealed 0 (bleeding not noted) was documented every shift when monitoring for abnormal signs & symptoms of bleeding related to anticoagulant therapy. Review of the careplan revealed the resident had altered skin integrity - has actual pressure ulcers to sacrum and venous ulcer to left great toe. Further review revealed the following interventions: head to toe weekly assessment weekly, report skin breakdown or changes skin, and head to toe skin assessment 3 times a week. Review of the Incident & Accident Reports for the past 6 months revealed there was no documentation of the skin tears and bruises on the right arm observed on 07/17/2023. An interview with S7Treatment Nurse on 07/19/2023 at 11:26 a.m. revealed she does daily skin check on residents with pressure ulcers. S7Treatment Nurse was notified of the skin tear at this time. S7Treatment Nurse revealed that there should be an Incident & Accident Report on the skin tear. An interview with S6LPN on 07/19/2023 at 12:56 p.m. revealed she was unaware of the skin tear on resident #120's right arm. S6LPN reported there should be an Incident &Accident Report done for the skin tear. An interview with S2DON on 07/19/2023 at 1:35 p.m. confirmed the skin tear had not been identified by staff. S2DON further confirmed an Incident & Accident Report should be performed for skin tears.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interview, the facility failed to implement a comprehensive person-centered care plan for 4 (#1, #2, #4, #5) of 5 (#1 - #5) residents reviewed for nutrition. The facility had incomplete documentation of the residents' meal intake percentages. Findings: Resident #1 Review of the medical record revealed the resident was admitted on [DATE] with diagnoses of heart disease, hypertension, dementia, dysphagia following cerebral infarction, gastroesophageal reflux disease, vitamin deficiency, need for assistance with personal care, and muscle wasting and atrophy. Review of the Minimum Data Set, dated [DATE] revealed the resident had severely impaired cognitive skills for daily decision making. The resident required extensive assistance for eating, bed mobility, personal hygiene, transfers, and toileting. Review of the physician orders for December 2022 revealed the following diet order: regular with chopped meats (resident is a feeder) ice cream to lunch and supper meals. Review of the care plan revealed: potential for altered nutrition and dehydration related to weight below ideal body weight, vitamin deficiency, and gastroesophageal reflux disease. Review of the interventions revealed resident must be fed at all times and monitor % meal intake and offer alternate if < 50% consumed. Review of the Meal Intake Roster from 10/01/2022 - 12/08/2022 revealed there was no documented evidence of meal intake percentages on 109 meals. An interview with S1Director of Nursing on 12/28/2022 at 2:00PM confirmed the resident's meal intake percentages should be documented as per the plan of care. Resident #2 Review of the medical record revealed the resident was admitted on [DATE] with diagnoses of Alzheimer's, hypertension, heart disease, anxiety, vitamin deficiency, muscle wasting, reflux, and delirium. Review of the Minimum Data Set, dated [DATE] revealed the resident had severely impaired cognitive skills for daily decision making. The resident required extensive assistance for eating, bed mobility, personal hygiene, transfers, and toileting. Review of the physician orders for December 2022 revealed the following diet order: mechanical soft diet, add house shake to lunch and supper tray (may assist with feeding 6:30 a.m., 11:00 a.m., and 4:30 p.m. everyday). Review of the care plan revealed: potential for altered nutrition and dehydration related to dementia, delirium, and anxiety. Review of the interventions revealed allow resident ample time to consume meals, monitor % of meal intake and offer alternate, and provide assist with dining as needed. Review of the Meal Intake Roster from 11/01/2022 - 12/27/2022 revealed there was no documented evidence of meal intake percentages for 19 meals. An interview with S1Director of Nursing on 12/28/2022 at 2:00PM confirmed the resident's meal intake percentages should be documented as per the plan of care. Resident #4 Review of the medical record revealed the resident was admitted on [DATE] with diagnoses of anxiety, vitamin deficiency, dysphagia, dementia, and reflux. Review of the Minimum Data Set, dated [DATE] revealed the resident had severely impaired cognitive skills for daily decision making. The resident required extensive assistance for eating, bed mobility, personal hygiene, transfers, and toileting. Review of the physician orders for December 2022 revealed the following diet order: mechanical soft with soft meat with nectar thick liquids with cranberry juice each meal. Review of the care plan revealed potential for altered nutrition and dehydration related to dementia and dysphagia. Review of the interventions revealed: allow ample time to consume meals and or snacks, monitor % of meal intake and offer alternate if less than 50% consumed, and must be fed all meals and snacks. Review of the Meal Intake Roster from 11/01/2022 - 12/27/2022 revealed there was no documented evidence of meal intake percentages for 20 meals. An interview with S1Director of Nursing on 12/28/2022 at 2:00PM confirmed the resident's meal intake percentages should be documented as per the plan of care. Resident #5 Review of the medical record revealed the resident was admitted on [DATE] with diagnoses of Alzheimer's, mild protein calorie malnutrition, dementia, vitamin deficiency, and anemia. Review of the Minimum Data Set, dated [DATE] revealed the resident had severely impaired cognitive skills for daily decision making. The resident required extensive assistance for eating, bed mobility, personal hygiene, transfers, and toileting. Review of the physician orders for December 2022 revealed the following diet order: pureed diet with nectar thick liquids with double meats, milk with all meals, give ice cream or chocolate pudding with lunch and dinner. Review of the care plan revealed potential for altered nutrition and dehydration related to Alzheimer's, depression, and dementia. Review of the interventions revealed monitor meal intake and if less than 50% consumed offer alternate and must be fed at all times. Review of the Meal Intake Roster from 11/01/2022 - 12/27/2022 revealed there was no documented evidence of meal intake percentages for 19 meals. An interview with S1Director of Nursing on 12/28/2022 at 2:00PM confirmed the resident's meal intake percentages should be documented as per the plan of care.