Inspection Reports for
Center Point Health Care and Rehab
8225 SUMMA AVENUE, BATON ROUGE, LA, 70809
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Inspection Report — Nov 25, 2025
Annual Inspection CMS
Date: Nov 25, 2025
Visit Reason
The inspection was conducted to assess compliance with professional standards of quality in nursing care, specifically focusing on feeding tube management and nutritional status of residents.
Findings
The facility failed to ensure nursing staff clarified and accurately administered tube feeding orders for Resident #1, resulting in feeding at a lower rate than ordered. Additionally, the facility failed to ensure the resident maintained acceptable nutritional status, as evidenced by weight loss and inadequate caloric intake.
Deficiencies (2)
Failed to clarify Resident #1's tube feeding orders with the physician and verify accurate administration of tube feeding rate prior to documentation.
Failed to ensure Resident #1 maintained acceptable nutritional status by not providing tube feedings based on comprehensive assessment.
Report Facts
Tube feeding rate: 50
Tube feeding rate: 40
Resident weight: 139.4
Resident weight: 136
Resident weight: 130
Resident weight: 128.8
Calories provided: 1320
Calories needed: 1636
Calories needed: 1800
Employees mentioned
| Name | Title | Context |
|---|---|---|
| S4LPN | Licensed Practical Nurse | Confirmed tube feeding order discrepancies and administration errors for Resident #1 |
| S1DON | Director of Nursing | Confirmed lack of clarification orders and nursing responsibilities regarding tube feeding for Resident #1 |
| S3RD | Registered Dietician | Provided nutritional assessment and recommended increase in tube feeding rate for Resident #1 |
| S2NP | Nurse Practitioner | Agreed with increasing Resident #1's tube feeding rate to 50 mL/hr |
Inspection Report — Sep 11, 2025
Complaint Investigation CMS
Date: Sep 11, 2025
Visit Reason
The inspection was conducted due to complaints regarding the facility's failure to develop and implement an effective discharge planning process and failure to provide required documentation or notification related to residents' needs, appeal rights, or bed-hold policies.
Complaint Details
The complaint investigation found substantiated deficiencies related to discharge planning and bed-hold policy notification failures affecting Residents #1, #2, and #3.
Findings
The facility failed to ensure an effective discharge planning process for Resident #1, including identifying discharge needs, involving the interdisciplinary team, documenting resident interest in community return, and creating an adequate discharge summary. Additionally, the facility failed to provide written notice of the bed-hold policy to Residents #2 and #3 or their representatives at the time of hospital transfers.
Deficiencies (2)
Failure to develop and implement an effective discharge planning process that meets resident needs and preferences.
Failure to provide required documentation or notification related to resident's needs, appeal rights, or bed-hold policies.
Report Facts
Residents reviewed for discharge: 2
Residents sampled for bed-hold policy: 3
Treatment program duration: 45
Resident #2 hospital transfer date: 2025
Resident #2 hospital return date: 2025
Resident #3 hospital transfer date: 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| S2 FADM | Interviewed regarding Resident #1's discharge and history | |
| S4 SW | Interviewed about Resident #1's interest in rehab and community living | |
| S5 NP | Nurse Practitioner | Interviewed about discharge documentation requirements |
| S3 DON | Director of Nursing | Confirmed lack of discharge documentation and bed-hold notices for Residents #1, #2, and #3 |
| S1 ADM | Administrator | Confirmed deficiencies in discharge planning and bed-hold policy notification |
Inspection Report — May 7, 2025
Routine CMS
Date: May 7, 2025
Visit Reason
The inspection was conducted as a routine survey to assess compliance with regulatory requirements including standard survey, complaint investigations, and review of care and services.
Findings
The facility was found deficient in multiple areas including failure to post survey results accessibly, incomplete PASRR screenings and referrals, failure to implement physician orders for oxygen therapy, medication storage violations, inadequate assistance with activities of daily living, improper care of enteral feeding equipment, lack of PICC line maintenance orders, missed laboratory tests, insufficient dietary staffing causing late meal delivery, improper therapeutic diet provision, unsanitary kitchen conditions, improper garbage disposal, failure to wear PPE during enteral feeding, and unsafe call light equipment.
Deficiencies (16)
Failed to post the results of the most recent standard and complaint surveys in a place readily accessible to residents, family members, and legal representatives.
Failed to ensure residents with new mental health diagnoses were referred for PASRR Level II evaluations as required.
Failed to implement physician's oxygen orders correctly by administering oxygen when SpO2 was 98%, contrary to order to maintain SpO2 >92% as needed.
Medications were left at a resident's bedside without physician's order, violating medication storage policy.
Failed to provide timely and adequate assistance with activities of daily living including nail care and incontinent care.
Enteral feeding flush bag was not labeled with date/time and feeding pole was dirty with dried formula.
Failed to have physician orders for daily assessment and flushing of PICC line for resident receiving IV therapy.
Failed to perform ordered laboratory tests timely; Depakote level not drawn as ordered every 3 months.
Dietary support personnel lacked competency in dishwasher operation and sanitation, risking ineffective dish cleaning.
Insufficient dietary support personnel resulted in late meal service on multiple days.
Residents did not consistently receive therapeutic diets as ordered; double/large portions not provided as prescribed.
Meals were served late and inconsistently, not in accordance with scheduled meal times.
Food service safety violations including dirty kitchen floor, uncovered food in refrigerator, dented cans in dry storage, improper dishwashing, and unsanitary meal service area.
Garbage and refuse were not properly contained or covered in kitchen and outdoor dumpster areas.
Staff failed to wear required gowns when providing enteral feeding to a resident on Enhanced Barrier Precautions.
Call light equipment was unsafe with covers pulled off and wires exposed in two resident rooms.
Report Facts
Residents affected: 148
Residents reviewed for PASRR: 6
Residents reviewed for care plans: 30
Residents reviewed for medication administration: 31
Residents reviewed for enteral feeding: 5
Residents reviewed for IV fluid therapy: 1
Residents reviewed for laboratory tests: 31
Dietary support personnel: 5
Meal times: 3
Residents reviewed for therapeutic diets: 3
Residents reviewed for infection control: 7
Residents reviewed for call light safety: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| S5LPN | Licensed Practical Nurse | Named in oxygen therapy and enteral feeding PPE findings |
| S4ADON | Assistant Director of Nursing | Reviewed oxygen therapy and therapeutic diet findings |
| S2DON | Director of Nursing | Confirmed PASRR, PICC line, lab test, and PPE findings |
| S1ADM | Administrator | Confirmed dishwasher training, meal service, garbage, and call light findings |
| S18DW | Dishwasher | Observed and interviewed regarding dishwasher operation deficiencies |
| S10DM | Dietary Manager | Interviewed regarding kitchen sanitation and dietary staffing |
| S19DDM | Dietary Director Manager | Interviewed regarding dishwasher training and dietary staffing |
| S23CNA | Certified Nursing Assistant | Interviewed regarding meal delivery times |
| S24LPN | Licensed Practical Nurse | Interviewed regarding resident complaints of late meals |
| S8MS | Maintenance Staff | Observed and interviewed regarding call light safety |
Inspection Report — Mar 12, 2025
Annual Inspection CMS
Date: Mar 12, 2025
Visit Reason
The inspection was conducted to assess the facility's compliance with regulatory requirements related to accurate resident assessments, development of comprehensive care plans, and staff competency in meeting behavioral health needs.
Findings
The facility failed to ensure accurate Minimum Data Set (MDS) assessments for Resident #2, including proper coding of diagnoses and Gradual Dose Reduction (GDR) information. Additionally, the facility did not develop a trauma-informed, comprehensive care plan for Resident #2's mental health diagnoses. The facility also lacked sufficient staff training and competency evaluations for non-pharmacological interventions to meet the mental and psychosocial health needs of residents diagnosed with Schizophrenia, PTSD, and Substance Use Disorder (SUD).
Deficiencies (3)
Failed to ensure accuracy of Minimum Data Set (MDS) Assessments for Resident #2, including coding of Schizoaffective Disorder, PTSD, and Gradual Dose Reduction (GDR) information.
Failed to develop a trauma-informed, comprehensive person-centered care plan for Resident #2's diagnoses of Schizoaffective Disorder and PTSD.
Failed to develop a facility assessment addressing staff training and competency for non-pharmacological interventions for residents with Schizophrenia, PTSD, and SUD; and failed to provide staff training and competency evaluations for relevant personnel.
Report Facts
Residents affected: 1
Personnel files reviewed: 4
Facility Assessment date: Mar 15, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| S3MDS | Interviewed and confirmed inaccuracies in Resident #2's MDS assessment and care plan | |
| S2DON | Director of Nursing | Confirmed MDS assessments and care plans should accurately reflect resident status |
| S1ADM | Administrator | Confirmed MDS assessments and care plans should accurately reflect resident status and acknowledged lack of staff training and competency processes |
| S4LPN | Licensed Practical Nurse | Personnel file reviewed; lacked documented training and competency evaluations |
| S5LPN | Licensed Practical Nurse | Personnel file reviewed; lacked documented training and competency evaluations |
| S6RN | Registered Nurse | Personnel file reviewed; lacked documented training and competency evaluations |
| S7MSW | Medical Social Worker | Personnel file reviewed; lacked documented training and competency evaluations |
Inspection Report — Nov 26, 2024
Annual Inspection CMS
Date: Nov 26, 2024
Visit Reason
The inspection was conducted to review compliance with professional standards regarding therapeutic diet orders for residents, specifically focusing on the accuracy and updating of diet orders in the electronic medical record.
Findings
The facility failed to maintain accurate therapeutic diet orders in the electronic medical record for Resident #2, despite having updated handwritten physician orders and diet requisition forms. This deficiency had the potential to affect 134 residents receiving physician-ordered nutrition.
Deficiencies (1)
Failed to ensure Resident #2's diet order was updated in the electronic medical record according to the latest physician order and diet requisition.
Report Facts
Residents affected: 134
Inspection Report — Jun 27, 2024
Complaint Investigation CMS
Date: Jun 27, 2024
Visit Reason
The inspection was conducted based on complaints and observations related to resident care, medication management, food service, pest control, and staffing practices at the facility.
Complaint Details
The investigation was complaint-driven, focusing on issues raised by residents and observations of care and facility conditions.
Findings
The facility was found deficient in multiple areas including failure to accommodate a resident's tube feeding needs, failure to maintain nutritional status for a resident, failure to ensure ordered enteral feedings were administered, failure to post nurse staffing data correctly, failure to provide timely pharmaceutical services including pain medication availability and documentation, failure to ensure psychotropic medications had acceptable diagnoses, failure to provide therapeutic diets as ordered, failure to serve meals at appropriate times, failure to maintain sanitary food storage and preparation conditions, and failure to maintain an effective pest control program.
Deficiencies (10)
Failed to accommodate a resident's needs for tube feeding management, resulting in missed feedings due to wheelchair incompatibility and resident mobility.
Failed to maintain acceptable nutritional status by not implementing interventions after weight loss, including failure to provide ordered Boost supplements.
Failed to ensure a resident received enteral feedings as ordered by the physician, with no documentation of refusals or held feedings despite missed feedings.
Failed to post nurse staffing data daily including resident census and actual hours worked for licensed and unlicensed nursing staff.
Failed to ensure availability and proper documentation of administration of physician ordered narcotic pain medication for a resident.
Failed to ensure a resident's drug regimen was free from unnecessary psychotropic medications by prescribing antidepressant and anti-anxiety medications with unacceptable diagnoses.
Failed to ensure a resident received a therapeutic diet as ordered by the physician, including failure to provide double portions of protein and vegetables.
Failed to ensure meals were served at regular times comparable to normal community meal times, with documented late lunch service for residents on Hall B.
Failed to store, prepare, and distribute foods under sanitary conditions, including uncovered food items, damaged packaging, unrestrained hair and facial hair among kitchen staff, and presence of insects and unsanitary conditions in food preparation and serving areas.
Failed to maintain an effective pest control program, with multiple observations of live and dead roaches, flies, gnats, and ants throughout resident rooms and facility areas.
Report Facts
Residents affected: 1
Residents affected: 5
Residents affected: 3
Residents affected: 142
Residents affected: 5
Residents affected: 5
Residents affected: 3
Residents affected: 1
Residents affected: 141
Residents affected: 142
Employees mentioned
| Name | Title | Context |
|---|---|---|
| S32LPN | Licensed Practical Nurse | Confirmed missed tube feedings and wheelchair incompatibility for Resident #19 |
| S31CNA | Certified Nursing Assistant | Reported Resident #19's tube feeding disconnections and compliance |
| S30CNA | Certified Nursing Assistant | Reported Resident #19's tube feeding disconnections and mobility |
| S26LPN | Licensed Practical Nurse | Confirmed Resident #19's tube feeding orders and compliance |
| S33RD | Registered Dietitian | Monitored Resident #19's nutrition and confirmed feeding issues |
| S3ADON | Assistant Director of Nursing | Confirmed tube feeding administration issues and narcotic medication availability |
| S2DON | Director of Nursing | Confirmed feeding and medication deficiencies and nurse staffing posting issues |
| S12NP | Medical Provider | Confirmed Resident #19's feeding orders and narcotic medication ordering process |
| S35CNA | Certified Nursing Assistant | Reported Resident #45 did not receive ordered Boost supplements |
| S15LPN | Licensed Practical Nurse | Reported Boost supplement ordering and administration issues |
| S37RD | Registered Dietitian | Recommended Boost supplements for Resident #45 |
| S23LPN | Licensed Practical Nurse | Administered last dose of narcotic pain medication to Resident #132 and confirmed medication shortage |
| S24P | Pharmacy Representative | Confirmed medication refill and delivery dates for Resident #132 |
| S6DM | Dietary Manager | Confirmed food service timing and sanitation deficiencies |
| S7C | Kitchen Staff | Observed unsanitary food preparation conditions |
| S1ADM | Administrator | Acknowledged food service and pest control deficiencies |
Inspection Report — Jun 27, 2024
Routine CMS
Date: Jun 27, 2024
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements including resident care, medication management, infection control, dietary services, hospice coordination, and facility environment.
Findings
The facility had multiple deficiencies including failure to accommodate a resident's tube feeding needs, incomplete resident assessment transmissions, inadequate PASARR coordination, missing weekly nursing notes, failure to provide ordered nutritional supplements and therapeutic diets, medication management issues including narcotic availability and documentation, improper medication storage, late meal service, poor infection control practices, inconsistent hospice documentation, and ineffective pest control.
Deficiencies (17)
Failed to accommodate Resident #19's needs for tube feeding management, including failure to administer tube feedings as ordered and wheelchair not accommodating tube feeding.
Failed to complete and transmit Discharge MDS assessment timely for Resident #105.
Failed to coordinate PASARR Level II screenings and incorporate recommendations into care plans for several residents.
Failed to maintain weekly nursing notes documentation as ordered for Resident #30.
Failed to provide ordered nutritional supplements (Boost) to Resident #45 despite documented weight loss.
Failed to ensure Resident #19 received enteral feedings as ordered by physician.
Failed to post nurse staffing data daily including resident census and hours worked for licensed and unlicensed staff.
Failed to ensure availability and proper documentation of narcotic pain medication administration for Resident #132.
Failed to ensure Resident #72's psychotropic medications had acceptable diagnoses documented.
Failed to ensure medications were stored in locked compartments and not left unsecured in resident rooms.
Failed to serve therapeutic diet as ordered for Resident #132 (double portions of protein and vegetables).
Failed to serve meals at scheduled times comparable to normal community meal times, with late lunch service observed on Hall B.
Failed to store, prepare, and distribute foods under sanitary conditions including presence of insects, unsealed foods, dirty equipment, and improper staff attire in kitchen.
Failed to ensure medical records consistently reflected Resident #30's code status, with discrepancies between DNR status in paper chart and full code in electronic records.
Failed to maintain infection prevention and control program by not using proper PPE during peg tube care for Resident #72.
Failed to maintain effective pest control program, with multiple live and dead roaches, flies, gnats, and ants observed throughout the facility.
Failed to coordinate hospice care services to ensure hospice binder was updated with current orders, certification period, and care plans for Resident #30.
Report Facts
Weight loss: 34
Weight loss: 7
Medication doses missing: 6
Medication doses missing: 1
Nurse staffing data missing: 3
Meal service delay: 95
Employees mentioned
| Name | Title | Context |
|---|---|---|
| S32LPN | Licensed Practical Nurse | Confirmed Resident #19's PEG tube feedings were scheduled but not always administered as ordered |
| S31CNA | Certified Nursing Assistant | Reported Resident #19's PEG tube feeding was disconnected during mobility and not refused |
| S30CNA | Certified Nursing Assistant | Reported Resident #19 requested tube feeding disconnection to propel around facility |
| S26LPN | Licensed Practical Nurse | Confirmed Resident #19's tube feeding orders and non-administration during mobility |
| S3ADON | Assistant Director of Nursing | Confirmed Resident #19's tube feeding should have been administered as ordered |
| S21MDS | MDS Coordinator | Confirmed failure to complete and transmit Discharge MDS for Resident #105 |
| S2DON | Director of Nursing | Confirmed failure to complete Discharge MDS and nurse staffing data omissions |
| S11SSD | Social Services Director | Confirmed PASARR Level II screenings not resubmitted and care plans not updated |
| S14LPN | Licensed Practical Nurse | Responsible for care plans, confirmed failure to update PASARR care plan for Resident #37 |
| S17LPN | Licensed Practical Nurse | Acknowledged weekly nursing notes task but failed to document notes for Resident #30 |
| S27LPN | Licensed Practical Nurse | Acknowledged weekly nursing notes task but failed to document notes for Resident #30 |
| S4ADON | Assistant Director of Nursing | Confirmed missing weekly nursing notes documentation for Resident #30 |
| S35CNA | Certified Nursing Assistant | Reported Resident #45 never received Boost supplement on meal trays |
| S36CNA | Certified Nursing Assistant | Confirmed no Boost supplement on Resident #45's meal tray or meal ticket |
| S15LPN | Licensed Practical Nurse | Confirmed Resident #45 ordered Boost supplement not provided due to order not triggering MAR |
| S37RD | Registered Dietitian | Recommended Boost supplement for Resident #45 due to weight loss, unaware it was not provided |
| S12NP | Nurse Practitioner | Confirmed Resident #45 ordered Boost supplement not provided and Resident #132 psychotropic meds diagnosis not acceptable |
| S5ADON | Assistant Director of Nursing | Confirmed ordered Boost supplement not provided to Resident #45 |
| S23LPN | Licensed Practical Nurse | Administered last dose of narcotic pain medication to Resident #132 and confirmed failure to document administration on MAR |
| S24P | Pharmacy Representative | Confirmed pharmacy received narcotic medication order and filled it after facility notification delay |
| S18LPN | Licensed Practical Nurse | Observed loose pills on Resident #28's refrigerator and confirmed improper medication storage |
| S6DM | Dietary Manager | Confirmed late meal service on Hall B and multiple kitchen sanitation issues |
| S7C | Kitchen Staff | Confirmed kitchen sanitation issues including dirty food prep tables and improper food storage |
| S1ADM | Administrator | Acknowledged pest control treatment delay and meal service complaints |
| S13TN | Trained Nurse | Failed to wear gown during peg tube care for Resident #72 |
| S16CNA | Certified Nursing Assistant | Failed to wear gown and gloves during peg tube care for Resident #72 |
| S28LPN | Licensed Practical Nurse | Hospice nurse who admitted Resident #30 to hospice |
| S3ADON | Assistant Director of Nursing | Confirmed medication storage and narcotic medication availability issues |
Inspection Report — Jul 12, 2023
Routine CMS
Date: Jul 12, 2023
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to residents' rights, environment safety, resident assessments, medication administration, and food safety in the nursing facility.
Findings
The facility was found deficient in multiple areas including inconsistent documentation of residents' code status, unsafe and unsanitary living conditions in resident rooms, failure to complete and transmit MDS assessments timely, failure to observe medication consumption by a resident, and improper food storage and preparation practices.
Deficiencies (5)
Failed to ensure all medical records regarding residents' code status consistently reflected residents' wishes for 2 of 32 residents reviewed.
Failed to ensure residents had a safe, functional, sanitary, and comfortable environment for 5 residents of 32 rooms observed.
Failed to complete and transmit MDS assessments in the required timeframe for 14 residents reviewed.
Failed to ensure staff observed 1 of 1 resident consume his medication.
Failed to store, prepare, and distribute foods under sanitary conditions including failure to properly seal and date opened food and failure of dietary staff to wear beard restraints.
Report Facts
Residents reviewed for advanced directives: 32
Residents affected by code status deficiency: 2
Resident rooms observed for environment safety: 32
Residents affected by environment deficiency: 5
Residents reviewed for MDS assessment timeliness: 14
Residents affected by medication observation deficiency: 1
Facility residents provided meals: 112
Food items improperly stored: 8
Pills found displaced: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| S11LPN | Licensed Practical Nurse | Interviewed regarding inconsistent resident code status documentation |
| S12LPN | Licensed Practical Nurse | Interviewed regarding resident code status determination |
| S6ADON | Assistant Director of Nursing | Interviewed regarding resident code status documentation |
| S14LPN | Licensed Practical Nurse | Interviewed regarding Resident #104's code status documentation |
| S2DON | Director of Nursing | Interviewed regarding resident code status and medication observation |
| S1ADM | Administrator | Interviewed regarding resident code status and environment deficiencies |
| S11M | Maintenance Staff | Interviewed regarding maintenance issues in resident rooms |
| S10EVM | Environmental Manager | Interviewed regarding housekeeping responsibilities |
| S9LPN | Licensed Practical Nurse | Interviewed regarding medication administration and displaced pills |
| S8MDS | MDS Coordinator | Interviewed regarding delayed MDS assessment transmissions |
| S3DM | Dietary Manager | Interviewed regarding food safety and dietary staff hygiene |
| S1DS | Dietary Staff | Observed assisting with food preparation without beard restraint |
| S2DS | Dietary Staff | Observed assisting with food preparation without beard restraint |
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