Landmark of Rayne

In the surveyor’s words

From the most serious findings on record at Landmark of Rayne, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF636Apr 9, 2025

  Based on record reviews and interview, the facility failed to ensure a Minimum Data Set (MDS) assessments were completed using the Resident Assessment Instrument (RAI) process within regulatory timeframes for 17 (#3, #10, #14, #15, #18, #20, #27, #28, #36, #37, #46, #61, #66, #67, #82, #89, #307) out of 24 (#3, #9, #10, #14, #15, #18, #20, #27, #28, #36, #37, #46, #52, #61, #66, #67, #68, #74, #82, #83, #89, #90, #95, #307) total residents reviewed for assessments. Findings: Review of Centers for Medicare and Medicaid Services (CMS) RAI Version 3.0 Manual- RAI Omnibus Budget Reconciliation Act (OBRA)-required Assessment Summary revealed that Assessment Reference Date (ARD) for Resident Assessments should be completed no later than the 14th calendar day of the resident's ARD. […]

• No harm, potential for more than minimal, widespreadF640Apr 9, 2025

  Based on interview and record review, the provider failed to transmit a completed Discharge MDS (Minimum Data Set) Assessments within 14 days after completion for 7 (#9, #52, #68, #74, #83, #90, #95) out of 24 (#3, #9, #10, #14, #15, #18, #20, #27, #28, #36, #37, #46, #52, #61, #66, #67, #68, #74, #82, #83, #89, #90, #95, #307) resident's investigated for resident assessments. Findings: Review of Resident #9's electronic clinical record revealed a quarterly MDS assessment, with an ARD (Assessment Reference Date) of 01/28/2025, was completed on 01/31/2025. […]

• No harm, potential for more than minimal, widespreadF867Mar 12, 2025

  Based on record review and interview, the facility's Quality Assurance and Performance Improvement (QAPI) Program failed to measure its success and track performance after identifying an area of improvement as evidenced by failing to have documented evidence of monitoring the effectiveness of the proposed plan of action. This deficient practice had the potential to affect a census of 98 residents. Findings: Review of the facility's form titled, Corrective Action Plan, dated 02/12/2025 revealed: 1. Problem Identified: Tasks not firing correctly due to facility changed from 12 hour shifts to 8 hour shifts. 12 hour shifts continued to fire to tasks in addition to 8 hours. Several time code discrepancies resulted in facility wide tasks audit to make corrections. 2. […]

• No harm, potential for more than minimal, widespreadF812Mar 20, 2024

  Based on observation, interview, and record review, the facility failed to store food in accordance with professional standards for food service and failed to ensure sanitary conditions were maintained in the kitchen by failing to: 1. Discard expired foods from the kitchen refrigerator, freezer, and dry storage area; 2. Label opened foods with the date they were opened; 3. Remove compromised cans from the dry storage area; 4. Clean the inside of oven and outside of refrigerator and freezer; and 5. […]

• No harm, potential for more than minimal, patternF842May 13, 2026

  Based on record reviews, observations, and interviews, the facility failed to maintain accurate medical records in accordance with accepted professional standards and practices when staff failed to immediately sign out narcotic medications on the narcotic record form at the time they were administered for the for 5 residents (#23, #29, #71, #76 and #77). Findings: A review of the facility's policy titled Drug- Controlled Substances with a last review date of 01/29/2026, read in part, Regulation requires that the community has a system in place to account for the receipt, usage, disposition, and reconciliation of all controlled medications. […]