Onyx Care of Ruston

In the surveyor’s words

From the most serious findings on record at Onyx Care of Ruston, in the surveyor’s own words.

• Immediate jeopardy, patternF689May 7, 2025

  Based on record review, observation, and interviews, the facility failed to ensure a resident received adequate supervision to prevent incidents and accidents. The facility failed ensure a resident received supervision during a bed bath for 1 (#1) of 3 (#1, #2, #3) residents reviewed for falls. The deficient practice resulted in an immediate jeopardy for Resident #1 on 04/15/2025 at 10:00 a.m. when Resident #1 fell out of the left side of the bed during a bed bath when S3CNA (Certified Nursing Assistant) failed to ensure the resident was secured and safe in the bed to prevent him from falling before she turned away to retrieve Resident #1's clothing from the closet. […]

• Immediate jeopardy, isolatedF689Jun 3, 2025

  Based on record review and interviews, the facility failed to maintain the door locking mechanism on an exterior door in the secured unit to prevent elopement from the secured unit for 1 (#1) of 3 (#1, #2, #3) residents reviewed. The deficient practice resulted in an immediate jeopardy for Resident #1 on 05/23/2025 at 11:07 a.m. when Resident #1 who was an elopement risk was able to exit the secured unit to the outside of the building through a door with a malfunctioning locking mechanism. Resident #1 was picked up on the two lane highway with a speed limit of 55 miles per hour approximately 0.2 miles from the facility by S8Housekeeper. […]

• Immediate jeopardy, isolatedF689Nov 2, 2023

  Based on observations, record reviews and interviews the facility failed to provide an environment free of accident hazards for 1 (#2) of 5 (#2, #4, #5, #6 and #7) residents identified at high risk for elopement. The facility failed to ensure all exit doors were secured to prevent residents at high risk for elopement from exiting the facility unsupervised. This deficient practice resulted in an Immediate Jeopardy situation on 10/22/2023 at approximately 1:15 a.m. when resident #2 (a severely cognitively impaired resident identified as an elopement risk) was found across the street in a neighbor's yard by a staff member. Resident #2 was located 50 minutes after she eloped on 10/22/2023 through an unsecured door and was returned to the facility at approximately 2:00 a.m. […]

• Immediate jeopardy, isolatedF835Nov 2, 2023

  Based on observations, record reviews and interviews the facility failed to administer its resources effectively to attain or maintain the highest practicable physical, mental, and psychosocial well-being for 1 (#2) of 5 (#2, #4, #5, #6 and #7) residents reviewed for elopement. The facility failed to: Have an effective system in place to ensure resident #2 (whom was at high risk for elopement, and wore a wander alert bracelet) was adequately supervised to prevent resident #2 from exiting the building through an unsecured door. […]

• No harm, potential for more than minimal, patternF695Jul 9, 2026

  Based on observations, record reviews, and interviews, the facility failed to ensure respiratory care was provided consistent with professional standards of practice for 6 (#72, #75, #76, #91, #120, #124) of 6 residents reviewed for respiratory care. The facility failed to ensure:1). emergency tracheostomy supplies were available in resident rooms (#72, #124), 2). Oxygen concentrator filters were cleaned timely (#120), and 3). signage regarding oxygen in use was placed on resident doors (#75, #76, #91). […]