Every finding on record at Carson Investments of Louisiana, Inc.

Based on record reviews and interview the provider failed to ensure care and services were provided in accordance with the plan of care for 5 (Patient #2, Patient #4, Patient #6, Patient #7, Patient #11) of 8 current patient records reviewed as evidenced by: 1. Failure to provide documentation of Skilled Nurse visits as ordered for Patient #2.2. Failure to provide documentation of Hospice Aide visits as ordered for Patient #2, Patient #4, Patient #6, Patient #7, and Patient #11. Findings:Patient #2Review of Patient #2’s record revealed an admission date of 11/012023. Review of Patient #2’s benefit period 08/22/2025 to 10/20/2025 revealed orders for Skilled Nurse visits 3 times a week for 9 weeks and Hospice Aide visits 2 times a week for 9 weeks.  Review of Patient #2’s Skilled Nursing notes for the week of 08/31/2025 revealed one missing Skilled Nurse visit.Review of Patient #2’s Hospice Aide notes for the week of 08/31/2025 revealed no Hospice Aide visits. Review of Patient #2’s benefit period 10/21/2025 to 12/19/2025 revealed orders for Hospice Aide visits 2 times a week for 9 weeks.  Review of Patient #2’s Hospice Aide notes for the week of 10/19/2025 no Hospice Aide visits. Patient #4 Review of Patient #4’s record revealed an admission date of 08/25/2023. Review of Patient #4’s benefit period 10/13/2025 to 12/11/2025 revealed orders for Hospice Aide visits 3 times a week for 9 weeks.  Review of Patient #4’s Hospice Aide notes for the week of 10/12/2025 revealed one missing Hospice Aide visit. Patient #6Review of Patient #6’s record revealed an admission date of 08/06/2025. Review of Patient #6’s benefit period 10/5/2025 to 12/03/2025 revealed orders for Hospice Aide visits 3 times a week for 9 weeks. Review of Patient #6’s Hospice Aide notes for the week of 10/12/2025 revealed one missing Hospice Aide visit. Patient #7Review of Patient #7’s record revealed an admission date of 05/05/2025. Review of Patient #7’s benefit period 08/03/2025 to 10/31/2025 revealed orders for Hospice Aide visits 2 times a week for 13 weeks. Review of Patient #7’s Hospice Aide notes for the week of 09/07/2025 revealed one missed Hospice Aide visit. Further review of Patient #7’s Hospice Aide notes revealed one missed Hospice Aide visit for the week of 09/14/2025. Patient #11Review of Patient #11’s record revealed an admission date of 08/07/2025. Review of Patient #11’s benefit period 08/07/2025 to 11/04/2025 revealed orders for Hospice Aide visits 2 times a week for 13 weeks.  Review of Patient #11’s Hospice Aide notes for the week of 08/31/2025 revealed no hospice aide visits. Further review of Patient #11’s Hospice aide notes revealed one missing Hospice Aide visit for the week of 10/5/2025. During an interview on 10/28/2025 at 3:00 p.m. S1 Administrator reviewed #2, 4, 6, 7, 11’s records and confirmed listed the missing visits were not conducted.

Based on record reviews and interviews the interdisciplinary group/attending physician failed to prepare a written plan of care for each patient by providing services to patient without having a written plan of care (POC) for 1(#4) out of 5 (#1, #2, #3, #4, #5) sampled patients. Findings: Review of facilitys census by status presented by S1 Administrator revealed patient #4 was admitted to the hospice agency on 06/09/2023 with a diagnosis of cardiac. Review of Patient #4s benefit period revealed a beginning date of 06/09/2023 with an ending date of 09/06/2023. Review of Patient #4s Hospice binder failed to reveal documentation that a written plan of care was developed by the interdisciplinary group. Review of Patient #4s nurse notes visits dated 06/09/2023 revealed a RN (Registered Nurse) Initial/ Comprehensive Assessment. During an interview on 09/06/2023 at 2:00 p.m. S1 Administrator reviewed Patient #4s hospice binder and confirmed a POC was not developed for Patient #4.

Based on record reviews and interviews the provider failed to provide documentation of care and services rendered as per the patients Plan of Care (POC) for 5 patients (#1, #2, #3, #4, #5) of 5 patient charts reviewed. Findings: Patient #1 Review of Patient #1s clinical record revealed Patient #1 was admitted to the provider on 07/07/2023 with a diagnoses of multiple myeloma not having achieved remission. Review of Patient #1s POC revealed the aide was to visit 2 times a week for 13 weeks, spiritual counselor visits 1 time a month for 3 months, and medical social worker (MSW) visits 1 time a month for 3 months. Review of Patient #1s aide notes failed to reveal documentation of an aide visit for the week of 08/27/2023 to 09/02/2023. Review of Patient #1s spiritual counselor notes failed to reveal documentation of a spiritual counselor visit for the month of July 2023. Review of Patient #1s record failed to reveal documentation of any visits by an MSW. During an interview on 09/06/2023 at 3:15 p.m. S1 Administrator reviewed Patient #1s clinical record and acknowledged there was not documentation of an aide visit for the week of 08/27/2023 to 09/02/2023. S1 Administrator further acknowledged there was not documentation of a spiritual counselor visit for the month of July 2023 or documentation of any visits by the MSW. Patient #2 Review of facilitys census by status presented by S1Administrator revealed Patient #2 was admitted to the hospice agency on 05/24/2023 with a diagnosis of CVA (cerebrovascular accident). Review of Patient #2s Initial POC dated 05/24/2023 with a benefit period of 05/24/2023 through 08/21/23 revealed the nurse was to visit 1 time a week for 13 weeks, hospice aide two times a week for 13 weeks, and spiritual counselor visit 1 time a month for 3 months. Review of Patient #2s nurse visit notes failed to reveal nurses notes for the week of 6/18/2023 through 6/24/2023. During an interview on 09/06/2023 at 12:30 p.m. S1 Administrator confirmed there was no documentation Patient #2 had a nurse visit during the week of 6/18/2023 through 6/24/2023. Review of Patient #2s Initial Plan of Care dated 05/24/2023 for benefit period for 5/24/2023 through 8/21/23 revealed an ordered frequency for Spiritual counselor: 1 time a month for 3 months, as needed 1 time a month for 3 months. Review of Patient #2s Hospice binder tab for spiritual care failed to reveal spiritual counselor notes/visits. During an interview on 09/06/2023 at 12:35 a.m. S1 Administrator reviewed Patient #2s binder and confirmed Patient #2 did not have a spiritual counselor visit. Review of Patient #4s aide notes failed to reveal documentation of aide visits as follows: -the week of 05/28/2023 through 06/03/2023, no visits documented -the week of 07/2/2023 through 07/8/2023, only one visit was documented -the week of 07/23/2023 through 07/29/2023, only one visit was documented -the week of 07/30/2023 through 08/05/2023, only one visit was documented During an interview on 09/06/2023 at 12:45 p.m. S1 Administrator reviewed Patient #2s hospice aide notes and confirmed Patient #2 did not have any hospice aide visit notes for the week of 5/28/2023 through 6/3/2023, no hospice aide visit notes for the week of 7/30/2023 through 8/5/2023. Further review of Patient #2s hospice aide notes revealed Patient #2 was seen only once a week the week of 07/02/2023 through 07/08/2023, the week of 07/23/2023 through 07/29/2023, and the week of 07/30/2023 through 08/05/2023. Patient #3 Review of Patient #3s clinical record revealed Patient #3 was admitted to the provider on 06/18/2023 with a diagnosis of striatonigral degeneration. Review of Patient #3s POC revealed the nurse was to visit 1 time week for 9 weeks, the aide was to visit 2 times a week for 9 weeks, and the spiritual counselor was to visit 1 time a month for 2 months. Review of Patient #3s nursing visit notes failed to reveal documentation of nurse visits for the weeks as follows: -the week of 07/09/2023 to 07/15/2023, no visits were documented -the week of 07/16/2023 to 07/22/2023, no visits were documented -the week of 07/23/2023 to 07/29/2023, no visits were documented Review of Patient #3s aide notes failed to reveal documentation of aide visits as follows: -the week of 06/18/2023 to 06/24/2023, only one visit was documented -the week of 07/02/2023 to 07/08/2023, no visits were documented -the week of 07/09/2023 to 07/15/2023, only one visit was documented -the week of 07/23/2023 to 07/29/2023, no visits were documented -the week of 07/30/2023 to 08/5/2023, no visits were documented -the week of 08/6/2023 to 08/12/2023, no visits were documented -the week of 08/13/2023 to 08/19/2023, no visits were documented -the week of 08/20/2023 to 08/26/2023, no visits were documented -the week of 08/28/2023 to 09/02/2023, no visits were documented Review of Patient #3s clinical record failed to reveal documentation of any visits by a spiritual counselor. During an interview on 09/06/2023 at 12:31 p.m. S1 Administrator reviewed Patient #3s aide notes acknowledged there was no documentation of that Patient #3 received aide visits from the week of 07/23/2023 to 07/29/2023 to present. S1 Administrator reported Patient #3 refused aide visits and visits were stopped. S1 Administrator further acknowledged there was not documentation of the refusal or an order to discontinue aide visits. During an interview on 09/06/2023 at 3:15 p.m. S1 Administrator further reviewed Patient #3s clinical record and acknowledged Patient #3 had 3 weeks without documentation of a nurse visit and there was not documentation of a visit by a spiritual counselor. Patient #4 Review of facilitys census by status presented by S1 Administrator revealed Patient #4 was admitted to the hospice agency on 06/09/2023 with a diagnosis of cardiac. Review of Patient #4s nurse visit notes failed to reveal any nurses visits for the weeks of 06/11/2023 through 06/17/2023 and 06/18/2023 through 06/24/2023. Further review of Patient #4s nurses notes dated 08/21/2023 revealed: ...Caregiver has requested that MSW (Medical Social Worker) look into Medicaid for patient and caregiver pay for daughter to come and care for patient...RN (Registered Nurse) agreed that she would. During an interview on 09/06/2023 at 12:30 p.m. S1 Administrator confirmed the social worker did not follow up after nurse visit on 08/21/2023. Patient #5 Review of Patient #5s clinical record revealed Patient #5 was admitted to the provider on 08/23/2023 with a diagnoses of malignant neoplasm occipital lobe. Review of Patient #5s POC revealed the nurse aid was to visit 1 time a week for 13 weeks. Review of Patient #5s clinical record failed to reveal documentation of an aide visit for the week of 08/27/2023 to 09/02/2023. During an interview on 09/06/2023 at 3:15 p.m. S1 Administrator reviewed Patient #5s clinical record and acknowledged there was no documentation of an aide visit for the week of 08/27/2023 to 09/02/2023.

Based on record reviews and interview the provider failed to ensure a criminal background check was obtained for 6 employees [S2 Registered Nurse (RN), S3 RN, S4 Licensed Practical Nurse (LPN), S5 Certified Nursing Assistant (CNA), S6 CNA, S7 Homemaker] out of 7 employees who had direct patient contact or access to patient records. Findings: Review of S2 RNs employee record revealed a hire date of 07/24/2023. Further review of S2 RNs employee record failed to reveal a criminal background check. Review of S3 RNs employee record revealed a hire date of 08/01/2022. Further review of S3 RNs employee record failed to reveal a criminal background check. Review of S4 LPNs employee record revealed a hire date of 11/15/2022. Further review of S4 LPNs employee record failed to reveal a criminal background check. Review of S5 CNAs employee record revealed a hire date of 05/01/2023. Further review of S5 CNAs employee record failed to reveal a criminal background check. Review of S6 CNAs employee record revealed a hire date of 02/27/2023. Further review of S6 CNAs employee record failed to reveal a criminal background check. Review of S7 Homemakers employee record revealed a hire date of 11/16/2022. Further review of S7 Homemakers employee record failed to reveal a criminal background check. During an interview on 09/06/2023 at 3:15 p.m. S1 Administrator reviewed S2 RN, S3 RN, S4 LPN, S5 CNA, S6 CNA, and S7 Homemakers employee records and acknowledged there were not background checks in the employee records.

Based on record reviews and interview the facility failed to provide documentation of an initial Registered Nurse (RN) assessment for 3 patients (#2, #8, #10) out of 12 patient clinical records reviewed. Findings: Review of Patient #2s clinical record revealed their start of care date was 10/19/22. Further review of Patient #2s clinical record failed to reveal documentation of an initial RN assessment. Review of Patient #8s clinical record revealed their start of care date was 7/17/22. Further review of Patient #8s clinical record failed to reveal documentation of an initial RN assessment. Review of Patient #10s clinical record revealed their start of care date was 10/7/22. Further review of Patient #10s clinical record failed to reveal documentation of an initial RN assessment. During an interview on 11/2/22 at 9:30AM S1 Administrator/Director of Nursing reviewed Patient #2, Patient #8, and Patient #10s clinical records and acknowledged there was not documentation of an initial RN assessment and should have been.

Based on record reviews and interview the provider failed to provide documentation of a bereavement assessment for 5 patients (#2, #8, #9, #10, #11) out of 12 patient clinical records reviewed. Findings: Review of Patient #2s clinical record revealed their start of care date was 10/19/22. Further review of Patient #2s clinical record failed to reveal documentation of a bereavement assessment. Review of Patient #8s clinical record revealed their start of care date was 7/17/22. Further review of Patient #8s clinical record failed to reveal documentation of a bereavement assessment. Review of Patient #9s clinical record revealed their start of care date was 10/21/22. Further review of Patient #9s clinical record failed to reveal documentation of a bereavement assessment. Review of Patient #10s clinical record revealed their start of care date was 10/7/22. Further review of Patient #10s clinical record failed to reveal documentation of a bereavement assessment. Review of Patient #11s clinical record revealed their start of care date was 3/24/22. Further review of Patient #11s clinical record failed to reveal documentation of a bereavement assessment. During an interview on 11/2/22 at 9:30AM S1 Administrator/Director of Nursing reviewed Patient #2, Patient #8, Patient #9, Patient #10, and Patient #11s clinical records and acknowledged there was not documentation of a bereavement assessment in their clinical records and should have been.

Based on record reviews and interview the provider failed to provide documentation of an initial Plan of Care (POC) for 7 (#1, #2, #5, #7, #8, #9, #10) out of 12 patient clinical records reviewed. Findings: Review of Patient #2s clinical record revealed their start of care date was 10/19/22. Further review of Patient #2s clinical record failed to reveal documentation of initial POC. Review of Patient #5s clinical record revealed their start of care date was 8/16/22. Further review of Patient #5s clinical record failed to reveal documentation of initial POC. Review of Patient #7s clinical record revealed their start of care date was 9/10/22. Further review of Patient #7s clinical record failed to reveal documentation of initial POC. Review of Patient #8s clinical record revealed their start of care date was 7/17/22. Further review of Patient #8s clinical record failed to reveal documentation of initial POC. Review of Patient #9s clinical record revealed their start of care date was 10/21/22. Further review of Patient #9s clinical record failed to reveal documentation of initial POC Review of Patient #10s clinical record revealed their start of care date was 10/7/22. Further review of Patient #10s clinical record failed to reveal documentation of initial POC. During an interview on 11/2/22 at 9:30AM S1 Administrator/Director of Nursing reviewed Patient #2, Patient #5, Patient #7, Patient #8, Patient #9, and Patient #10's clinical records and acknowledged there was not documentation of an initial POC and should have been.

Based on record reviews and interview the provider failed to provide documentation of care and services rendered as per the patients Plan of Care (POC) for 12 (#1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #11, #12) of 12 patient charts reviewed. Findings: Review of Patient #1s clinical record revealed their start of care date was 6/29/22. Further review of Patient #1s POC for 10/8/22 to 12/6/22 failed to reveal documentation of visits by the Skilled Nurse (SN), Aide, Chaplain, and Medical Social Worker (MSW) as per Patient #1s POC. Review of Patient #2s clinical record revealed their start of care date was 10/19/22. Further review of Patient #2s POC for 10/19/22 to 1/14/23 failed to reveal documentation of visits by the SN, Aide, Chaplain, and MSW as per Patient #2s POC. Review of Patient #3s clinical record revealed their start of care date was 3/19/22. Further review of Patient #3s POC for 9/15//22 to 11/13/22 failed to reveal documentation of visits by the SN, Aide, Chaplain, and MSW as per Patient #3s POC. Review of Patient #4s clinical record revealed their start of care date was 2/14/22. Further review of Patient #4s POC for 10/12/22 to 12/10/22 failed to reveal documentation of visits by the SN, Aide, Chaplain, and MSW as per Patient #4s POC. Review of Patient #5s clinical record revealed their start of care date was 8/16/22. Further review of Patient #5s POC for 8/16/22 to 11/13/22 failed to reveal documentation of visits by the SN, Aide, Chaplain, and MSW as per Patient #5s POC. Review of Patient #6s clinical record revealed their start of care date was 10/6/22. Further review of Patient #6s POC for 10/6/22 to 12/24/22 failed to reveal documentation of visits by the SN, Chaplain, and MSW as per Patient #6s POC. Review of Patient #7s clinical record revealed their start of care date was 9/10/22. Further review of Patient #7s POC for 10/19/22 to 1/14/23 failed to reveal documentation of visits by the SN and Chaplain as per Patient #7s POC. Review of Patient #8s clinical record revealed their start of care date was 7/17/22. Further review of Patient #8s POC for 10/14/22 to 11/5/22 failed to reveal documentation of visits by the SN, Aide, Chaplain, and MSW as per Patient #8s POC. Review of Patient #9s clinical record revealed their start of care date was 10/21/22. Further review of Patient #9s POC for 10/21/22 to 1/7/23 failed to reveal documentation of visits by the SN, Chaplain, and MSW as per Patient 9s POC. Review of Patient #10s clinical record revealed their start of care date was 10/7/22. Further review of Patient #10s POC for 10/7/22 to 12/24/22 failed to reveal documentation of visits by the SN, Aide, Chaplain, and MSW as per Patient #10s POC. Review of Patient #11s clinical record revealed their start of care date was 3/24/22. Further review of Patient #11s POC for 9/20/22 to 11/18/22 failed to reveal documentation of visits by the SN and Chaplain as per Patient #11s POC. Review of Patient #12s clinical record revealed their start of care date was 9/2/22. Further review of Patient #12s POC for 9/2/22 to 11/26/22 failed to reveal documentation of visits by the SN, Aide, and Chaplain as per Patient #12s POC. During an interview on 11/2/22 at 9:30AM S1 Administrator/Director of Nursing reviewed Patient #1-#12s clinical records and acknowledged there was missing documentation visits rendered as per all 12 Patients POC and the visits should have been documented.

Based on record review and interview the agency failed to implement an on-going, comprehensive, integrated, self-assessment quality improvement process that provided assurance patient home care was provided at all times in compliance with accepted standards of professional practice. Findings Review of the QAPI (quality assurance performance improvement) information provided revealed no data for the year 2022. On 11/2/2022 at 02:45pm an interview with S1 Administrator/Director of Nurses confirmed the QAPI process had not been implemented for the past year.