Health inspection·February 3, 2023

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents received services with reasonable accommodations of resident needs and preferences for 2 (Resident # 17, Resident #19) of 15 residents reviewed for accommodations of needs. Residents Affected - Some The facility failed to ensure Resident #17's and Resident's 19's call light was within reach. This deficient practice could place residents at risk of injury or harm due to not being able to call for assistance. The findings were: Record review of Resident #17's admission Record indicated Resident #17 was a [AGE] year-old admitted to facility on 02/22/22 with diagnoses of anemia (condition in which the blood doesn't have enough red blood cells), hypertension (abnormally high blood pressure), and chronic kidney disease, stage 5 (the kidneys are getting very close to failure or have already failed). Record review of Resident #17's MDS quarterly assessment dated [DATE], revealed Resident #17: -understood and was understood by others, -was moderately cognitively impaired, -required extensive assistance of one person for dressing and personal hygiene, -totally dependent for bed mobility, toileting, and bathing, -had functional limitation in range of motion to both sides of the upper extremities (shoulder, elbow, wrist, hand). Record review of Resident #17's Comprehensive Care plan dated 02/10/22, revealed: Resident #17 has the potential for falls related to generalized weakness, poor safety awareness . Place the resident's call light within reach and encourage the resident to use it for assistance as needed. Record review of Resident #19's admission Record indicated Resident #19 was a [AGE] year-old admitted to facility on 03/20/12 with diagnoses of vascular dementia, cerebrovascular accident (a loss of Page 1 of 10 455423 455423 02/03/2023 Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520

F 0558 blood flow to part of the brain), hemiplegia (muscle weakness or partial paralysis on one side of the body), affecting unspecified side, muscle weakness (generalized), and anxiety disorder. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #19's MDS quarterly assessment dated [DATE], revealed: Resident #19, Residents Affected - Some -understood and was understood others, -was moderately cognitively impaired, -required extensive assistance of two persons for bed mobility and toileting, -totally dependent for dressing and personal hygiene, -had functional limitation in range of motion to one side of her upper extremities (shoulder, elbow, wrist, hand). Record review of Resident #19's Comprehensive Care plan dated 07/07/15, revealed: Resident #19 has and ADL self-care performance deficit. Encourage the resident to use bell to call for assistance. Observation and interview on 02/01/23 at 10:16 AM revealed Resident #19 lying down in bed A with the head of bed raised slightly. Resident was on her back and covered with a blanket up to her shoulders. Surveyor observed Resident #19's call light clipped to the bed sheet on the left side at top of head of bed and it is dangling off the bed. Surveyor asked Resident#19 if she used her call light and Resident #19 said she used the call light occasionally. Surveyor asked if she could press the call light and Resident said she did not know where it was. Surveyor told Resident #19 it was hanging off the bed. Resident #19 tried to grab the call light but was not able to. Observation on 02/01/23 at 10:17 AM revealed Resident #17 was lying in bed B with the head of bed raised. Surveyor observed Resident #17's call light clipped to the left side of the head of the bed with the call light dangling off the bed. Surveyor asked Resident #17 if she used her call light. Resident #17 said she used the call light to ask for assistance. Resident #17 said it was usually close to her hand. Resident #17 looked around and said she could not find it. Surveyor told Resident #17 the call light was clipped to the bed above her and hanging off the bed. Resident tried to reach around but could not get it. On 02/01/23 at 10:24 AM surveyor called Med Aide I to Resident #17 and Resident #19's room. Med Aide I told surveyor she was also assisting as a CNA. Med Aide I said Resident #19 could use the call light and Resident #19 could reach it. Med Aide I asked Resident #19 to grab the call light and Resident #19 tried to get it but was unsuccessful. Resident #19 told Med Aide I she could not reach it. Med Aide I then said she would place the call light for Resident #17 and Resident #19. Med Aide I said the CNAs were supposed to place them where the resident could reach the call light. In an interview on 02/01/23 at 10:48 AM CNA J said the resident should have the call light where the resident can reach it. CNA J said if the resident had debility on the left side, then the CNA had to place it on the right side so that the resident was able to reach it. If the resident was not able to use his hands, then the call light was placed close to his head so he could tap the soft side call light with his head. CNA J said that he just had an in-service on abuse/neglect and customer 455423 Page 2 of 10 455423 02/03/2023 Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some service. CNA J said it was important for the resident to have his call light to be able to ask for assistance. CNA J said a resident could fall or get hurt trying to call for assistance. In an interview on 02/01/23 at 01:45 PM the DON said the CNAs were to place the call light within reach. DON said she did spot checks and if she saw a resident that does not have the call light within reach, then the DON would look for the CNA and remind them that they must leave the call light within reach. The DON said if a resident does not have a call light the resident might have to verbally call for the staff or get up and must look for the CNA. The DON said the worst-case scenario would be that a resident might hurt themselves trying to get assistance. Record review of facility's Annual Competency Check Off indicated CNA's profeciency on all tasks including call lights were tested on August of 2022 and did not reveal any issues. Record review of the facility's Call Light Use Policy dated 01/01/23 indicated: It is the policy of this center to ensure residents have a call light within reach that they are physically able to access and that they have been instructed on its use. .12. Be sure call lights are placed near the resident, never on the floor or bedside stand. 455423 Page 3 of 10 455423 02/03/2023 Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to develop and implement a comprehensive person-centered care plan that includes measurable objectives and time frames to meet a resident's medical and nursing needs to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for one of 8 residents (Resident #10) reviewed for care plans in that: Resident #10's comprehensive person-centered care plan did not address the resident's behavior of removing her nasal cannula used (O2 tubing) for oxygen therapy. This deficient practice could place residents in the facility at risk of not being provided with the necessary care or services and having personalized plans developed to address their specific needs. The findings included: Record review of the admission record dated 02/02/23 for Resident #10 indicated Resident #10 was a [AGE] year-old female who was initially admitted to the facility on [DATE] and re-admitted on [DATE]. Resident #10's diagnosis included intellectual disabilities, dysphagia (difficulty in swallowing), schizophrenia (chronic severe mental illness), cardiomegaly (enlargement of heart), anxiety disorder, diabetes, heart failure, gastrostomy status (surgical procedure of an external opening in stomach for nutritional support), insomnia (sleep disorder), and convulsions (seizures). Record review of Resident #10's most recent MDS quarterly assessment dated [DATE] revealed. -the resident's cognitive status was severely impaired for daily decision-making skills -had physical behavioral symptoms directed at others (hitting, kicking, pushing, and scratching). -had verbal behavioral symptoms directed at others (threatening others, screaming at others, and cursing at others). -required total dependence on two persons for bed mobility, dressing, toilet use and bathing. -received oxygen treatment. Record review of Resident #10's physician's orders dated 01/09/23 revealed an order for 2L NC every shift, start date 01/09/23. Record review of Resident #10's MARs/TARs dated February 2023 indicated an order for 2L NC, every shift, start date, 01/09/23. The resident's pulse, respirations and O2 SATs were documented. Record review of Resident #10's care plan, last review/revision date, 10/27/22 Resident #10 has oxygen therapy r/t CHF, and interventions included to monitor for s/sx of respiratory distress and report to MD (PRN), and oxygen settings at 02 via N/C @ 2L PRN. Resident #10's care plans did not include she had behaviors of removing her O2 tubing for oxygen therapy. 455423 Page 4 of 10 455423 02/03/2023 Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520

F 0656 Level of Harm - Minimal harm or potential for actual harm Observation on 02/01/23 at 10:06 am revealed Resident #10 lying in bed. Resident #10's oxygen tank was turned on and Resident #10's O2 tubing for oxygen treatment was on her shoulder and not on her face. Observation on 02/01/23 at 2:46 pm revealed Resident #10 lying in bed, eyes closed and not responding to greeting by surveyor. Resident #10's O2 tubing for oxygen treatment was on the floor beside her bed. Residents Affected - Few Interview on 02/01/23 at 2:50 pm with LVN C revealed Resident #10 was supposed to always have the O2 tubing on her nose. LVN C said resident would always take the O2 tubing off and it would be resting on her shoulder or sometimes on the floor. Staff would routinely come into her room and check that she did have the O2 tubing on her nose. LVN C said he would go and change the tubing on the O2 because it had been on the floor. Interview on 02/01/23 02:58 pm with CNA D revealed Resident #10 had a habit of throwing the O2 tubing on her shoulder or on the floor. CNA D said this behavior happened regularly. CNA D said when the O2 tubing fell off into the floor, or on her bed, they would get the nurse to change it and place it back on her nose. Interview on 02/02/23 at 9:48 am with CNA E revealed Resident #10 would remove her O2 tubing from her face often. CNA E said she had informed the charge nurses several times about this behavior. Interview on 02/02/23 at 9:48 am with CNA F revealed Resident #10 would remove her O2 tubing from her face often. CNA F said she had informed LVN D and LVN G when Resident #10 would remove her O2 tubing. Interview on 02/02/23 9:45 am with LVN G revealed Resident #10 removed her O2 tubing often. Staff had informed her that Resident #10 had this behavior and she had not documented on her clinical chart, progress notes. LVN G said staff had mentioned this to her often, but she had not documented for no reason other than she forgot. When staff would tell her Resident #10 had taken off O2 tubing she would go in and replace on her nose. If it was on the floor, she would replace the whole tubing due to infection control. Resident #10's orders did indicate the resident should be receiving O2 continuously. LVN G said she would check Resident #10's O2 levels SAT as need when she was seen having difficulty breathing. Interview on 02/02/23 at 1:58 pm with LVN/MDS H revealed Resident #10 was discharged to the hospital on [DATE] and returned on 11/26/22. This behavior of removing her O2 tubing should have been care planned so that staff could be informed on the interventions required to provide resident with specific care for this concern. Interview on 02/02/23 at 2:35 pm with the DON revealed Resident #10's behavior should be care planned to assess when and why resident was removing her O2 tubing. If Resident #10 is continuously removing her O2 tubing, she might not need it and they could obtain orders to administer only as PRN. The DON said her staff needed to be in-serviced to communicate the behaviors in their documentation so that it could be addressed in care planning. Record review of the facility policy titled :Care plan dated 01/01/23 indicated it is the policy of this center that staff must develop a comprehensive person centered care plan to meet the needs of 455423 Page 5 of 10 455423 02/03/2023 Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520

F 0656 the resident. Sources are, and are not limited to problems relating to diagnosis, behavior control problems, etc. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 455423 Page 6 of 10 455423 02/03/2023 Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to provide pharmaceutical services that assure acquiring, receiving, dispensing, and administering of all drugs and biologicals to meet the needs of one (Resident #50) of 10 residents whose medications were reviewed for pharmacy service. -LVN A prepped medications for Resident #50 and placed them unsecured in a medicine cup on the top drawer in the 300 hall medication cart to administer at a later time. This failure could place residents at risk of medication errors. The findings included: 1.) Record review of Resident #50's face sheet dated 02/03/2023 indicated Resident #50 was a [AGE] year-old male, admitted on [DATE] and readmitted on [DATE] with the diagnoses of Acute and chronic respiratory failure with hypercapnia, pulmonary fibrosis, chronic obstructive pulmonary disease, type 2 diabetes mellitus, gastroparesis, dysphagia, cognitive communication deficit, hypertension, tracheostomy, and depressive disorder. Record review of Resident #50's Minimum Data Set (MDS) documented: -BIMS score of 13 which means Resident #50 was Cognitively intact. -Resident #50 required extensive assistance with one-person physical assist for Dressing. -Resident #50 required supervision with set up help only for eating. -Resident #50 required limited assistance with one-person physical assistance for personal hygiene. Record review of Resident #50's physician orders documented: -Simethicone talet chewable 80 MG; give 2 tablets by mouth Three times a day. -busPIRone HCL tablet 15 MG; gie 1 tablet by mouth three times a day. -Gabapentin Capsule 300 MG; give 1 capsule by mouth three times a day. -Lactobacillus; give 1 capsule by mouth three times a day. During an observation of 300 hall nursing cart on 02/03/23 at 10:00 AM revealed there was a clear medication cup on the top shelf of the cart with prepped medication. In an interview with LVN A on 02/03/23 at 10:00 AM revealed the prepped medication in the clear medication cup are for Resident # 50 for later. He stated, he was not supposed to prep medication and he knows that. LVN A stated I give them to him at 11 AM and wanted to have them ready. He stated it was important to not prep medications because you never know what could happen because someone might 455423 Page 7 of 10 455423 02/03/2023 Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few get them and not know what medications they are. LVN A also revealed something might happen and the resident might not be able to get the medication, which could cause a medication error. During interview and observation of clear medication cup with LVN A revealed the first medications noted in a cup are 2 white tablets with the number 019 on them. It was revealed those 2 white tablets were simethicone 80 mg tablets. Next medication was a long square tablet noted in the medicine prepped cup, it was revealed it was buspirone HCL 15 mg. Next medication was a yellow capsule, and it was revealed as Gabapentin. Last pill was a white pill that the LVN A stated was Lactobacillus. In an interview with DON on 02/03/23 at 10:12 AM revealed prepping medications and having them placed in the cart is not a standard practice and should not be done. the staff are educated within the last 5 months on how to properly administer medications. DON revealed it was important to not prep medications because the nurses should be following the medication administration rules of right patient, right medication, right time, to ensure the right medication is administered to the right resident at the correct time. She revealed prepping medications can lead to medication errors. Record review of LVN A's Valley Grande Medication administration skill assessment dated [DATE] revealed pass checked off on all clinical proficiency criteria which include #7. Items dated when opened and #14. Medications are not left on top of the cart or a resident's bedside. Record review of the facility's Medication Administration policy dated 1/01/2023 documented it is the policy of this home that medication will be administered and documented as ordered by physician and in accordance with state regulations. Procedures include 3. Medication are administered at the time they are prepared. 455423 Page 8 of 10 455423 02/03/2023 Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review; it was determined the facility failed to ensure medications were stored and labeled in accordance with currently accepted professional principles on 1 of 3 medication carts (200) reviewed for medication storage in that: 1 liquid medication and 2 ointments found in 200 hall carts were not marked with the date they were opened and accessed. 1 ointment medications in the 200-hall medication cart were past the expired date. The failure could place residents receiving medication at risk for administration of medication incorrectly or that are ineffective resulting in exacerbation of the disease being treated or the introduction of infection from contamination. Findings include: During observation of 200 hall cart (back cart) on 02/03/23 at 09:33 AM revealed undated and expired medications. Findings include the medication Pink Bismuth regular strength -used for upset stomach reliever. Pink Bismuth was noted opened and used with no opened date. An antibiotic ointment bacitracin ointment tube was found opened with no open date and was noted with an expiration date of 04/2022. Calmoseptine ointment was found with no open date, but the tube was half empty and no expiration date noted on the tube. In an interview with LVN B on 02/03/23 at 09:39 AM revealed she had been working at the facility for 3 weeks. She revealed there was a lot of people who were using the cart throughout the day and weeks. She said it was everyone's responsibility to audit and make sure everything was dated when opened and not expired. She was unsure what date the medication cart was audited last. She revealed it was important to check for expiration dates so that nursing staff don't use those medications for residents and the staff should be following the expiration shelf life of the medications. In an interview with the DON on 02/03/23 at 09:48 AM revealed all the nurses and herself check for expired medication monthly and they do spot checks randomly. She revealed any bottle, vial, ointment, and medication opened should be dated when opened. The DON revealed a pharmacist comes monthly and would randomly pick a cart to audit for expired medications. The DON revealed depending on the pharmacists' findings, she will educate the staff individually or educate all the staff. She revealed it was important to date opened medication and check for expiration dates because the medication need to be affective and there could be possible infection control issues. Record review of Valley Grande Medication administration skill assessment dated [DATE] check off on all clinical proficiency criteria which include #7: Items dated when opened. Record review of the facility's Record of In-service for Medication carts dated 10/10/22 documented 3: Date items when opened. Record review of Medication Storage dated 03/08/2020 documented it is the policy of this center 455423 Page 9 of 10 455423 02/03/2023 Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520

F 0761 Level of Harm - Minimal harm or potential for actual harm that medications will be stored appropriately as to be secure from tampering, exposure, or misuse . 12. Outdated, contaminated, or deteriorated medications, and those in containers that are cracked, soiled, or without secure closures are immediately removed from stock. Residents Affected - Some 455423 Page 10 of 10