Health inspection·January 25, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure a comfortable, homelike environment, with safe temperature levels within a range of 71 to 81 degrees Fahrenheit for 5 of 11 rooms (room [ROOM NUMBER], #204 #208, #210, and #213) reviewed for environmental concerns. On 01/25/24, the facility failed to ensure the temperatures in room [ROOM NUMBER], #204 #208, #210, and #213 were maintained at a safe and comfortable range, even after the facility's boiler had been adjusted. This failure could place residents at risk of an uncomfortable environment and diminish their quality of life. Findings included: An observation on 01/25/24 at 9:10 AM revealed, when entering the facility, the entrance lobby area, the hallways near the entrance, and the conference room all felt cold. The conference room's HVAC unit was blowing cool air. An observation of the thermostat on the wall in the front hallway was observed to be set at 73 degrees Fahrenheit but reflected an inside temperature of 64 degrees Fahrenheit. In an observation and interview on 01/25/24 starting at 10:25 AM, room [ROOM NUMBER] was observed to feel cool. Resident #1 stated she did not believe the heat was working because the HVAC unit was blowing cold air. The air blowing from the HVAC unit was observed to feel cool. Resident #2 was observed to be sleep in her bed and was tucked under the blankets with only her head out. Resident #2's bed was directly beside the HVAC unit. Resident #1 stated at night the room did get cold, but she was hot natured, so it did not bother her. She stated Resident #2 was her FM and always complained to be cold. She stated the facility was aware and brought her an extra blanket. In an interview on 01/25/24 at 10:29 AM, Resident #3 was observed laying on her bed with a hoodie and blanket over her. She stated she noticed the heat stopped working on Friday (01/19/24) almost a week ago and the facility still had not fixed the heat. Resident #3 stated during the day when it was warmer outside the room temperature was not as cold, so it was bearable, but at night when the temperature dropped outside it was really cold in the room. Resident #3 stated the facility put those machines in the hallway and told them to keep their doors open to help warm their rooms. She stated it helped, but the HVAC unit in her room was blowing cool air and her bed was right by it. The air blowing from the unit was observed to feel cool. Resident #3 stated she was going to turn the unit off because it was making the room cooler. Resident #3 was observed to turn off the unit. She stated the Page 1 of 4 455463 455463 01/25/2024 The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231

F 0584 facility provided her additional blankets. Resident #3's bed was observed to have three blankets. Level of Harm - Minimal harm or potential for actual harm In an interview on 01/25/24 at 10:37 AM, RN A stated she worked on Saturday (01/20/24) from 6:00 AM to 2:00 PM. She stated when she arrived to work, the facility was very cold, and the residents were complaining. RN A stated contacted the Weekend Supervisor to let him know the heat was not working. She stated the staff provided the residents with extra blankets. RN A stated when she left the facility at 2:00 PM, the heat was still not working. RN A stated when she returned to work on Monday (01/22/24) at 6:00 AM, the big heating units were in the hallways and the hallways were warm. RN A stated some of the residents' rooms were still cold and they were complaining. She stated the rooms did fell cold to her as well, so she told the residents to leave their room door's open so the heat would circulate into their rooms. RN A stated some of the rooms had heat and some did not. She stated the Maintenance Director told her about the heaters in the hallways would help provide heat to the resident's room, so she told them to keep their doors opened. RN A stated it was just in the mornings when the rooms were cold. She stated as the day progressed and the outside temperatures rise, the resident's rooms with no heat would get warmer. RN A stated she did not know the status of the heat and if it was fully repaired. Residents Affected - Some In an interview on 01/25/24 at 10:51 CNA B stated she believed the facility was still working on repairing the heat, but they provided the big heaters in the hallways to help. CNA B stated she normally worked from 2:00 PM to 10:00 PM and since the facility put out the heaters, she had not received complaints from the residents. She stated because she normally arrived to work during the day at 2:00 PM, it was warmer outside, so she was not receiving complaints, but today she was helping on the morning shift and when she started at 6AM, some of the residents were complaining that they were cold, and it had been cold throughout the night. CNA B stated the rooms were cold to her as well. She stated some of the heaters were not working in some of the rooms, and those residents were the ones complaining of being cold throughout the night. CNA B stated she was providing extra blankets to residents and asked the residents to leave their bedroom doors opened so the heat from the hallway could circulate in their rooms. In an observation and interview on 01/25/24 starting at 11:02 AM, Resident #4 stated he felt kind of cold right now, but at night it was really cold. Resident #4 stated the HVAC unit in his room was blowing out cool air and had not been working since he returned from the hospital about one week ago. Resident #4 stated he did complain to the facility and was provided an extra blanket. Resident #4 was observed with two blankets on his bed. In an observation and interview on 01/25/24 starting at 11:06 AM, Resident #5 stated the heat was not working in his room, but he felt okay for right now. Resident #5 was observed to be in bed with two blankets. Resident #5 stated at nighttime his room got really cold. He stated the facility provided him with an additional blanket. Resident #5 stated maintenance was in his room earlier and looked at his HVAC unit. He stated the heat had not been working for a few days. An observation on 01/25/24 at 11:09 AM revealed room [ROOM NUMBER] felt cold. An interview was attempted with the resident in the room, but they were non-verbal. In an interview on 01/25/24 at 11:20 AM, the Maintenance Director (MD) stated he was contacted on Sunday (01/21/24) that the heat wasn't working so he went to the facility and the temperature was 70 degrees Fahrenheit. The MD stated he contacted the HVAC company, and they came to the facility on Monday (01/22/24) and Tuesday (01/23/24). He stated they added the portable heaters in the hallways on Monday. The MD stated when the HVAC tech came on Monday, it was discovered the water temperature 455463 Page 2 of 4 455463 01/25/2024 The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some was set to 70 degrees Fahrenheit, so the air was not blowing out warm. He stated the heat and air ran off the water from the boiler, so the tech increased the temperature to 72. The MD stated he had to reset all the units in each room, which consisted of turning them off for a couple of minutes and then turning them back on. The MD stated the temperature was still not reaching 71 in some rooms, so he called the HVAC company back out on Tuesday. He stated on Tuesday they told him one of the valves was closed on the broiler, so the tech opened it and raised the temperature on the broiler. He stated he thought it was fixed and he was not notified there were still issues overnight. He stated he had been doing spot checks and temping random room and it was above 71. The MD stated he was doing temperatures in the morning about 8:30/9:00 AM and before he left in the evenings about 5/6 PM. He stated had not been temping the rooms at overnight. In an observation and interview on 01/25/24 from 12:03 to 12:10, the MD temped resident's rooms with a digital thermometer. The MD stated the room temperatures were supposed to be between 71 to 81 degrees Fahrenheit. 11 rooms were temped, and 5 rooms were not between 71 to 81 degrees Fahrenheit. The temperatures were the following: room [ROOM NUMBER] - 69.5 degrees Fahrenheit room [ROOM NUMBER] - 69.5 degrees Fahrenheit room [ROOM NUMBER] - 70.0 degrees Fahrenheit room [ROOM NUMBER] - 69.5 degrees Fahrenheit room [ROOM NUMBER] - 70.0 degrees Fahrenheit The MD stated he would contact the HVAC company to have them come back to the look at the units the resident's rooms. In an interview on 01/25/24 at 12:27 PM, the Administrator stated he was notified there were issues with the heat and the MD contacted a HVAC company. He stated they added the heaters in the hallways and gave residents extra blankets. He stated the HVAC company came out to the facility on Monday and Tuesday and fixed the issue with the boiler. He stated boiler was not broken, but the temperature needed to be adjusted. He stated if some of the temperatures in room were 69-70 degrees and it was in the afternoon; if the HVAC units in the rooms were not working, he could understand the temperature would drop lower in those rooms overnight. The Administrator stated he was not aware there were still issues with the heat. He stated they had contacted the HVAC company again, and they will back out at the facility either later today or tomorrow morning. In a phone interview on 01/25/24 at 4:17, the HVAC Technician (Tech) stated he was at the facility on Monday (01/22/24). He stated the facility's boiler temperature was set too low. The HVAC Tech stated the facility's boiler can be safely set between 65-90 degrees Fahrenheit. He stated he believed the facility's boiler was set to 70 degrees, so he increased it to he believed 75 degrees. The HVAC stated the MD started resetting the units in each room, by turning them off and then back on. He stated the MD tested a few and temperature was good, so he left the facility. The HVAC Tech stated the facility called back and said there were still issues, so he stated he had to send another, but he would pull the invoice from Tuesday. The HVAC Tech stated the other Tech found one of the balancing valves on the boiler was closed, so he opened it back up and raised the temperature again on the boiler. The HVAC Tech stated he was not sure of the exact number he adjusted it to, because it was not 455463 Page 3 of 4 455463 01/25/2024 The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some documented on the invoice. He stated he was contacted by the facility again and was told that some of the rooms were not heating. He stated each unit in the rooms were connected to the boiler and were water source heat pumps, that used the water from the boiler as the condenser. The HVAC Tech stated so whatever temperature the boiler is set to, then the air should be blowing close to that same temperature. He stated it may be off a few degrees off. The HVAC Tech stated for example if you set the boiler temperature at 80 the air should be blowing between 77 to 80 degrees. He stated the boilers were running with no issues, so it sounded like there were issues with the units in the rooms, but he would have to check them out to be sure. The HVAC Tech stated he would be returning to facility tomorrow morning. 455463 Page 4 of 4