Health inspection·May 25, 2023

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to have evidence that an alleged violation of abuse was thoroughly investigated and the results reported to the State Survey agency within 5 working days of the incident when CR#1 alleged abuse. Residents Affected - Few ---The facility failed to complete an investigation, provide an investigation report, and report an incident when CR#1 became upset and charged at a staff member. This failure could affect any resident and could result in allegations not being investigated timely. Findings include: Record review of CR#1's face sheet revealed admission date 1/31/23, with diagnoses including respiratory failure with hypoxia (lack of oxygen in the tissues), non-ST elevation myocardial infarction (heart attack when the heart's need for oxygen can't be met), endocarditis (infection of the heart's inner lining), asthma (inflammation of the airway), Schizoaffective disorder (mental health condition that could exhibit symptoms of delusions, hallucinations, depressed episodes, feeling of superiority and/or manic periods of high energy), heart failure, muscle wasting and lack of coordination. Record review of CR#1's care plan (undated) revealed he was independent with ADL's (transfer, hygiene, toileting, feeding, bathing). Record review of CR#1's admission MDS dated [DATE] revealed a BIMS score of 15, indicating independence in cognitive skills for daily decision making, and no supervision required for ADL's. Record review was completed on 5/25/23 for the self-report in state database and documentation there was no report found. Record reviews and interviews on 5/25/23 showed CR#1 alleged abuse after the incident occurred, when CNA B went with him to his room to calm him down. CNA B denied any abuse happened. Record review of CR#1's facility skilled nursing progress note written by LVN A, dated 4/9/23 read, in part: .around 7 A.M. this morning, the resident was standing in the doorway of the room across the hall from his room. the CNA asked why he was in that room. the resident proceeded to exit the room, walking hastily toward the nursing station, where myself and a CNA were standing. The resident was talking out loud, I couldn't make clear what he was saying until he came into my personal space and accused me of writing him up in a threatening gesture. I backed away and raised my hands to guard Page 1 of 2 455490 455490 05/25/2023 The Lakes at Texas City 424 N Tarpey Rd Texas City, TX 77591

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the resident away from me. The resident stated he would kill me and walked away. I notified the DON who informed me to alert 911. Police arrived to facility, a statement was made, but I was informed there was not enough criminal evidence for them to process the matter. [Local] MHMR was contacted, an officer arrived and spoke to the resident and myself. Intake officer states he doesn't see a reason to transfer the resident. Record review of CR#1's skilled nursing note dated 4/9/23, written by LVN A, read, in part: .CNA informed this writer county sheriff re-entered the building and recorded a statement of his interaction with the resident. CNA informed this writer that he was given a case number and was told of an investigation towards his encounter with the resident previously . Record review of CR #1's Social Services note dated 4/10/23, written by SW, read, in part: .SSD asked resident if he felt safe here. He said he did. He went on talking about the red marks on his face and said he scratched his face trying to get a very close shave. SW explained she had a report the police came, and he was questioned. Resident then explained he had to tell the police about the staff that came into his room and wrestled with him .he told the police about the scratches he got on his face, the bruise on his side, and the red marks on his back .SW told resident that didn't make sense because he explained to her before that the scratches on his face were from shaving and the bruise was there the first of last week when he showed it to her. Resident then began talking about being a billionaire and he was framed for stealing and then he wanted to live here but was getting ready to go get his money and leave. He then politely left the SW office. Interview with LVN A on 5/26/23 at 10:15 a.m., LVN A stated that around 6:30 a.m. on 4/9/23, resident was in a room across the hall from his room. The CNA asked why he was in the room, and he left and walked up to the nurses' station accusing her of writing him up. She said he was in her face, it scared her, she stepped back and raised up her arms to protect herself. She said she told the DON, ADON, called the police. The MHMR people were here but the resident said he did not want to go home. Interview with CNA B on 5/26/23 at 1:15p.m. CNA B stated he was just coming in to work that day, 4/9/23, and he saw and heard what was going on with the resident. He said he tried to talk to the resident and re-directed him back to his room to get him to calm down. He said the resident sat on his bed, and CNA B sat on a chair. When the resident calmed down, CNA B said he left the room. CNA B said there was no abuse, and he and the resident remained in separate spots while CNA B was trying to talk to the resident to calm him down. Interview with Administrator on 5/26/23 at 9:30 a.m., the Administrator said she had called this incident in to the CII after hours on the weekend and was not given an intake number, so the investigation report to the state survey agency could not be completed and was not sent in to the state survey agency. She said they did not have an incident report, but stated they had done in-services. Record review of facility policy on Abuse, Neglect and Exploitation, dated 10/24/22, read, in part: .immediate thorough investigation is warranted when suspicion or reports of abuse occur .administrator will follow up to report the results of the investigation when final within 5 working days of the incident, as required by state agencies. 455490 Page 2 of 2