Health inspection·August 7, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to treat each resident with dignity and respect and care for residents in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life for one (Resident #1) of six residents reviewed for dignity. The facility failed to ensure MA A treated Resident #1 with dignity and respect when she spoke to the resident in a rude manner in front of others . This failure could place residents at the risk for psychosocial harm due to diminished self-esteem and quality of life. The findings were: Record review of Resident #1's face sheet, dated 08/07/24, reflected a [AGE] year-old-male who was admitted to the facility on [DATE]. His diagnoses included Severe protein-calorie malnutrition, Mood disorder, BMI 19.9 or less (Low body weight), Nausea with vomiting, Muscle weakness, Abnormalities of gait and mobility, Hypertension and chronic kidney disease . Record review of Resident #1's quarterly MDS assessment, dated 07/30/24. reflected a BIMS of 15, which indicated his cognition was intact. Record review of Resident #1's quarterly Care Plan, dated 07/30/24, reflected Resident #1 made verbal expressions of distress related to feeling depressed (Sad), fearful (not feeling safe), and anxiety (over needs and care) . The relevant interventions were: 1. Establish a trusting relationship with the resident and family. 2. Maintain a calm environment and approach to the resident. 3.Convey an attitude of acceptance toward the resident. 4.Acknowledge to the resident that the current situation must be difficult. 5.Allow resident to make decisions, to set realistic goals, and to participate in self-care. Page 1 of 3 455497 455497 08/07/2024 Creekside Terrace Rehabilitation 1555 Powell Avenue Belton, TX 76513

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of the incident report by the facility, dated 08/02/24, reflected on 08/02/24 at 6:15 PM, Resident #1 reported a rude interaction during meal services and was witnessed by MA B and CNA C. Resident #1 stated he was standing at the dining door with his water pitcher when MA A approached and asked him what he wanted. He explained to her he wanted to make a change to his meal and refill his pitcher. MA A told him he had to make meal changes earlier if he wanted, not possible now and asked him to walk around the corner and fill up his pitcher instead of getting it from the kitchen. In an observation and interview on 08/07/24 at 12:10 PM revealed Resident #1 was lying in bed in his room. When the State Surveyor asked about the incident that happened in the dining room on 08/02/24 at 5:20 PM, he stated he was upset about how the staff member, MA A, talked to him in the dining room while other residents were present. He said he was at the dining room door waiting for dietary staff to come out so he could tell the changes he wanted in his meal and fill up the water pitcher. He continued, that time MA A approached and asked him why he was waiting there. He stated he explained to her the reason why he was there. He stated, at that time she rudely told him he had to get his meal changes in by 3:00 PM and asked him not to stand at the door, instead walk around the corner and fill up the water pitcher. He said he asked for her name and instead of telling her name, asked him to look at her name tag and read. He stated he felt humiliated in front of others and did not want to go to the dining hall anymore . He stated he reported this to the ADON and decided to move out of the facility as he believed the staff at the facility were not treating him with dignity and respect . He also stated he was afraid MA A would do something with his food from the kitchen, as retaliation for complaining. During an interview over the phone on 08/07/24 at 1:30 PM, MA A stated she worked as a med aide for more than 30 years and was working at the facility for about a year. She stated she would never do anything that would harm any resident. She stated on 08/02/24 in the evening she was helping Resident #1 however her actions were misinterpreted. MA A said she was on suspension after the incident until the facility investigation was completed, however she decided to resign as she felt the facility did not have a stable policy. She stated she was following the facility's policy that no meal changes were allowed after 3:00 PM, however after the incident the facility changed their stand and blamed her for her actions. She stated some people thought she was rude due to her English. She added, she was from a different ethnicity and had a think English accent. MA A said she used hearing aids and sometimes it was difficult to hear and understand what others said. During an interview, over the phone on 08/07/24 at 2:00 PM, CNA C stated he went to throw trash at the dumpster and when he walked in through the door, he heard the resident asking MA A's name. CNA C said he heard MA A stated she didn't need to tell her name to residents, instead he could look at her name badge and read if he wanted. CNA C said MA A was rude and argumentative with Resident #1. The resident appeared upset and walked off. CNA C stated he did not know what they were talking about before then or why the resident asked for her name. CNA C stated MA A did not use any abusive or derogatory words; however, she was unpolite in her conversation and not helpful in her actions. During an interview on 08/07/24 at 2:30 PM, MA B stated she was present in the dining room when the incident occurred and Resident #1 asked MA A something at the dining room door. MA B said the only thing she heard was MA A telling the resident where the water station in his hall was. She said, when Resident #1 asked if could go to the hall close to the dining hall for filling his water pitcher, MA A asked him to go to his hallway and fill the water. MA B stated MA A could be stubborn and sometimes got into arguments with the residents. During an interview on 08/07/24 at 3:00 PM with the ADON, she stated at about 6:00 PM Resident #1 455497 Page 2 of 3 455497 08/07/2024 Creekside Terrace Rehabilitation 1555 Powell Avenue Belton, TX 76513

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few approached her to report MA A was very unkind with him when he asked for help. She stated, Resident #1 was visibly upset about it. The ADON stated there was no such rule stated that residents must let the dietary team know any meal changes before 3:00 PM. She said residents could request for a meal change anytime they wanted, and residents were free to collect drinking water from any hall. She stated ideally the staff ensured regular supply of water in residents' rooms, however some residents occasionally liked to collect it personally as well. The ADON stated MA A was under suspension until the facility investigation on the incident was completed. During an interview on 08/07/24 at 3:00 pm, the ADM stated the incident was under investigation and MA A was suspended until the investigation was completed. She stated the expectation from all the staff was treating every individual at the facility with dignity, respect and empathy. She stated any violation to this would never be tolerated and the facility was committed to ensure this policy was implemented. Record review of the policy Social Services Policies and Procedures: Resident Rights revised on 06/09/2023, reflected: The Facility employs measures to ensure patient and resident personal dignity, well-being, and self-determination are maintained and will educate patients and residents regarding their rights and responsibilities . The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility, including those specified in this section. A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes. 455497 Page 3 of 3