Health inspection·July 2, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure that all alleged violations involving abuse, neglect, or mistreatment, including injuries of unknown source were reported by staff immediately or not later than 24 hours for 2 of 2 residents reviewed for abuse and neglect. The facility failed to report verbal altercation between Resident #45 and Resident #53 during week of 6/23/2025. This failure could place residents at risk for abuse and neglect. Findings included:1. Record review of a face sheet dated 6/30/2025 revealed Resident #45 was [AGE] year-old female who was admitted on [DATE] with diagnoses which included nontraumatic intracerebral hemorrhage (a type of stroke that causes bleeding in the brain), protein-calorie malnutrition (a form of undernutrition is characterized by insufficient intake of protein and calories leading to various health issues), Type II Diabetes (occurs when the body becomes resistant to insulin or when the pancreas fails to produce enough insulin), cerebral infarction (a type of stroke that results from the interruption of blood supply to the brain), and hypertension (a common condition where the force of blood against the artery walls is consistently too high). Record review of a quarterly MDS dated [DATE] indicated Resident #45 was usually able to make self-understood and usually understood others. The MDS indicated a BIMS 10 indicating moderate cognitive impairment. The MDS indicated Resident #45 did not exhibit any physical or verbal behavioral symptoms during the look back period. Further review of MDS revealed Resident #45 was taking an antidepressant for depression. Record review of a care plan last revised on 1/29/2025 indicated Resident #45 required an antidepressant with goal to be free from discomfort or adverse reactions related to antidepressant therapy through the review date. Interventions included to administer antidepressant medication as ordered, monitor and document side effects and effectiveness. Additional interventions included monitoring, documenting and reporting to Physician as needed any ongoing signs and symptoms of depression, unaltered by antidepressant medications such as sadness, irritable, anger, never satisfied, crying, shame, worthlessness, guilt, suicidal ideations, negative mood/comments, slowed movement, agitation, disrupted sleep, fatigue, lethargy, does not enjoy usual activities, changes in cognition, changes in weight/appetite, fear of being alone or with others, unrealistic fears, attention seeking, concern with body functions, anxiety and constant reassurance. During an interview on 6/30/2025 at 11:19 AM, Resident #45 said a white staff member called her a N word and a B word. Resident stated the incident happened sometime last week. Resident said there were witnesses but could not provide names or description. Resident #45 said she was in the TV room with the incident occurred. Resident #45 had difficultly conveying details and information. During an interview on 6/30/2025 at 1:30 PM, discussed with survey team of Resident #45's report of a white staff member who she reported called her the N word and a B word and the story being difficult to follow. This surveyor notified the DON of Resident #45's report. The ADM was out of the building at the time of report and returned at approximately 1:35 PM. He said Resident #45's story was difficult to follow Page 1 of 4 455569 455569 07/02/2025 Heritage at Longview Healthcare Center 112 Ruthlynn Dr Longview, TX 75605

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few but would make a self-report and begin investigation. During an interview on 6/30/2025 at 2:44 PM, Resident #45's RP said she had been talking with Resident #45. RP said her Resident #45 had not reported any staff being disrespectful to her. RP said the staff call her with any changes with her mother and did not indicate any verbal altercation with staff or residents.2.Record review of Resident #53's face sheet dated 7/2/2025 revealed Resident #53 was a [AGE] year-old female who was admitted on [DATE] with diagnoses which included heart failure (occurs when the heart muscle does not pump blood as well), chronic venous hypertension with ulcer of bilateral lower extremities (when blood refluxes and starts to accumulate in the lower leg), lymphedema (tissue swelling caused by fluid buildup in the lymphatic system), Type II diabetes (occurs when the body becomes resistant to insulin or when the pancreas fails to produce enough insulin), hypertension (a common condition where the force of blood against the artery walls is consistently too high), chronic atrial fibrillation (am irregular and often rapid heart rhythm that can lead to stroke), and chronic obstructive pulmonary disease (a lung condition caused by damage to the airways that limit airway). Record review of a quarterly MDS dated [DATE] indicated Resident #53 was understood and usually understood others. The MDS indicated a BIMS 12 indicating moderate cognitive impairment. The MDS indicated Resident #53 did not exhibit any physical or verbal behavioral symptoms during the look back period. Further review of MDS revealed Resident #53 was taking antianxiety medication. Record review of a care plan last revised on 3/10/2025 indicated Resident #53 used antianxiety medication with goal to decrease episodes of signs and symptoms of anxiety. Interventions included to administer antianxiety medications as ordered by physician, monitor, document side effects and effectiveness, monitor and record occurrence for target behavior symptoms such as pacing, wandering, disrobing, inappropriate response to verbal communication, violence/aggression towards others and document per facility protocol. During an interview on 7/2/2025 at 9:50 AM, MA G said she had not observed or overheard any staff members being ugly to Resident #45. She said she had overheard other residents being ugly to each other. MA G said she did hear the aftermath of a confrontation between Resident #45 and Resident #53. She said Resident #45 had been upset last Thursday or Friday. MA G said she was not sure what the staff did but she said she had provided Resident #45 with reassurance. MA G said she had asked Resident #45 what was wrong, and Resident #45 told her she had words with a friend. MA G said she did not report this to anyone. MA G said Resident #45 told her Resident #53 called her a B word. MA G said she did not hear or observe the occurrence and did not report it to staff. MA G said the two residents were loud with each other and other staff could hear what was going on. MA G could not recall the date or time of the incident. During an interview on 7/2/2025 at 10:31 AM, RN B said he heard the arguing between Resident #45 and Resident #53. He said Resident #53 said she did not use the N word. He said they were yelling back and forth. RN B said Resident #45 and Resident #53 were good friends. He said the residents separated themselves. RN B said he reported the incident to the DON and said he was not sure what she did. He said he thought something was written up about it yesterday. RN B said there had not been any changes in Resident #45 and Resident #53's mood. RN B said he reported the incident to the DON, family and NP but did not document in the computer about his report. RN B said resident to resident interactions could affect the residents depending on what was said. He said staff monitor behaviors every shift. He said the staff put the information in a 24-hour report and the staff usually send a request for psychiatric referral. RN B said if a resident's feelings were hurt, it could cause depression. During an interview on 7/2/2025 at 12:17 PM, LVN L said she heard it get loud in the dining/TV room next to the nurse's station. She said Resident #45 and Resident #53 were arguing with each other. LVN L said she did not recall all what was said. LVN L said Resident #53 was upset and down after 455569 Page 2 of 4 455569 07/02/2025 Heritage at Longview Healthcare Center 112 Ruthlynn Dr Longview, TX 75605

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the incident. LVN L said she thought RN B reported the incident to the DON and ADM. LVN L said she was in-serviced on Abuse, Neglect and Exploitation. During an interview on 7/2/2025 at 1:52 PM, Resident #53 said Resident #45 had a bad attitude toward her one-day last week. She said they were both calling each other the B word. She said Resident #45 had told someone that Resident #53 had called her the N word. Resident #53 said she would never do that, and her family would be upset with her if she did something like that. Resident #53 said the staff separated them. Resident #53 said she had been friends with Resident #45 for a long time. Resident #53 said it bothered her that her friend was upset with her. Resident #53 said she was not experiencing any adverse depression symptoms from the incident and she and Resident #45 were friends again. During an interview on 7/2/2025 at 3:00 PM, ADON said she was not aware of the incident between Resident #45 and Resident #53. She said she expected staff to report any resident-to-resident abuse allegations. She said not reporting could result in the resident becoming depressed or perpetrator could continue to abuse the other person. The ADON said the staff had been in-serviced on abuse, neglect, and exploitation. The ADON said the staff jump in and separate residents to keep them safe. She said the facility would complete a trauma informed care assessment at 24 hours, 48 hours, and 72 hours to identify if a resident needed additional services. She said the facility would report to the NP/family and it would be documented on an incident report.During an interview on 7/2/2025 at 3:30 PM, the DON said she did not know what had happened with Resident #45 and Resident #53. She said she was out of town last week and was not made aware of verbal altercation. DON said she expected the staff to report resident to resident altercations and should have been reported to the ADM. She said it was investigated after reported by this surveyor. The DON said the residents should have been separated and staff in-serviced on resident-to-resident altercations. The DON said the staff should make sure there were no injuries of physical or mental distress to the residents. During an interview on 7/2/2025 at 4:27 PM, the ADM said he was not aware of verbal altercation until reported by surveyor. Resident #45 had not told anyone about the incident. The ADM said he expected his staff to report to him immediately any allegations of abuse. He said the facility put both residents on Q 15-minute checks, referred to psychiatric services and kept the residents apart. The ADM said Resident #45 cussed at Resident #53 first. He said it was confirmed that Resident #45 was the perpetrator and not Resident #53. The ADM said Resident #45 had been more sensitive lately due to the loss of a friend. Review of a policy titled Abuse/Neglect revised on 3/29/2018 indicated, .The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart.Definition .1. Abuse: Abuse is the willful inflection of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. 3. Verbal abuse: Any use of oral, written, or gestured language that willfully includes disparaging and derogatory terms to residents, or within or within their hearing distance, regardless of their age, ability to comprehend, or disability.6. Mental Abuse: Includes but not limited to, humiliation, harassment, threats of punishment or deprivation. B. Training.The facility will train through orientation and on-going in-services in issues related to abuse/neglect prohibition practices regularly. C. Prevention.1. The facility will provide the residents, families, and staff an environment free from abuse and neglect. 2. The facility will post the Customer service hotline and the Abuse Preventionist of the facility.3. All reports of abuse or suspicion of abuse/neglect or potentially criminal behavior will be investigated as per facility policy. 4. The facility will be responsible to identify, correct, and intervene in situations of possible abuse/neglect.5. All employees will sign a statement acknowledging the receipt of information notifying the employee of 1.) possible criminal liability for failure to report abuses.E. Reporting.A. If the 455569 Page 3 of 4 455569 07/02/2025 Heritage at Longview Healthcare Center 112 Ruthlynn Dr Longview, TX 75605

F 0609 Level of Harm - Minimal harm or potential for actual harm allegation involve abuse or result in serious bodily injury, the report is to be made within 2 hours of the allegation. B. If the allegation does not involve abuse or serious bodily injury, the report must be made within 24 hours of the allegation. Residents Affected - Few 455569 Page 4 of 4