Health inspection·November 18, 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 care for each resident in a manner that promotes maintenance and enhancement of their quality of life for two (Resident #1 and Resident #2) of 4 residents reviewed for privacy and dignity. The facility failed to ensure Resident #1 and Resident #2's urinary catheter bags were covered. This failure could place residents at risk for diminished quality of life and loss of dignity and self-worth. Findings were: Record review of Resident #1's face sheet dated November 15, 2024, revealed Resident #1 admitted on [DATE] for Alzheimer's Disease (a progressive disease that destroys memory and other important mental functions), pressure ulcer of sacral region (lower back/upper buttocks area), major depressive disorder, and neuromuscular dysfunction of bladder (bladder muscles and nerves are not functioning properly due to damage to the nervous system). Care plan, undated, indicated Resident #1 has altered urinary elimination secondary to catheter with an intervention of a privacy cover in place. Care plan also indicated foley catheter care every shift. Record review of Resident #1's MDS assessment dated [DATE] revealed resident has a BIMS score of 08 (moderate cognitive impairment). Section H of MDS indicated Resident #1 has an indwelling catheter and is always incontinent of bladder. During an observation on November 14, 2024, at 1:00 p.m., Resident #1 was sitting in the dining room in his wheelchair with his catheter bag uncovered at the resident's side. During an interview with Resident #1 on November 14, 2024, at 1:00 p.m., Resident #1 stated he was unaware that the catheter bag needed a cover and does not know when it had a cover. Resident #1 does not need the catheter bag to have a cover and it does not bother him. Record review of Resident #2's face sheet dated November 14, 2024, revealed Resident #2 admitted on [DATE] for pressure ulcer of sacral region, severe protein-calorie malnutrition, chronic kidney disease, vascular dementia (a type of dementia that occurs when the brain doesn't receive enough blood flow, which can damage brain tissue and impair cognitive function), and neuromuscular dysfunction of bladder. Resident #2's care plan indicated to change catheter every 60 days and as needed, catheter care every shift, and utilize catheter bag cover. Page 1 of 2 455608 455608 11/18/2024 Hacienda Oaks at Beeville 4713 Business 181 N Beeville, TX 78102

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of Resident #2's MDS assessment dated [DATE], revealed resident has a BIMS score of 12 indicating resident has moderate cognitive impairment. Section H of MDS indicated Resident #2 has indwelling catheter and is always incontinent of bladder. During an observation on November 14, 2024, at 1:15 p.m., Resident #2 had an uncovered catheter bag while lying in her bed in her room eating her lunch. During an interview with Resident #2 on November 14, 2024, at 1:15p.m., the resident stated her bag normally has a cover and does not know why her bag is uncovered at this time. During an interview on November 14, 2024, at 1:20 p.m. the ADON stated the catheter bag on Residents #1 and #2 are usually covered because the only supply of bags in the facility have covers, however if Hospice changed the catheters and/or catheter bags then they may have used their own bags. During an interview on November 18, 2024, at 3:54 p.m., the DON stated Resident #1 and #2's catheter bags were not covered due to hospice changing the bags. The DON stated she will ensure the urinary bags will be covered in the future and Hospice will be using the facility supply of catheter bags with covers. The DON also stated she will be in-servicing Hospice and all in-house nurses about Hospice using the facility supplies of catheter bags with covers. DON stated it is expected that all catheter bags are covered as this is the facility's policy and it is to ensure residents dignity and rights are protected. During an interview on November 18, 2024, at 4 p.m., the Administrator stated it is expected for all residents with catheters to have urinary covers for the catheter bags. The Administrator stated it is also policy for catheters to have covers on the bags. Record review of Catheter care, urinary policy revision dated August 2024 indicated the care and application of a catheter but does not include information about a covering. Record review of Resident rights policy revised December 2016 revealed Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's right to: A. A dignified existence, B. Be treated with respect, kindness, and dignity, and .T. privacy and confidentiality. 455608 Page 2 of 2