Health inspection·November 17, 2023

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review revealed the facility failed to ensure a comprehensive care plan was revised by the interdisciplinary team after the quarterly review assessments were completed for 2 of 8 Residents (#51 and #66) whose care plans were reviewed. 1. Resident #51's revised Care Plan did not address her ADL deficits and the level of assistance she required for all ADL's. 2. Resident #66's revised Care Plan did not reflect Resident #66's used corrective lenses for adequate vision. These deficient practice could contribute to residents not receiving required care identified in their MDS assessment. The findings were: 1. Review of Resident #51's face sheet, dated 11/17/23, revealed she was admitted to the facility on [DATE] with diagnoses including anxiety disorders (persistent and excessive distress that affects daily life) and cognitive communication deficit (difficulties with communication that have an underlying cause in a cognitive deficit more than a language or speech deficit). Review of Resident #51's quarterly MDS assessment, dated 8/11/23, revealed her BIMS score was 7 reflecting severe cognitive impairment; she required supervision by 1 person for bed mobility, transfers, dressing; she required minimal assistance by 1 person for hygiene and supervision and set up for eating. Review of Resident #51's Care Plan revised on 8/16/23 revealed her ADL deficits and the level of assistance she required was not addressed. Interview on 11/17/23 at 10:19 AM with the MDS Coordinator/LVN B revealed Resident #51's Care Plan was not accurate. Resident #51's ADL deficits and the level of assistance she required was not addressed in the revised Care Plan per the quarterly MDS assessment, dated 8/11/23. LVN B stated that all identified CAAS on the MDS assessment should be reflected on the Care Plan. 2. Review of Resident #66's face sheet, dated 11/17/23, revealed she was admitted to the facility on [DATE] with diagnoses including unspecified dementia (group of symptoms that affects memory, thinking and interferes with daily life, mild and cognitive communication deficit (difficulties with Page 1 of 6 455618 455618 11/17/2023 Eden Home 631 Lakeview Blvd New Braunfels, TX 78130

F 0657 communication that have an underlying cause in a cognitive deficit more than a language or speech deficit). Level of Harm - Minimal harm or potential for actual harm Review of Resident #66's quarterly MDS assessment, dated, 8/31/23, revealed her BIMS score was 5 reflecting severe cognitive impairment and she had adequate vision with the use of corrective lenses. Residents Affected - Few Review of Resident #66's Care Plan, revised 9/15/23, revealed it did not reflect Resident #66's used of corrective lenses. Observation on 11/14/23 at 12:45 PM revealed Resident #66 was lying in bed awake. She was wearing glasses. Interview on 11/17/23 at 10:49 AM with MDS Coordinator/LVN B revealed she confirmed Resident #66's Care Plan did not reflect she wore glasses and therefore was not accurate. MDS Coordinator stated all of the residents' care areas needed to be addressed because it directed their care allowing nursing staff to use the Care Plan as a guide. Review of facility policy, Comprehensive Care Plans dated 3/15/19 read It is the policy to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that includes measurable objectives and timeframe to meet a resident's medical, nursing, and mental and psychosocial needs that are identified inn the resident's comprehensive assessment. 5. The comprehensive care plan will be reviewed and revised by the interdisciplinary team after each comprehensive and quarterly MDS assessment. 6. The comprehensive care plan will include measurable objectives and timeframe's to meet the resident's needs as identified in the resident's comprehensive assessment. The objectives will be utilized to monitor the resident's progress. Alternative interventions will be documented, as needed. 8. Qualified staff responsible for carrying out the interventions specified in the care plan will be notified of their roles and responsibilities for carrying out the interventions, initially and when changes are made. 455618 Page 2 of 6 455618 11/17/2023 Eden Home 631 Lakeview Blvd New Braunfels, TX 78130

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure the resident environment remained as free of accident hazards as was possible for 3 of 4 Residents (#35, #51 and #75) reviewed for accident hazards. The water temperature at the bathroom sink exceeded the safe water temperature of 110 degrees for Resident's #35, #51 and #75. 1. The water temperature in Resident #35's bathroom was 119 degrees. 2. The water temperature in Resident #51's bathroom was 115 degrees. 3. The water temperature in Resident #75's bathroom was 118 degrees. This deficient practice could place residents at risk for avoidable skin burns. The findings were: Review of the facility water temperature checks log from 11/8/23 to 11/14/23 revealed the temperature in the unit where Resident #35, #51 and #75 residents read 110+. 1. Review of Resident #35's face sheet, dated 11/17/23, revealed she was admitted to the facility on [DATE] with diagnoses including unspecified Dementia mild ( group of symptoms that affects memory, thinking and interferes with daily life), and other recurrent depressive disorders (mental disorder characterized by repeated episodes of depression. Review of Resident #35's quarterly MDS assessment, dated 9/22/23, revealed her BIMS score was 15 reflecting no cognitive impairment; she required supervision with bed transfers by 1 person, minimal assistance by 1 person for hygiene and toileting. Review of Resident #35's Care Plan revised on 9/22/23 confirmed she had an ADL care deficit and she required assistance with her ADL's. Observation on 11/14/23 at 2:29 PM revealed the water at the bathroom sink in Resident #35's room was hot to the touch. Resident #35 was not in the room. Observation and interview on 11/17/23 at 2 PM revealed the water at the bathroom sink in Resident #35's room was 119 degrees. The MS stated that was too hot and Resident #35 could get burned. He stated the water temperature should not exceed 110 due to the risk for skin burns. 2. Review of Resident #51's face sheet, dated 11/17/23, revealed she was admitted to the facility on [DATE] with diagnoses including anxiety disorders (persistent and excessive distress that affects daily life) and cognitive communication deficit (difficulties with communication that have an underlying cause in a cognitive deficit more than a language or speech deficit). Review of Resident #51's quarterly MDS assessment, dated 8/11/23, revealed her BIMS score was 7 455618 Page 3 of 6 455618 11/17/2023 Eden Home 631 Lakeview Blvd New Braunfels, TX 78130

F 0689 Level of Harm - Minimal harm or potential for actual harm reflecting severe cognitive impairment; she required supervision with bed transfers and toileting by 1 person, minimal assistance by 1 person for hygiene. Review of Resident #51's Care Plan revised on 8/16/23 revealed her ADL deficits and the level of assistance she required was not addressed. Residents Affected - Some Observation and interview on 11/17/23 at 2:06 PM revealed the water at the bathroom sink in Resident #51's room was 115 degrees. The MS stated that it was too hot and Resident #51 could get burned. He stated the water temperature should not exceed 110 due to the risk for skin burns. 3. Review of Resident #75's face sheet, dated 11/17/23, revealed he was admitted to the facility on [DATE] with diagnoses including unspecified Dementia mild ( group of symptoms that affects memory, thinking and interferes with daily life), and lack of coordination (neurological sign consisting of lack of voluntary coordination of muscle movements and Parkinson's Disease (chronic degenerative disorder of the central nervous system affecting both the motor system and non-motor systems). Review of Resident #75's quarterly MDS assessment, dated 10/12/23, revealed his BIMS score was 9 reflecting moderate cognitive impairment and he utilized a wander guard related to elopement. Interview on 11/15/23 at 9:20 AM with LVN A revealed Resident #75 was confused and would often wander in and out of other residents rooms and throughout the unit. Observation and interview on 11/17/23 at 2 PM revealed the water at the bathroom sink in Resident #75's room was 119 degrees. The MS stated that was too hot and Resident #35 could get burned. He stated the water temperature should not exceed 110 due to the risk for skin burns. Observation and Interview on 11/17/23 at 2:12 PM in the mechanical room revealed there were 2 water heaters and 1 boiler. The MS stated the 2 water heaters serviced the 2 resident halls in the unit. He stated the setting on the water heaters was 110 and 112 degrees. He stated that sometimes the reading would exceed the setting when the water was in constant use like when residents were being showered. The MS further stated the water temperatures were taken in a couple of rooms in every hall on a daily basis. Observation and interview on 11/17/23 at 2:45 PM revealed Resident #75 was sitting in his wheelchair in the common area. Resident #75 was alert but presented as confused and was was not interviewable. Further observation revealed he had a wander guard bracelet on his right wrist. Interview on 11/17/23 at 3:20 PM with the MS and the Supervisor of Maintenance Operations revealed each water heater had a cold and hot mixing valve and the water would circulate in a loop therefore the temperature would fluctuate and not remain constant. However, the Supervisor stated the temperature should not exceed 110; and 115, 119 degrees was way too hot and residents could get burned. He also stated the Maintenance Assistants should notate the exact temperature reading and not document 110+. They should also tell the MS so he could make adjustments to the water heater setting to avoid accidents. The MS stated the assistants took daily water temperature readings in multiple rooms in every hallway. He stated the assistant who took water temperatures last week and noted 110+ degrees was in the same unit where Resident's #35, #51 and #75 resided. He stated he briefly reviewed the water temperatures but did not notice the 110+ recordings. Review of facility policy, Safe Water Temperatures, reviewed on 1/26/23 read It is the policy of 455618 Page 4 of 6 455618 11/17/2023 Eden Home 631 Lakeview Blvd New Braunfels, TX 78130

F 0689 Level of Harm - Minimal harm or potential for actual harm this facility to maintain appropriate water temperatures in resident care areas. 1. Maintenance staff will monitor water temperatures daily. 2. Water temperatures will be recorded inn the water temp log. 4. Report any abnormal findings, such as complaints of water too cold or hot, or any problems with water temperature (ex. water is painful to touch or causes redness) to the maintenance supervisor immediately. Residents Affected - Some 455618 Page 5 of 6 455618 11/17/2023 Eden Home 631 Lakeview Blvd New Braunfels, TX 78130

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review revealed the facility failed to prepare, distribute and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for meal service. Dietary staff stacked 12 trays on a food cart filled with multiple individual servings of lemon cake which were exposed to the elements in the kitchen. This deficient practice could contribute to the spread of foodborne illnesses and make the residents sick. The findings were: Observation and interview in the kitchen on 11/14/23 at 11:46 AM revealed 3 Dietary Staff preparing lunch trays. Further observation revealed a cart with 12 trays filled with 6 to 8 slices of lemon cake on individual plates next to the steam table. The food cart was not covered. Interview with the DM revealed the dietary staff prepared the food cart with the desserts. He stated one food cart with desserts had already been delivered to one of the resident halls. The DM stated it would take staff about 1 hour to prepare meal trays and distribute all lemon cakes. He stated the cart was usually not covered during meal service. He stated the empty tray on the top shelf would keep debris from falling on the top of the pieces of cake. However, they were exposed from the sides because they were not covered all the way around. He stated debris could fall into the pieces of lemon cake and contaminate them as the dietary staff prepared the meal trays. He further stated any contamination or bacteria could make the residents sick. The DM stated he provided dietary staff with inservices on a routine basis regarding kitchen sanitation but stated they had not identified the food cart not being covered as a potential risk. Record review of facility policy Food and Supply Storage, revised 01/2022, revealed [ .] cover, label and date unused portions and open packages. 455618 Page 6 of 6