Health inspection·August 11, 2022

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to ensure residents receive services in the facility with reasonable accommodation of resident needs and for 1 of 68 residents (Resident #36) reviewed for call lights. Residents Affected - Few The facility failed to have a call light within reach for Resident #36. This failure could place residents at risk for a delay in care and services, increased falls, excessive wait times, pain, and a decreased quality of life. Findings included: Record review of Resident #36's face sheet revealed the resident was admitted to the facility on [DATE] with diagnoses including Pyogenic Arthritis (painful infection of joint), Systolic Congestive Heart Failure (heart does not pump blood effectively), Stage 3 Chronic Kidney Disease, History of Falling, Generalized muscle Weakness. Record review of Resident #36's care plan, revised 07/14/2022, revealed, Focus: High risk for falls related to gait/balance problems and previous falls. Goal: to be free from falls. Interventions: Call light within reach of resident and encourage resident to use the call light for assistance; resident needs prompt response to all requests for assistance; resident needs a safe environment with a working and reachable call light. Record review of Resident #36's MDS, dated [DATE], revealed a BIMS score of 3 which indicated severe cognitive impairment. Further review revealed the resident required extensive assistance from one or more staff members to perform activities of daily living. Observation on 08/08/2022 at 10:30 AM revealed Resident #36's call light cord was wrapped around the left siderail of residents bed and was not within the resident's reach. Resident #36 was sitting in wheelchair in front of his television. During an interview on 08/08/2022 at 10:30 AM with Resident #36, resident states that he cannot use the call light when it's tied up to the arm rails of bed and I am not in bed, I can't reach it. During an interview on 08/08/2022 at 11:00 AM with LVN D, she stated that it is the CNA's responsibility and her responsibility to make sure that the call light is within reach of resident for safety reasons. Page 1 of 12 455690 455690 08/11/2022 Parks Health Center 111 Parks Village Dr Odessa, TX 79765

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 08/11/22 at 01:00 PM, the DON stated that Resident #36 had been to therapy that morning. DON stated the therapist failed to ensure that call light was within reach of resident. DON stated that she will do an in-service on call lights as soon as possible. Record review of the Answering the Call Light Policies and Procedures dated 2001, revised March 2021 revealed that the purpose of this procedure is to ensure timely responses to the residents requests and needs. When the resident is in bed or confined to a chair be sure the call light is within easy reach of the resident. 455690 Page 2 of 12 455690 08/11/2022 Parks Health Center 111 Parks Village Dr Odessa, TX 79765

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview, and record review the facility failed to ensure that 2 (Resident #60 and Resident #33) of 19 residents reviewed for respiratory care was provided care consistent with professional standards of practice in that: Residents Affected - Some Resident # 60's oxygen nasal cannula tubing and water was not changed, labeled and dated and stored according to the facility's policy. Resident # 33's nasal cannula tubing was not changed, labeled and dated and stored according to the facility's policy. This deficient practice could affect 19 residents who received oxygen treatments and result in respiratory infection. Findings include: Record review of Resident #60's face sheet revealed admission date of 07/04/2019 with diagnoses of Chronic Obstructive Pulmonary Disease with Acute Exacerbation, Acute Respiratory Failure with Hypoxia (absence of enough oxygen in the tissues to sustain bodily functions), Acute Respiratory Failure with Hypercapnia, Shortness of Breath, Wheezing, Solitary Pulmonary Nodule. She was [AGE] years of age. Record review of Resident #60's care plan dated 06/06/22 indicated, in part: Focus: Altered respiratory status/ difficulty breathing related to hypoxia. Goal: no complications related to shortness of breath. Interventions: O2 concentrator with oxygen via nasal cannula at 2-4 liters per minute every 12 hours, as needed, humidified. Record review of Resident #60's medication profile dated 08/31/2022 indicated in part: Oxygen at 2-4 Liter per minute via nasal cannula as needed to maintain oxygen saturations 92% or greater. Record review of MDS dated [DATE] indicated, in part, that Oxygen is required. Record review of Resident #33's face sheet revealed admission date of 11/07/2021 with diagnoses of Unspecified Atrial Fibrillation, Anxiety Disorder, Age-related Physical Debility. She was [AGE] years of age. Record review of Resident #33's care plan dated 05/23/2022 indicated, in part: Focus: Shortness of breath related to Anxiety. Goal: will maintain normal breathing pattern as evidenced by normal skin color, regular respiratory rate/pattern. Interventions: Oxygen concentrator in room and has order for oxygen to be set at 2 liters per minute via nasal cannula as needed to maintain saturations over 90%. Record review of Resident #33's medication profile dated 03/15/2022 indicated in part: Oxygen at 2 liters per minute every 4 hours as needed related to age- related physical debility and 455690 Page 3 of 12 455690 08/11/2022 Parks Health Center 111 Parks Village Dr Odessa, TX 79765

F 0695 hypoxemia (low level of oxygen in blood). Level of Harm - Minimal harm or potential for actual harm Record review of MDS dated [DATE] indicated, in part, that Oxygen is required. Residents Affected - Some During an interview and observation on 08/09/2022 at 4:30 PM of Resident #60's oxygen tubing revealed the water bottle and oxygen tubing connected to oxygen concentrator were dated 07/29/2022 with black marker, showing last date changed. The used nasal cannula was in residents unmade bed. Interview with LVN D stated that tubing is supposed to be changed every Sunday on night shift by the nurse. LVN D stated she will change the tubing and water immediately. During an interview and observation on 08/10/22 02:20 PM of Resident #33 oxygen tubing revealed it to be on the floor, disconnected from the oxygen concentrator, with no dates on tubing. CNA E stated that Resident #33 does not use the oxygen and proceeded to pick up the soiled tubing, rolled up the soiled tubing and placed the soiled tubing on the handle of the concentrator. LVN C stated that tubing should be in a plastic bag and plugged into the machine when not in use. LVN C stated that the tubing on the floor can get bacteria and cause the resident an infection. During an interview with DON on 08/10/2022 at 11:10 AM, the DON stated that oxygen tubing and water should be changed every Sunday night by nurse on duty. DON stated that the Resident #60 does not like staff entering her room at night. DON stated that night shift nurse failed to change the tubing and failed to communicate with day shift about the failure to change tubing. Record review of the facility's policy dated 2001, revised November 2011, titled Respiratory TherapyPrevention of Infection indicated, in part: The purpose of this procedure is to guide prevention of infection associated with respiratory therapy tasks and equipment among residents and staff. Change the oxygen cannula and tubing every seven days. Keep the oxygen cannula and tubing used PRN in a plastic bag when not in use. [NAME] bottle with date and initials upon opening. 455690 Page 4 of 12 455690 08/11/2022 Parks Health Center 111 Parks Village Dr Odessa, TX 79765

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide pharmaceutical services including procedures that assure the accurate administering of all drugs and biologicals, to meet the needs of 1 of 14 residents reviewed for pharmacy services. (Resident # 31) CMA B failed to administer scheduled medications to Resident #31 during medication administration observation. These failures could place residents at risk of under dose and not produce the desired effect. Findings included: Record review of Resident #31's admission record dated 08/11/22 indicated she was admitted to the facility on [DATE] with diagnoses which included urinary tract infection and muscle weakness. She was [AGE] years of age. Record review of Resident #31's care plan dated 07/11/22 indicated in part: Problem: Resident has history of a Urinary Tract Infection. Goal: Resident's urinary tract infection will resolve without complications by the review date. Interventions/tasks: Give antibiotic therapy as ordered. Monitor/document for side effects and effectiveness. Record review of Resident #31's order summary report dated 08/11/2022 indicted in part: Bactrim DS Tablet 800-160 MG (Sulfamethoxazole-Trimethoprim) (Antibiotic), Give 1 tablet by mouth two times a day for UTI for 10 Days. Order date 08/08/2022. During an observation on 08/09/22 at 03:55 PM CMA B administered the following medications by mouth to Resident #31. Divalproex 500mg x1 (medication for seizures), Eliquis 5mg x1 (prevents blood clots), Gabapentin 300mg x1 (treats nerve pain), Keppra 750mg x1 (medication for seizures). Bactrim DS Tablet 800-160 MG (antibiotic) was not administered . During an interview on 08/10/22 at 3:22 PM CMA B said she did not recall seeing the Bactrim order for Resident #31 so she did not administer the medication yesterday 08/09/22. CMA B said she had administered the Bactrim this morning but had not given the 2 doses yesterday because she had not seen the order on her computer. During an interview on 08/11/22 at 02:48 PM the DON was made aware of the observation of the medication that was omitted for Resident #31. The DON said the CMA was expected to administer the medications as ordered and that the CMA probably got nervous and failed to administer it. The DON said they had done an in-service training with the CMA and had added more antibiotic medication days to make up for the missed dose. During an interview on 08/11/22 at 02:50 PM the Administrator was made aware of the observation of the medication that was omitted for Resident #31. The Administrator said the CMA was expected to administer the medications as ordered and that the CMA probably got nervous and failed to administer it. The Administrator said they had done an in-service training with the CMA and had added more antibiotic medication days to make up for the missed dose. 455690 Page 5 of 12 455690 08/11/2022 Parks Health Center 111 Parks Village Dr Odessa, TX 79765

F 0755 Level of Harm - Minimal harm or potential for actual harm Record review of the facility's policy titled Administering medications and dated April 2019 indicated in part: Medications are administered in a safe and timely manner and as prescribed. The Director of Nurses supervises and directs all personnel who administer medications and/or have related functions. Medications are administered in accordance with prescribed orders including any required time frame. Residents Affected - Few 455690 Page 6 of 12 455690 08/11/2022 Parks Health Center 111 Parks Village Dr Odessa, TX 79765

F 0812 Level of Harm - Minimal harm or potential for actual harm 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 the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed in that: Residents Affected - Many The facility failed to label, date, and properly seal food items. The facility failed to discard rancid food items. The facility's kitchen staff failed to practice proper hand hygiene during meal preparations. The facility failed to maintain the appropriate sanitizing solution in the red sanitizing bucket. The facility failed to clean/sanitize countertop preparation areas after each use during meal service. These deficient practices could place residents who received meals prepared from the kitchen and placed them at risk for food borne illness and cross-contamination. Findings include: Observation on 08/08/22 at 09:20 AM during an initial tour of the kitchen revealed the following: Dietary Manager L and Dining Service Lead J pull their mask down below their mouth when speaking, fully exposing their mouth and nose, touching surfaces in the kitchen and did not use hand sanitizer or wash their hands. Observation at 08/08/22 at 09:30 AM of the facility's refrigerator revealed: - Eight hardboiled eggs wrapped in cellophane, no date, and no label. -One gallon size container of Catalina dressing, spillage all over the outside with mold. - One foil sheet size pan of cut lettuce, not properly covered, no date. Observation at 08/08/22 at 09:40 AM of the facility's pantry revealed: - One pack of seasoning open not sealed correctly, not labeled or dated. 455690 Page 7 of 12 455690 08/11/2022 Parks Health Center 111 Parks Village Dr Odessa, TX 79765

F 0812 Observation at 08/08/22 at 09:55 AM of the facility's freezer revealed: Level of Harm - Minimal harm or potential for actual harm - One sheet of chocolate cake not labeled or sealed. - One clear bag of steak fingers not labeled or dated. Residents Affected - Many - Cutting board on prep counter with several squash sliced, unattended and uncovered. Observed on 08/08/22 10:10 AM DA #G, mask was pulled down below her mouth as she licks her fingers to separate the menus while standing in front of the service line, she sees this surveyor and pulls up mask and continues with taping the menus to the shelf of service line, did not wash or sanitize her hands. Observation/Interview on 08/08/22 at 10:12 AM accompanied by the Dietician revealed there was no available red buckets filled with sanitizer solution. Dietician verbalized there was no sanitizer in the red buckets to sanitize countertops. Observation on 08/08/22 at 10:25 AM of Sous Chef #M, touching his earpiece with gloved hand and then continues to cut squash without hand sanitizing, washing hands or changing gloves. Interview/Observation on 08/08/22 at 11:40 AM accompanied with DM # L verbalized chocolate cake dessert in pan not properly wrapped, dated, or labeled, steak fingers in the freezer should be dated and labeled. The DM #L acknowledged chocolate cake desert should be sealed, dated, and labeled. He also verbalized steak fingers should be dated and labeled. DM#L verbalized dressing should have been discarded, He acknowledged serving these foods to the residents could have caused them to get a food borne illness. DM #L verbalized Sous Chef #M should have washed his hands before continuing with food prep. He said the sink is by the dishwasher and the staff should be washing their hands to prevent the food from being contaminated and causing infection to the residents. Observation on 08/10/22 01:20 PM with DA#F, demonstrated hand washing, turned water on, soaped hands washed for 10 seconds, rinsed hands, turned water off, then dried her hands. Interview on 08/10/22 01:25 PM with DM #L, and Dining Services Lead #J. Dining Services Lead #J verbalized DM #L and Dietician #K had been doing all the in-services, but she was going to start helping them. DM #L verbalized he and the Dietician #K is responsible along with Dining Services Lead #J for monitoring staff regarding hand washing/infection control. DM #L verbalized staff should have mask on correctly at all times and if they touch their mask, they should be washing their hands. Dining Services Lead #J verbalized the residents can get really sick if the food becomes contaminated, even result in death. Interview on 08/11/22 at 10:45 AM with DM#L verbalized red sanitation buckets should be filled with sanitizer solution in the morning to sanitize the counter tops before and after prep. DM#L verbalized non-sanitized counter tops can contaminate the food, which could cause infection to the residents, and could result in death. DM#L verbalized that himself, Sous Chef #M and Dining Services Lead # J are responsible to monitor staff, but ultimately, himself and Dietician #K are responsible to monitor the staff and do the In-services. Interview on 08/11/22 at 2:15 PM Interview with Administrator and Cross Healthcare, 455690 Page 8 of 12 455690 08/11/2022 Parks Health Center 111 Parks Village Dr Odessa, TX 79765

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Administrator verbalized turn warm water on, wet hands, soap and scrub >30 seconds, rinse, dry with paper towel, throw away in trash, new paper towel and turn off faucet. Administrator verbalized DM#L is responsible for monitoring kitchen staff are correctly washing their hands, when to wash their hands, and wearing their masks correctly, then Myself, dietician, and ICP are responsible for monitoring DM#L of his duties. Administrator verbalized not washing hands properly could cause food borne illness and harm to the residents. administrator verbalized the DM #L, is responsible for making sure kitchen staff are sanitizing the countertops, using the red buckets, and sanitizing solution. Administrator verbalized not sanitizing the counter tops again, could cause food borne illness and harm to the residents. Administrator explained the DM#L is responsible for doing a walk through in the kitchen making sure food in the freezer, pantry, and refrigerator are stored, labeled, and dated correctly and throwing away expired foods. Administrator verbalized himself, the dietician and ICP are responsible for monitoring kitchen staff of their duties, he verbalized he does a walk through every week to 2 weeks along with Dietician, and ICP/ADON. Administrator verbalized himself, the DON, and ADON, are all certified for Infection Control Preventionists. Record review of the facility's policy titled, Hand Washing, dated 12/01/11 read in part .The consultant dietician will monitor each facility to ensure that good hand washing practices are followed. Employees will be in-serviced as needed. The following guidelines should be used to ensure adequate sanitation practices are in place. 3. Hand Washing steps as followed: a. Wet hands and exposed arms with hot water at least 100 F. b. Apply soap. c. Scrub hands, exposed arms, and fingernails for a minimum of twenty seconds being sure to apply a vigorous friction. d. Rinse hands and exposed arms thoroughly under hot running water. e. Dry hands and arms with paper towel. f. Turn off faucet with the paper towel to avoid contaminating hands and discard towel . Record review of the facility's policy titled, Food Storage, dated 12/01/11 read in part . The consultant dietician will monitor the storage of foods to ensure that all food served by the facility is 455690 Page 9 of 12 455690 08/11/2022 Parks Health Center 111 Parks Village Dr Odessa, TX 79765

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many of good quality and safe for consumption. All food will be stored according to the state Federal Food Codes. The following guidelines should be followed: 1. Dry Storage rooms d. To ensure freshness, opened and bulk items are stored in tightly covered containers. All containers are labeled and dated. 2. Refrigerators e. All refrigerated foods are dated, labeled and tightly sealed, include leftovers, use clean, nonabsorbent, covered containers, that are approved for food storage. All leftovers are used within 48 hours. Items that are over 48 hours old discarded. 3. Freezers e. Frozen foods are stored in moisture-proof wrap or containers that are labeled and dated . Record review of the facility's policy titled, Food Preparation & Handling, dated 12/01/11 read in part .The consultant dietician will monitor the preparation and handling of food items to ensure that all food served by the facility is of good quality and safe for consumption according to the state and Federal Food Codes and HACCP guidelines. The following guidelines should be followed: 1. General Guidelines a. Clean, sanitized surfaces, equipment and utensils are used. b. Hands are properly washed before beginning food preparation . Record review of the facility's In-service titled, Cleaning vs Sanitizing, not dated, read in part . When to clean and sanitize: Everything in your operation must be kept clean, but any surface that comes in contact with food must be cleaned and sanitized . Each time you use them When you are interrupted during a task When you begin working with a different type of food As often as possible, but at least every four hours if items are in constant use . 455690 Page 10 of 12 455690 08/11/2022 Parks Health Center 111 Parks Village Dr Odessa, TX 79765

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections for one (Resident #10) of 3 residents reviewed for infection control. Residents Affected - Few The facility failed to ensure CNA A changed her gloves after they became contaminated during incontinent care while assisting Resident #10. This failure could place resident's risk for cross contamination and the spread of infection. Finding include: Record review of Resident #10's admission record dated 08/10/22 indicated he was admitted to the facility on [DATE] with diagnoses which included Alzheimer's disease and muscle weakness. He was [AGE] years of age. Record review of Resident #10's MDS dated [DATE] indicated in part: Bladder and Bowel: Urinary Continence =. 2. Frequently incontinent. Bowel Continence = 2. Frequently incontinent. Record review of Resident #10's care plan dated 03/08/22 indicated in part: Problem: Resident is frequently incontinent of bladder and bowel. Goal: Resident will remain free from skin breakdown due to incontinence and brief use. Interventions/tasks: Clean peri-area with each incontinence episode. During an observation on 08/09/22 at 10:10 AM CNA A performed incontinent care for Resident #10. CNA A entered the resident's room washed her hands and donned gloves. Resident #10 was laying in his bed awake and alert. CNA A asked the resident to stand up and then proceeded to remove the resident's pull up. The resident had a small amount of bowel movement on his bottom and the pull up. CNA A took some wet wipes and wiped the resident's bottom then also wiped the resident front peri-area. During the wiping the residents bottom and peri-area came in contact with the CNA's gloves. While still wearing the same gloves, CNA A proceeded to apply a clean brief on the resident. During an interview on 08/09/22 at 10:40 AM CNA A said she should have changed her gloves once they became contaminated during the incontinent care she performed on Resident #10. CNA A said there was a chance of leading to cross contamination by possibly spreading bowel movements with the soiled gloves if she did not change them before applying the clean brief. CNA A said they received ongoing training on hand washing and changing gloves . During an interview on 08/11/22 at 2:40 PM the DON was made aware of the observation of incontinent care performed by CNA A. The DON said when staff performed incontinent care they were expected to change their gloves prior to proceeding to applying the clean brief. The DON said if the staff did not change their gloves that could possibly lead to cross contamination. The DON said she believed the failure occurred because the CNA got nervous and forgot to change her gloves. The DON said the staff received several trainings regarding hand washing and performing incontinent care. During an interview on 08/11/22 at 2:42 PM the Administrator was made aware of the observation of incontinent care performed by CNA A. The Administrator said he agreed with the DON's statement that 455690 Page 11 of 12 455690 08/11/2022 Parks Health Center 111 Parks Village Dr Odessa, TX 79765

F 0880 Level of Harm - Minimal harm or potential for actual harm when staff performed incontinent care they were expected to change their gloves prior to applying the clean brief. The Administrator said if the staff did not change their gloves that could possibly lead to cross contamination. The Administrator said he believed the failure occurred because the CNA got nervous and forgot to change her gloves. The Administrator said the staff received several trainings regarding hand washing and performing incontinent care. Residents Affected - Few Record review of the facility's policy titled Perineal Care and dated February 2018 indicated in part: The purpose of this procedure is to provide cleanliness and comfort to the resident, to prevent infections and skin irritation and to observe the resident's skin condition. Preparation - review the resident's care plan to assess for any special needs of the resident. For male resident: wash perineal area starting with urethra and working outward, continue to wash perineal area including the penis, scrotum and inner thighs, wash and rinse the rectal area thoroughly, including the area under the scrotum, the anus and the buttocks, dry area thoroughly, discard disposable items into designated containers, remove gloves and discard into designated container, wash and dry your hands thoroughly, reposition the bed covers make the resident comfortable. Record review of the facility's policy titled Handwashing/hand hygiene and dated August 2019 indicated in part: This facility considers hand hygiene the primary means to prevent the spread of infections. Use an alcohol=based hand rub containing at least 62% alcohol; or alternatively, soap (antimicrobial or non-antimicrobial) and water for the following situations: Before moving from a contaminated body site to a clean body site during resident care, after contact with blood or bodily fluids, Hand hygiene is the final step after removing and disposing or personal protective equipment. The use of gloves does not replace hand washing/hand hygiene. 455690 Page 12 of 12