Health inspection·April 10, 2025

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 the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences for 5 of 34 (Residents #31, #49, #64, #17, and #107) residents reviewed for reasonable accommodation of needs. Residents Affected - Some The facility failed to ensure the call light system in Resident #31, #49, #64, #17, and #107's rooms were in a position that was accessible to the residents. This failure could place the residents at risk of being unable to obtain assistance when needed and help in the event of an emergency. The findings included: Resident #31 Record review of Resident #31's Face Sheet, dated 04/10/2025, reflected the resident was a [AGE] year-old male who admitted to the facility on [DATE]. Resident #31's diagnoses included congestive heart failure (a weakened heart condition that causes fluid buildup in body tissues) and difficulty in walking. Record review of Resident #31's Quarterly MDS (assessment used to determine functional capabilities and health needs) Assessment, dated 03/26/2025, reflected a BIMS (screening tool to assess cognition) was not completed because the resident was rarely/never understood. The staff assessment indicated Resident #31 had severely impaired cognition with daily decision making. Section G indicated Resident #31 needed extensive assistance with acts of daily living. Record review of Resident #31's Comprehensive Care Plan, dated 03/31/2025, reflected the resident had the potential for falls related to being unaware of safety needs. One intervention was to have the call light within reach and encourage the resident to use it for assistance as needed. An observation on 04/08/2025 at 9:15 AM revealed Resident #31 lying in bed asleep. The resident's call light was on the floor between the bed and night stand. Resident #49 Record review of Resident #49's Face Sheet, dated 04/10/2025, reflected the resident was a [AGE] year-old female who admitted to the facility on [DATE]. Resident #49 had a history of falls. Page 1 of 15 455731 455731 04/10/2025 Advanced Health & Rehab Center of Garland 1201 Colonel Drive Garland, TX 75043

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #49's Quarterly MDS Assessment, dated 03/26/2025, reflected severe cognitive impairment with a BIMS score of 00. Section G indicated Resident #49 needed extensive assistance with acts of daily living. Record review of Resident #49's Comprehensive Care Plan, dated 03/27/2025, reflected Resident #49 had the potential for falls related to dementia (a decline in mental ability that interferes with daily life) and one intervention was to place items frequently used items within easy reach of the resident. An observation on 09/08/2025 at 9:18 AM revealed Resident #49 was lying in bed awake. The call light was on the resident's night stand. When asked about the call light, the resident smiled but did reply. Resident #64 Record review of Resident #64's Face Sheet, dated 04/10/2025, reflected the resident was a [AGE] year-old female who admitted to the facility on [DATE]. Resident #64's diagnoses included dementia and repeated falls. Record review of Resident #64's Quarterly MDS Assessment, dated 03/26/2025, reflected a BIMS was not completed because the resident was rarely/never understood. The staff assessment indicated Resident #64 had severely impaired cognition with daily decision making. Section G indicated Resident #64 needed extensive assistance with acts of daily living. Record review of Resident #64's Comprehensive Care Plan, dated 03/27/2025, reflected the resident had a potential for fall related to dementia, poor balance, an unsteady gait, and was unaware of safety precautions. One intervention was to have the call light within reach and encourage the resident to use it for assistance as needed. An observation on 04/08/2025 at 9:19 AM revealed Resident #64 lying in bed awake. The resident's call light was on the floor under the head of the bed. When asked about her call light, the resident did not answer. During an interview on 04/08/25 at 11:35 AM, LVN A stated the call lights should have been within the residents reach. She stated residents may need help or may have an emergency situation. She stated sometimes the call light was the only source of communication so it was important to place it where the residents could reach it. During an interview on 04/09/2025 at 7:25 AM, CNA B stated the call lights should have been in reach for the residents. She stated it was very important for residents to have their call light where they can reach it. She stated if residents needed something, they need a way to let staff know. She stated the call light was the residents' lifeline. During an interview on 04/08/2025 at 8:20 AM Medication Aide H stated before leaving a resident's room, it was important to always make sure the call light was in reach. He stated the call light might be the only way a resident could reach staff. He stated for residents who forgot, it was important to remind them what the call light was and how to use it. Resident #17 455731 Page 2 of 15 455731 04/10/2025 Advanced Health & Rehab Center of Garland 1201 Colonel Drive Garland, TX 75043

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #17's Face Sheet, dated 04/10/2025, reflected the resident was a [AGE] year-old female who admitted to the facility on [DATE]. Resident #17 had a history of falls. Record review of Resident #17's Quarterly MDS Assessment, dated 03/26/2025, reflected severe cognitive impairment with a BIMS score of 00. Section G indicated Resident #17 needed extensive assistance with acts of daily living. Record review of Resident #17's Comprehensive Care Plan, dated 03/27/2025, reflected Resident #17 had the potential for falls related to cognitive impairment. One intervention was to place items frequently used by the resident within easy reach. An observation and interview on 09/08/2025 at 9:27 AM revealed Resident #17 lying in bed with head of the bed elevated. The call light was draped over the headboard of the resident's bed. When asked about the call light, the resident stated she could not reach it. During an interview on 04/08/2025 at 09:32 AM, CNA I stated the call light should have been within the resident's reach. CNA I went into the resident's room and placed the call light on the bed near the resident. She stated it was important for all residents to have their call light within reach so the residents could call if they needed staff. Resident #107 Record review of Resident #107's Face Sheet, dated 04/10/2025, reflected the resident was a [AGE] year-old female who admitted to the facility on [DATE]. Resident #107 had diagnoses which included dementia and difficulty in walking. Record review of Resident #107's Quarterly MDS Assessment, dated 02/19/2025, reflected moderate cognitive impairment with a BIMS score of 11. Section GG indicated Resident #107 required moderate to maximal assistance with self-care and was dependent on staff for transfers. Record review of Resident #107's Comprehensive Care Plan, dated 01/30/2025, reflected Resident #107 had impaired visual function and was at risk for falls, injury, and a decline in functional ability. One intervention was to keep the call light in reach when the resident was in the room or bathroom. An observation on 04/08/2025 at 9:45 AM revealed Resident #107 lying in bed asleep. The call light was on the floor under the resident's bed. During an interview on 04/08/2025 at 9:48 AM CNA J stated the call light was important for the resident's safety. She stated when she sees a light outside a resident's room, it lets her know the resident needs her. CNA J placed the call light near the resident. During an interview on 04/10/2025 at 8:05 AM, ADON E stated a call light should always be placed where the resident can reach it. She stated a resident may fall and need help. She stated a resident might be lying flat in bed and want to sit up or may need to use the restroom. She stated a resident might have an emergency situation and her expectation of staff was to ensure the residents' call lights were always in reach. During an interview on 04/10/2025 at 10:00 AM, ADON G stated it was important for all staff to 455731 Page 3 of 15 455731 04/10/2025 Advanced Health & Rehab Center of Garland 1201 Colonel Drive Garland, TX 75043

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some understand the urgency of residents' having their call light where it could be reached. She stated residents should be able to call for staff for assistance whenever they need it. During an interview on 04/10/2025 at 11:55 AM, ADON D stated it was important to ensure residents could reach the call light before leaving the room. She stated when she rounds, she reminds staff to be sure residents can reach their call lights. She stated staff may have to remind residents why it's important to have the call light in reach. During an interview on 04/10/2025 at 11:25 AM, the DON stated she expected staff to ensure the resident had their call light where they could reach it whether they were in their bed or sitting up in a chair in their room. She stated when residents need assistance, they must have the ability to call for help. She stated she had already begun in-servicing staff. Record review of the facility's policy Clinical Practice Guidelines Nursing Call Light Response dated 02/10/2021, reflected With each interaction in the resident's room or bathroom, staff will ensure the call light is within reach of resident and secured, as needed. 455731 Page 4 of 15 455731 04/10/2025 Advanced Health & Rehab Center of Garland 1201 Colonel Drive Garland, TX 75043

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure residents had the right to a safe, clean, comfortable, and homelike environment including but not limited to receiving treatment and supports for daily living safely for 10 of 15 resident rooms in the memory care unit (Resident room [ROOM NUMBER], #2, #3, #4, #5, #6, #7, #8, #9, and #10) reviewed for environment. 1. The facility failed to ensure Resident room [ROOM NUMBER], #2, #3, #4, #5, #6, #7, #8, #9, and #10, in the memory care unit, were thoroughly cleaned and sanitized. This deficient practice could place residents at risk of living in an unclean and unsanitary environment which could lead to a decreased quality of life. Findings include: An observation on 04/08/25 at 10:24 AM of resident room [ROOM NUMBER] reflected the air condition unit in the room had thick black and brown dirt along and between the vents. The bathroom sink faucet had brownish stains along the base of the faucet. The floor of the shower area had brown stains along the edges of the floor. An observation on 04/08/25 at 10:30 AM of resident room [ROOM NUMBER] reflected the air condition unit in the room had thick black and brown dirt along and between the vents. There was also a thick white substance between the top vents. The bathroom toilet had brownish stains along the base of the it. An observation on 04/08/25 at 10:38 AM of resident room [ROOM NUMBER] reflected the air condition unit in the room had thick black and brown dirt along and between the vents. The floor of the shower area had brown stains along the edges of the floor. An observation on 04/08/25 at 10:44 AM of resident room [ROOM NUMBER] reflected the air condition unit in the room had thick black and brown dirt along and between the vents. The air vent on the ceiling in the shower area had thick dust on and between the vents. An observation on 04/08/25 at 10:47 AM of resident room [ROOM NUMBER] reflected the air condition unit in the room had thick black and brown dirt along and between the vents. There was also a thick white substance between the top vents. A wall near the resident's bed had light brownish stains. The bathroom sink faucet had brownish stains along the base of the faucet. The bathroom toilet had brownish stains along the base of the it. An observation on 04/08/25 at 10:51 AM of resident room [ROOM NUMBER] reflected the air condition unit in the room had thick black and brown dirt along and between the vents. The bathroom toilet had brownish stains along the base of the it. The air vent on the ceiling in the shower area had thick dust on and between the vents. The floor of the shower area had brown stains along the edges of the floor. An observation on 04/08/25 at 10:55 AM of resident room [ROOM NUMBER] reflected the air condition unit in the room had thick black and brown dirt along and between the vents. There was also a piece 455731 Page 5 of 15 455731 04/10/2025 Advanced Health & Rehab Center of Garland 1201 Colonel Drive Garland, TX 75043

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some of flour tortilla wrapped with cheese and meat between the top vents. The air vent on the ceiling in the shower area had thick dust on and between the vents. The bathroom toilet had brownish stains along the base of the it. An observation on 04/08/25 at 10:59 AM of resident room [ROOM NUMBER] reflected the bathroom toilet had brownish stains along the base of the it. The air condition unit in the room had thick black and brown dirt along and between the vents. An observation on 04/08/25 at 11:05 AM of resident room [ROOM NUMBER] reflected the air condition unit in the room had thick black and brown dirt along and between the vents. The air vent on the ceiling in the shower area had thick dust on and between the vents. The floor of the shower area had brown stains along the edges of the floor. An observation on 04/08/25 at 11:08 AM of resident room [ROOM NUMBER] reflected the air condition unit in the room had thick black and brown dirt along and between the vents. The air vent on the ceiling in the shower area had thick dust on and between the vents. The floor of the shower area had brown stains along the edges of the floor. The wall around the upper portion of the door frame had black handprint stains. In an interview on 04/10/25 at 8:55 AM, the Housekeeping Supervisor stated he had been at the facility for a year. He stated housekeeping was supposed to clean the general areas, bathrooms, beds, cabinets, windowsills, and outside of air condition units. He was shown pictures of the concerns observed Resident room [ROOM NUMBER], #2, #3, #4, #5, #6, #7, #8, #9, and #10. He stated maintenance was supposed to clean the inside of the air condition units and he coordinated with them to have it done. He stated maintenance was also responsible for cleaning the air vents in the rooms. He stated he randomly checked rooms for cleanliness. He stated the risk of the rooms not being cleaned thoroughly could result in sickness. In an interview on 04/10/25 at 9:09 AM, Housekeeping D stated she had been at the facility for 18 months. She stated she cleans the rooms in the memory care unit. She stated they were responsible for cleaning the bathrooms, clean floors, walls, windowsills, and they wiped down the air condition units. She was shown pictures of the concerns observed in Resident room [ROOM NUMBER], #2, #3, #4, #5, #6, #7, #8, #9, and #10, and she stated they were responsible for cleaning the areas shown. She stated the air vents and air condition units were to be cleaned by maintenance. She stated they were responsible for notifying maintenance for areas they were unable to clean. She stated the risk of not cleaning the areas could result in bacteria build up and infections. In an interview on 04/10/24 at 9:27 AM, the Maintenance Director, stated he had been at the facility for nearly three years. He stated he or housekeeping were responsible for cleaning the air vents, and he cleaned the inside of the air condition units in the resident rooms monthly. He was shown the pictures of the concerns observed in Resident room [ROOM NUMBER], #2, #3, #4, #5, #6, #7, #8, #9, and #10, and he stated it could cause breathing problems. In an interview on 04/10/25 at 9:50 AM the Administrator stated she had been at the facility for 4 months. She was shown pictures of the concerns in Resident room [ROOM NUMBER], #2, #3, #4, #5, #6, #7, #8, #9, and #10. She stated the management team conducted daily rounds and checked rooms for hazards, resident condition, and cleanliness of the room. She stated her expectation were for rooms to be cleaned thoroughly daily. She stated the risk to the residents of rooms not thoroughly cleaned could result in bacteria and particles in the air, which could be bad for their health. 455731 Page 6 of 15 455731 04/10/2025 Advanced Health & Rehab Center of Garland 1201 Colonel Drive Garland, TX 75043

F 0584 Level of Harm - Minimal harm or potential for actual harm Record review of the facility's policy on Resident Room Cleaning (Undated) reflected Daily cleaning of resident rooms help to provide a sanitary environment, prevent odors, and prolong the useful life of furniture, equipment, paint, and floor finish. Residents Affected - Some 455731 Page 7 of 15 455731 04/10/2025 Advanced Health & Rehab Center of Garland 1201 Colonel Drive Garland, TX 75043

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for a resident for one (Resident #17) of six residents reviewed for Care Plans. The facility failed to ensure Resident #17's treatment for Dermatitis was care planned. This failure could place the resident at risk of not receiving the necessary care and services needed. Findings included: Record review of Resident #17's Face Sheet, dated 04/09/25, reflected she was a [AGE] year-old female admitted on [DATE]. Relevant diagnoses included skin changes, Alzheimer's (memory loss), and Basal Cell Carcinoma of skin (skin cancer). Record review of Resident #17's Quarterly Minimum Data Set (MDS) assessment, dated 03/15/25, reflected she had a BIMS score of 15 (Cognitively intact). Active diagnosis included skin application treatment. Record review of Resident #17's physician orders dated 04/09/25, reflected Apply Vaseline to left cheek lesion twice daily per dermatology. Record review of Resident #17's Quarterly Care Plan, dated 03/19/25, did not reflect a care plan for the resident's treatment for Dermatitis. In an interview on 04/09/25 at 09:30 AM, LVN O stated Resident# 17 had lesions on her face and was required to have Vaseline applied to the left side of her face daily. He stated the resident should have it care planned to ensure that the care was being provided to the resident. He stated the risk of not care planning the treatment could prevent her from receiving the care. In an interview on 04/09/25 at 12:40 PM, the DON was advised that Resident #17 did not have a Care plan for the treatment of the lesions on the resident's face. She stated the resident had orders for Vaseline to be applied to the resident's skin. She stated the risk of the treatment not being added to the Care plan could result in missed care for the resident. She stated they discussed change in conditions for residents during their morning meetings and any changes to care plans are updated by the ADON, DON, or MDS nurse. The DON initially stated the resident did have the treatment for Dermatitis care planned on 02/28/25; however, she was advised that the care was not added until 04/09/25, after it was brought to the staff's attention. In an interview on 04/09/25 at 1:30 PM, ADON D stated she had updated Resident #17's care plan to include the care she was receiving for dermatitis on 04/09/25. She stated it should have been updated at the time the resident had received the orders for the treatment on 04/02/25, but it was somehow overlooked. She stated it was very important to update the resident's care plan because it ensured 455731 Page 8 of 15 455731 04/10/2025 Advanced Health & Rehab Center of Garland 1201 Colonel Drive Garland, TX 75043

F 0656 the resident was receiving the treatment for her diagnosis. Level of Harm - Minimal harm or potential for actual harm Record review of facility's policy, Care Plans and CAAs (Care Area Assessments) (05/06/16) revealed It is the intent of Advanced Health Care Solutions to meet and abide by all State and Federal regulations that pertain to resident care plans and subsequent Care Area Assessments (CAAs) completion. The purpose of this guide is to ensure that an interdisciplinary (IDT) approach is utilized in addressing the Care Area Triggers (CATs) that were generated by the completion of the Minimum Data Set (MDS) in order to effectively address the Care Area Assessments (CAAs) and ultimately achieve the Residents Affected - Few 455731 Page 9 of 15 455731 04/10/2025 Advanced Health & Rehab Center of Garland 1201 Colonel Drive Garland, TX 75043

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. Based on observation, interview, and record review, the facility failed to ensure all drugs and biological were stored in accordance with currently accepted professional principles for 1 (hall 200 medication cart) of 4 medication carts reviewed for medication storage. The facility failed to dispose of one bottle of Magnesium Oxide (vitamin supplement), which expired January of 2025, from the Hall 200 medication cart on 04/09/2025. This failure could place residents at risk of receiving medications which might not provide the full therapeutic benefits of the medication or possibly cause side effects. The findings included: During an observation and interview 04/09/2025 at 11:15 AM, a bottle of expired Magnesium Oxide 400 milligrams was in the medication aide cart on hall 200. The expiration date printed on the bottle was 01/2025. Medication Aide F stated she was not aware the bottle of medication on the cart was expired. Medication Aide F stated no resident on her hall currently had an order for the medication. She stated expired medication should not be given to residents because it may not be as effective. In an interview on 4/10/2025 at 9:03 AM, LVN A stated an expired medication could potentially do more harm. She stated medication had a shelf life for a reason. She stated staff cannot administer expired medication to residents. LVN A stated she would remind staff to be in the habit of checking the medications carts monthly. In an interview on 4/10/2025 at 09:55 AM, ADON D stated the pharmacist audited medications at the facility monthly and checked the medication carts for expired medication. ADON D stated it was important to ensure medications were not expired because a resident might not get the full effect of the medication. During an interview on 4/10/2025 at 11:25 AM, the DON stated the ADONs were responsible for ensuring there were no expired medications on the medication carts. She stated the medication carts were checked monthly and any expired medication was discarded. She stated expired medication should not be administered to residents because the resident might not be getting the full benefits of the treatment. The DON stated she had already began in-service training to staff members. Review of the facility's policy Pharmscript Consultant Pharmacist Services Provider Requirements, dated 08/2020, reflected 6. Specific activities that the consultant pharmacist performs may include but are not limited to . d. Checking the medication storage areas and the medication carts for proper storage and labeling of medications, cleanliness, and removal of expired medications. 455731 Page 10 of 15 455731 04/10/2025 Advanced Health & Rehab Center of Garland 1201 Colonel Drive Garland, TX 75043

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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, distributed, and serve food in accordance with professional standards for food service safety for the facility's only kitchen, reviewed for food and nutrition services. 1. The facility failed to ensure the ice machine in the facility kitchen was thoroughly cleaned. 2. The facility failed to ensure kitchen cooking equipment was cleaned. 3. The facility failed to place a cover on top of the tea dispenser to avoid air borne contaminants. 4. The facility failed to ensure foods in the refrigerator was sealed from air-borne contaminants. 5. The facility failed to ensure the storage bins in the dry food area was clean and covered from air-borne contaminants. These failures could place residents at risk for cross contamination and other air-borne illnesses. Findings include: Observations on 04/08/25 from 9:08 AM to 9:15 AM in the facility's only kitchen revealed: The ice machine, located in the kitchen had white stains inside the walls of the machine and light brownish stains on the inside of the door. One large deep fryer had built up dark brown dirt along the inside walls of the fryer. Two containers containing flour and sugar, located in the dry storage area, had white stains along the opening of the containers and there were no lids on the containers. One zip locked bag of boiled eggs, located in the refrigerator, was not dated with the month, day and year the items were stored after being prepared, and was unsealed from air-borne contaminants. One large tea dispenser, located in the kitchen area, had tea in it and it did not have a lid placed on the top of the dispenser to avoid air-borne contaminants. o 455731 Page 11 of 15 455731 04/10/2025 Advanced Health & Rehab Center of Garland 1201 Colonel Drive Garland, TX 75043

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some One large ice dispenser, located in the dining area, had brownish and thick white stains along the bottom of the dispenser. In an interview on 04/09/25 at 1:14 PM, the Dietary Manager stated she had been at the Dietary Manager for one month. She was shown pictures of the concerns observed in on the kitchen and she stated she had her cooks and dishwasher labeled and dated the food when it arrives from the vendors on Tuesdays and Saturdays. She stated they use a cleaning log posted on the wall and the cook cleaned the fryer monthly. She stated she should be checking for cleanliness. She stated maintenance cleaned the ice machine every two months and he kept a log. She stated the kitchen aide was supposed to cover the tea dispenser once the tea is made but she had gotten distracted. She stated the storage bins should be cleaned every time it was opened. She stated the risk of not addressing the issues could result in food borne illness. She stated she completed an in-service on labeling and dating on 04/08/25. In an interview on 04/10/2025 on 9:55 AM the Administrator stated she had met with the Dietary Manager about the concerns observed in the kitchen area. She was shown pictures of the concerns observed and stated the risk of the areas not being addressed could result in bacteria spreading and cause infections. She stated maintenance was responsible for cleaning the ice machine monthly and they should have a log sheet tracking when they were cleaned. Record review of the facility's policy on Equipment Cleaning Procedures (07/22), revealed It is the policy of this facility that all dietary equipment and environment are cleaned and sanitized in a manner that meets local (if applicable), state, and federal regulations. Record review of the facility's policy on Food Safety and Sanitation (2023), revealed All local, state, and federal standards and regulations will be followed to assure a safe and sanitary food and nutrition services department. Record review of the U.S. Food and Drug Administration (FDA) Code (2022) revealed, Food shall be protected from contamination that may result from a factor or source not specified under Subparts 3-301 3-306. 455731 Page 12 of 15 455731 04/10/2025 Advanced Health & Rehab Center of Garland 1201 Colonel Drive Garland, TX 75043

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 establish and maintain an Infection Prevention and Control Program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for two of twelve (Resident #97 and Resident #102) residents reviewed for infection control. Residents Affected - Some 1. The facility failed to ensure RN C removed her gloves and performed hand hygiene before using the laptop on the medication cart outside of Resident #97's room on 04/08/2025. 2. The facility failed to ensure Medication Aide F removed her gloves and performed hand hygiene before using the laptop on the medication cart outside of Resident #102's room on 04/09/2025. This failure could place residents at risk of cross-contamination and development of infections. The findings included: 1. Record review of Resident #97's Face Sheet, dated 04/10/2025, reflected the resident was a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #97 had diagnoses which included aphasia (disorder that affects how you speak and understand language) following a cerebral infarction (stroke) and muscle wasting and atrophy (reduced muscle mass). Record Review of Resident #97's physician's order, dated 04/02/2025, reflected an order for enhanced barrier precautions (use of gloves and gown to minimize risk of infection transmission) related to a tracheostomy (surgical hole in the windpipe that helps with breathing) and peg tube (insertion of feeding tube into the stomach). Record review of Resident #97's Quarterly MDS (assessment used to determine functional capabilities and health needs) Assessment, dated 01/25/2025, reflected a BIMS (screening tool used to assess cognitive status) was not conducted for Resident #97. Section O reflected Resident #97 received oxygen therapy and tracheostomy care. Section K reflected Resident #97 received nutrition and hydration through the feeding tube. Record review of Resident #97's Comprehensive Care Plan, dated 01/26/2025, reflected the resident has a tracheostomy and is at risk for potential complications such as weight loss, increased secretions, congestion, infection, and respiratory distress. Tracheostomy status is related to chronic respiratory failure. One intervention was to provide oxygen, humidity, tracheostomy care, and tubing changes as indicated by physician's orders. During an observation and interview on 04/08/2025 at 3:55 PM, RN C stated she would check Resident #97's blood pressure before administering medication. RN C used hand sanitizer to clean her hands and put on a gown, gloves, and mask before entering the resident's room. After checking Resident #97's 455731 Page 13 of 15 455731 04/10/2025 Advanced Health & Rehab Center of Garland 1201 Colonel Drive Garland, TX 75043

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some blood pressure, RN C returned to the medication cart parked in the hall near the resident's door. She did not remove the gown or gloves. RN C documented the resident's blood pressure in the laptop on top of the medication cart, then removed her gloves and used hand sanitizer. She did not wipe the laptop after touching it while wearing gloves. RN C's gown touched the front of the medication cart while she looked at the laptop and verified medication pulled from the drawers of the medication cart. RN C administered the medication and removed the gloves, gown, and mask. She washed her hands in the resident's restroom prior to exiting. When asked about wearing the gloves and gown to the medication cart, RN C agreed she should not have worn the gown and gloves to the medication cart to document the vital signs in the laptop and remove medication. She stated it was cross contamination and could cause infection. During an interview on 04/10/2025 at 8:05 AM, ADON E stated RN C should have removed the gloves and gown before exiting the resident's room. She stated staff should always wash their hands or use hand sanitizer after removing gloves. She stated these were important infection control measures to control the spread of infection to Resident #97 and to the other residents. 2. Record review of Resident #102's Face Sheet, dated 04/10/2025, reflected the resident was an [AGE] year-old female who was admitted to the facility on [DATE]. Resident #102 had diagnoses which included hypertension (high blood pressure) and stage 3 chronic kidney disease (moderate decrease in kidney function). Record review of Resident #102's Quarterly MDS Assessment, dated 02/27/2025, indicated a BIMS test was not conducted because the resident was never or rarely understood. The staff assessment indicated the resident had severely impaired cognitive skills for daily decision making. Section I indicated active diagnoses which included hypertension and kidney disease. Record review of Resident #102's Comprehensive Care Plan, dated 03/28/2025, reflected the resident had hypertension and was at risk for fluctuations in blood pressure. One intervention was to monitor/document/report to physician as needed any signs or symptoms of malignant hypertension (spike in blood pressure that can cause organ damage) including headache, visual problems, confusion, disorientation, nausea and vomiting, irritability, seizure, or difficulty in breathing. During an observation and interview on 04/09/2025 at 07:51 AM, Medication Aide F was preparing to enter Resident #102's room to check her blood pressure prior to administering medication. Medication Aide F used hand sanitizer, put on gloves, and entered Resident #102's room. Medication Aide F exited the room and did not remove the gloves prior to documenting the information in the laptop on top of the medication cart. She removed her gloves and used hand sanitizer before preparing the medications to administer. When asked about wearing the gloves, Medication Aide F stated she should have removed the gloves before documenting the residents vital signs in the laptop. She stated she would remove her gloves and use hand sanitizer before using the laptop and stated it was important to prevent cross-contamination. During an interview 04/10/2025 at 9:03 AM, LVN A stated Medication Aide F should not have worn gloves out of Resident #102's room and documented vital signs in the laptop before removing the gloves. She stated gloves should be removed and discarded immediately after providing care. She stated that was important to prevent the spread of infection. 455731 Page 14 of 15 455731 04/10/2025 Advanced Health & Rehab Center of Garland 1201 Colonel Drive Garland, TX 75043

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 4/10/2025 at 10:00 AM, ADON G stated staff members should not wear gloves in the halls. She stated gloves should be removed and hands washed before exiting a resident's room. She stated it was important to prevent cross contamination and the spread of infection. During an interview on 04/10/2025 at 11:25 AM, the DON stated gloves were worn for a reason and staff members should not wear gloves out of the resident's room. She stated RN C and Medication Aide F should not have worn gloves out of the resident's room and contaminated the laptops. She stated gloves and gowns should be removed before exiting a room. She stated it was important to prevent the spread of infection. The DON stated she had already begun in-service training for staff members. Review of the facility's policy Hand Hygiene, dated 11/12/2017, reflected Staff Involved in direct resident contact will perform proper hand hygiene procedures to prevent the spread of infection to other personnel, residents, and visitors . The use of gloves does not replace hand washing. Wash hands after removing gloves. 455731 Page 15 of 15