Health inspection·January 29, 2024

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to incorporate the recommendations from the PASRR report for 1 of 2 resident (Resident #1) reviewed for PASRR services. The facility did not submit a request for approval for Resident #1's CMWC in the LTC Online Portal within 20 business days after the date of the IDT meeting. NFs have 20 business days from the IDT meeting to enter a request for NF Specialized Services. This failure could place residents with a positive PASRR evaluation at risk for not receiving specialized PASRR services which would enhance their highest level of functioning and could contribute to a decline in physical, mental, psychosocial well-being and quality of life. Findings included: Record review of Resident #1's face sheet, dated 01/30/2024, indicated Resident #1 was a [AGE] year old male, admitted on [DATE], Medicaid PASRR therapies listed as a payer source with diagnoses including quadriplegia , which is a symptom of paralysis that affects all a person's limbs and body from the neck down, degenerative disease of nervous system, seizures, muscle spasms, abnormal weight loss, protein-calorie malnutrition, vitamin deficiencies, metabolic encephalopathy , a problem in the brain caused by a chemical imbalance in the blood, hypercholesterolemia (high cholesterol), contractures of the left knee and right knee, lack of coordination, muscle weakness, multiple fractures of left ribs, secondary hypertension (secondary high blood pressure), Type 2 diabetes, anemia, which is a condition that develops when your blood produces a lower-than-normal amount of healthy red blood cells, allergic rhinitis, which is inflammation of the inside of the nose caused by an allergen, intellectual disabilities, hypothyroidism (underactive thyroid), which happens when the thyroid gland doesn't make enough thyroid hormone, aphasia which is loss of ability to understand or express speech, caused by brain damage, dysphagia which is difficulty swallowing, oropharyngeal phase of swallowing which involves transferring a food bolus posteriorly to the epiglottis (a flap of tissue that sits beneath the tongue at the back of the throat) and then to the upper esophageal sphincter, the high-pressure zone located in between the pharynx (throat) and the cervical esophagus (behind the trachea), neck fracture of left femur, dysarthria (difficulty speaking) and anarthria (loss of speaking), cognitive communication and traumatic subdural hemorrhage, which is bleeding in the area between the brain and skill without loss of consciousness, cognitive communication deficit, and conversion disorder with seizures or convulsions, sequela which is a pathological condition resulting from a disease, injury, therapy, or other trauma . PASRR Level 1 Screening assessment dated [DATE] indicated Resident #1 had an intellectual Page 1 of 3 455733 455733 01/29/2024 Heritage at Turner Park Health & Rehab 820 Small St Grand Prairie, TX 75050

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few disability. Further review indicated the facility was able and willing to serve Resident #1; therefore, Resident #1 was admitted . Record review of Resident #1's PCSP dated 07/07/2022 indicated Resident #1 had an IDT meeting for specialized services review on 07/06/2022. The IDT form indicated the IDT members recommended Resident #1 receive a Customized Manual Wheelchair . Record review of Resident #1's care plan updated on 08/29/2022 indicated Resident #1 had a chronic health condition and comorbid conditions that affected physical functioning with the goal to maintain quality of life. Record review of Resident #1's care plan updated on 01/01/2024 indicated Resident #1 had a positive PASRR status related to intellectual disability and used a wheelchair for mobility. Record review of Resident #1's quarterly MDS assessment dated [DATE] indicated Resident #1 was severely cognitively impaired, totally dependent upon staff for ADL s and used a wheelchair for mobility. Review of PASRR compliance call report for June 2022 spreadsheet for Resident #1's IDD services PASRR Unit indicated the following: *IDT meeting was held on 07/06/2022, *PCSP was created on 07/07/2022, *IDT date plus 30 days was on 08/06/2022 Further review of the spreadsheet indicated services needed were a Customized Manual Wheelchair. Record Review of the PASSR Assessment revealed that the DLN was submitted to the LTC Online Portal by the previous MDS Coordinator on 08/06/2022, which was more than 20 days after the IDT Meeting on 07/06/2022. The Status of the PASSR Assessment was set to Pending Denial on 08/08/2022. The PASSR Assessment received a system-generated Denial on 08/22/2022. Due to the PASSR Assessment receiving a system-generated Denial the service request for the CMWC was denied manually. On 11/07/2022, the facility resubmitted a DLN for the service request for the CMWC for Resident #1. The Status of the PASSR Assessment tab was set to Pending Denial on 11/07/2022. The LTC Online Portal sent the facility an alert requesting more information. The PASSR Assessment received a system-generated Denial on 11/21/2022. Due to the PASSR Assessment receiving a system-generated Denial on 11/21/2022, the request of the CMWC was manually Denied. The facility failed to follow-up with the alerts sent by the LTC Online Portal requesting more information from the facility and the service request resulted in another denial. On 06/30/2023, the facility submitted a new NFSS request with a DLN and the PASSR Assessment was set to Pending Denial on 07/03/2023. On 07/03/2023, the facility made corrections and uploaded the CMWC/DME Signature page, and the Assessment was approved on 07/06/2023. The CMWC Request Tab was approved on 07/07/2023 . Resident #1 received the CMWC on 07/24/2023. In an interview with the facility's DON on 01/29/2024 at 10:34 AM, she stated that she has been employed at the facility since 02/06/2023. The DON stated that she was not directly involved with the situation involving Resident #1 and his CMWC. 455733 Page 2 of 3 455733 01/29/2024 Heritage at Turner Park Health & Rehab 820 Small St Grand Prairie, TX 75050

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In a telephone Interview on 01/29/2024 at 12:35 PM, Resident #1's RP stated that she did not have any concerns regarding his care at the facility. She stated that Resident #1 has not expressed to her any concerns regarding his care at the facility. RP stated that Resident #1 did not mention anything to her about needing his CMWC after the IDT Meeting. In an interview with the facility's ADM on 01/29/2024 at 1:07 PM, she stated that her hire date was 06/19/2023. The ADM stated that the prior Administration at the facility which included the Administrator, DON and MDS/PASSR Coordinator were involved with the IDT Meeting and the request for specialized services for Resident #1 to obtain a CMWC. She stated that the prior Administration did not this was all before her start date of employment at the facility and she had no insight and no additional information. In an interview with the facility's Social Worker on 01/29/2024 at 1:48 p.m., she stated that she has been employed at the facility since 03/14/2023. Social Worker reported that she does not have any information regarding the CMWC for Resident #1 because the IDT Meeting was held prior to her employment. The Social Worker stated that Resident #1 has not filed any Grievances regarding being in discomfort or pain. The Social Worker reported that Resident #1 has not mentioned anything to her regarding his CMWC. In an interview with the facility's MDS/PASRR Coordinator on 01/29/2024 at 2:07 p.m., she stated the facility was unable to confirm a request for the wheelchair was ever sent for Resident #1. She stated that she was unable to provide more information because the previous MDS/PASRR Coordinator was no longer employed at the facility. She reported that her hire date was 9/01/2023. Observation of Resident #1 on 01/29/2024 at 3:15 PM in his room. Resident #1 is verbal but was unable to be interviewed. Record review of the facility's policy titled PASRR Level 1 Screen Policy and Procedure last revised on 03/06/2019, revealed It is the policy of Creative Solutions in Healthcare facilities to obtain a PL1 screening form from the RE (referring entity) prior to admission to the NF. The PL1 will be submitted via SimpleLTC (software simplifies regulatory compliance, reimbursement optimization and quality measurement for post-acute care healthcare) timely per PASRR Regulatory timeframes. PASRR is a federally mandated program requiring all states to pre-screen all individuals seeking admission to a Medicaid-certified nursing facility, regardless of payor source or age. The PASRR Program is important because it provides options for individuals to choose where they live, who they live with and the training and therapy they need to live as independently as possible The NF must convene an IDT meeting after the LIDDA submits the PE and within 14 days after admitting the individual. The IDT will determine which specialized services the resident will receive. After the IDT meeting, the NF must submit the information from the IDT meeting on the LTC Online Portal. Record review of the facility's undated policy entitled Comprehensive Care Planning revealed no information about submitting requests for specialized services. 455733 Page 3 of 3