Health inspection·May 28, 2024

F 0839 Employ staff that are licensed, certified, or registered in accordance with state laws. 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 professional staff were licensed, certified, or registered in accordance with applicable State laws for 1 of 30 staff (LVN A) reviewed for staff qualifications. Residents Affected - Few The facility failed to ensure LVN A renewed her nursing license before the expiration date in order to practice nursing in the State of Texas. This failure could place residents at risk of not receiving care and services from staff who were properly licensed. The findings included: Record review of the Texas Board of Nursing website license verification portal on [DATE] at 5:44 p.m. revealed LVN A's Texas nursing license was listed as delinquent with a license expiration date of [DATE]. Record review of the Texas Board of Nursing website on [DATE] stated, If you do not renew your license before the expiration date, your license will go into delinquent status, and you cannot practice/work as a nurse with a delinquent license. You will not be able to practice nursing until your license is successfully renewed and placed into an active/current status. Record review on [DATE] of LVN A's timecard revealed she worked the following days and hours with a delinquent license. a. Sunday - [DATE] - 11.25 Hours b. Tuesday - [DATE] - 11.50 Hours c. Wednesday - [DATE]- 12 Hours d. Page 1 of 5 455761 455761 05/28/2024 Mission Nursing & Rehabilitation Center 1013 S Bryan Rd Mission, TX 78572

F 0839 Monday - [DATE] - 11.50 Hours Level of Harm - Minimal harm or potential for actual harm e. Tuesday [DATE]- 11.75 Hours Residents Affected - Few f. Friday [DATE]- 11.75 Hours g. Saturday [DATE]- 11.75 Hours h. Sunday [DATE]- 12 Hours i. Monday [DATE]- 12 Hours j. Tuesday [DATE] - 11.75 Hours k. Friday [DATE] - 11.75 Hours l. Saturday - [DATE] - 11 Hours m. Sunday - [DATE] - 11 Hours n. Tuesday - [DATE] - 11 Hours o. Wednesday - [DATE] - 11.75 Hours p. Thursday - [DATE] - 12 Hours 455761 Page 2 of 5 455761 05/28/2024 Mission Nursing & Rehabilitation Center 1013 S Bryan Rd Mission, TX 78572

F 0839 q. Level of Harm - Minimal harm or potential for actual harm Monday - [DATE] - 11.5 Hours r. Residents Affected - Few Tuesday - [DATE] - 11.5 Hours s. Friday - [DATE] - 12 Hours t. Saturday - [DATE] - 12.25 Hours u. Sunday - [DATE] - 12 Hours v. Wednesday - [DATE] - 11.75 Hours w. Thursday - [DATE] - 11.25 Hours x. Monday - [DATE] - 11.75 Hours y. Tuesday - [DATE] - 12.5 Hours z. Friday - [DATE] - 11.25 Hours During an observation LVN A was observed in the facility's south wing on [DATE] at 6:18pm and [DATE] at 4:15pm, LVN A was not observed providing direct patient care. During an interview and record review with the DON on [DATE] at 2:35pm she stated before surveyor B identified LVN A had a delinquent license on [DATE] she was not aware of LVN A's delinquent license. The DON stated HR was responsible for verifying staff licenses and certifications and had started checking the nurse aides but had not started checking the nurses. The DON was not sure how often those checks were completed and stated she did know that during their annual survey window they would check and be given a list of expiration dates. The DON stated the last time licenses were checked was 455761 Page 3 of 5 455761 05/28/2024 Mission Nursing & Rehabilitation Center 1013 S Bryan Rd Mission, TX 78572

F 0839 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few in [DATE] and stated she would get a licensure report/update on renewals from HR. The DON stated the nurses themselves were responsible for renewing their licenses. The DON reviewed LVN A licensure information retrieved from the Texas Board of Nursing website license verification portal on [DATE] at 5:44pm and confirmed LVN A's licensure stated delinquent. The DON stated LVN A had since submitted for renewal and was pending confirmation. Shortly after this interview, the DON returned and stated LVN A's renewal had gone through and was active as of [DATE]. The DON stated LVN A had been working the floor and had provided nursing care to residents since her licensure date of expiration on [DATE] and stated the last day she worked was on [DATE]. The DON stated she nor other staff had sent LVN A any reminders for her licensure renewal. The DON stated HR was the only person reviewing staff qualifications. The DON stated she had not identified LVN A's license was delinquent because she thought LVN A would be on top of it. The DON stated LVN's were not allowed to work with a delinquent license because their licenses needed to be active to practice as a nurse. The DON stated when LVN A was identified to be delinquent she was written up, sent home, suspended, and would not be allowed to return to work until LVN A provided proof her license was active. The DON stated although LVN A was not compliant with the regulations of the Texas Board of Nurses she had not had any complaints or seen any effects on resident care due to LVN A not having an active license. During an interview on [DATE] at 2:58pm LVN A stated on Friday [DATE] her nursing license was delinquent and stated she had since renewed it and had confirmed it had become active on [DATE]. LVN A stated she did not have the exact date her nursing license had expired on. LVN A stated she had not known her license had expired and stated she had been working at the facility providing patient care from the time of licensure expiration on [DATE] until Surveyor B identified that her license was delinquent on [DATE]. LVN A stated she didn't know if there was anyone at the facility designated to oversee when staff licensure/certifications were set to expire. LVN A stated no one at the facility notified her of needing to renew her license. LVN A stated the responsibility to renew her license and maintain it active was hers. LVN A stated she had not renewed it because she did not know it was expiring. LVN A stated she was not allowed to work as an LVN and provide nursing care to patients with a delinquent license. LVN A stated when she was identified to have a delinquent license, she was removed from providing patient care. When LVN A was asked about the impact not having an active license could have on residents, LVN A stated that although she did not have an active license she would still have the skills and knowledge. During an interview with HR on [DATE] at 3:11pm she stated before surveyor B identified LVN A had a delinquent license on [DATE] she was not aware of LVN A's delinquent license. She stated she would only track the nurse aides and did not know she needed to check the nurses. HR stated she did not think anyone was responsible for checking the nurse licenses and stated she only checked the nurse's licenses upon hire and had not checked otherwise. HR stated the nurses would now be included in her monthly checks. HR stated because nurses were not being reviewed, she had not provided any licensure report or updates to the DON or Administrator for the nurses. HR stated the nurses themselves were responsible for renewing their licenses. HR stated LVN A had been working the floor and providing nursing care to residents since her licensure date of expiration on [DATE]. HR stated between [DATE] and [DATE] LVN A worked a total of 26 days. HR stated she had not sent LVN A any reminders for her licensure renewal. HR stated she was the only person reviewing staff qualifications and stated she had not identified LVN A's delinquent license because previously she was only checking the aides and not nurses. HR stated LVN s are not allowed to work with a delinquent license because they weren't certified. HR stated when LVN A was identified to have a delinquent license she was written up, suspended, and not able to work until her license was active. HR stated nurses not having 455761 Page 4 of 5 455761 05/28/2024 Mission Nursing & Rehabilitation Center 1013 S Bryan Rd Mission, TX 78572

F 0839 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few an active license could negatively impact residents because they wouldn't be up to date on what's new and updated in their continuing education. During an interview with the Administrator on [DATE] at 4:17pm he stated before surveyor B identified LVN A had a delinquent license he was not aware of LVN A having a delinquent license. The Administrator stated the nurses themselves were responsible for verifying their licenses were renewed, active, and were expected to monitor and check themselves. The Administrator stated HR would check nurse aides' certifications monthly, with the last check completed [DATE]. The Administrator stated no one had been in charge of checking the nurse's licenses and stated they had been checked upon hire, but they had not been checked regularly that he knew of. The Administrator stated there was no licensure report or updates on renewals coming up that was being sent to him for the nurses. The Administrator reviewed LVN A licensure information retrieved from the Texas Board of Nursing website license verification portal on [DATE] at 5:44pm and confirmed LVN A's licensure stated delinquent. The Administrator stated LVN A had been working the floor and providing nursing care to residents since her licensure date of expiration on [DATE] and stated the last day she worked was on [DATE]. The Administrator stated he nor other staff had not sent LVN A any reminders for her licensure renewal. The Administrator stated there was no one who specifically reviewed nurse licenses, and stated they had not identified LVN A's license being delinquent because they did not check them. The Administrator stated LVN's were not allowed to work with a delinquent license because it was part of their job description and expectations. The Administrator stated when LVN A was identified to have a delinquent license she was taken off the floor immediately, counseled, suspended, and stated he completed an audit of other licensed nursing staff with no other issues identified. The Administrator stated nurses not having an active license could negatively impact residents because they may not have the best or most active practices. Record review of a facility document provided by the DON that was titled, Charge Nurse indicated the specific requirements for the position and stated, Must possess a current, unencumbered, active license to practice as an RN or LPN/LVN in this state. Record review of excerpt from the facility handbook provided by the Administrator dated [DATE] revealed section 13.1.7 titled, LICENSE RENEWAL/CONTINUING EDUCATION UNITS stated, All other employees are responsible for maintaining current license including the cost of continuing education. If an employee allows their license to lapse, the employee will be suspended without pay until such a time a license in good standing is produced and verified. 455761 Page 5 of 5