Health inspection·August 10, 2023

F 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Allow resident to participate in the development and implementation of his or her person-centered plan of care. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the resident's right to participate in the development and implementation of his or her person-centered plan of care, for 1 of 6 Residents (Resident #1) reviewed for care plans. The facility did not have a quarterly care plan meetings to discuss Resident #1's care. This failure could cause residents not to be able to participate in the planning of their care, not receiving the care they want or need, and not being informed of all services offered by the facility. The findings were: Record review the face sheet dated 8/10/23 indicated Resident #1 was a [AGE] year-old male admitted to the facility on [DATE] with a diagnoses including traumatic brain injury (brain dysfunction caused by an outside force usually a violent blow to the head), depression, need for assistance with personal care, lack of coordination, muscle weakness, and hemiplegia and hemiparesis following cerebral infarction (paralysis of partial or total body function on one side of the body following a stroke). Record review of the MDS dated [DATE] indicated Resident #1 was understood by other and understood others. The MDS indicated Resident #1 had a BIMS of 15 and was cognitively intact. The MDS indicated Resident #1 required supervision with bed mobility, transfers, dressing, eating, and toileting. The MDS indicated Resident #1 required limited assistance with personal hygiene. Record review of the care plan last revised 8/09/23 indicated Resident #1 had depression. The care plan indicated Resident #1 had potential for impaired psychosocial well-being with a goal of expressing/exhibiting satisfaction. Interventions were to allow the resident to participate in daily care and decision/goal making and listen carefully and be non-judgmental. Record review of the care conference report dated 8/09/23 indicated Resident #1 had a care plan conference on 7/06/22 and 8/09/23. During an interview on 8/09/23 at 9:15 a.m. the Ombudsman said she had been trying to get a care plan meeting scheduled with the facility for Resident #1 for several months. The Ombudsman said the facility had not scheduled a care plan meeting or responded to her request. Page 1 of 6 455831 455831 08/10/2023 Paris Healthcare Center 610 Deshong Dr Paris, TX 75460

F 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 8/09/23 at 12:04 p.m. Resident #1 said he had been trying to get a care plan meeting for 6-8 months. Resident #1 said he had asked several facility staff members about scheduling a care plan meeting. Resident #1 said staff will not schedule him a care plan meeting. During an interview on 8/09/23 at 1:40 p.m. the Corporate Nurse said the last care plan meeting/conference with Resident #1 was on 7/6/22. The Corporate Nurse said care plan meeting should be done quarterly. During an interview on 8/10/23 at 2:00 p.m. the DON said she was responsible for ensuring care plan were completed. The DON said care plans were completed/revised on admission, quarterly, and with a change of condition. The DON said residents were not routinely invited to care plan meetings. The DON said a care plan meeting/conference would be performed on a resident's request. The DON said she was unaware of Resident #1 or the Ombudsman requesting a care plan meeting. The DON said it was important to involve residents in care plan meetings because it was their care and an inter-departmental meeting that would inform residents of different services the facility had to offer they might not be aware of. During an interview on 8/10/23 at 2:18 p.m. the Administrator said care plans were performed on admission, quarterly, and with a change in condition. The Administrator said residents and their families/responsible parties were invited to care plan meeting quarterly. The Administrator said Resident #1's care plan meetings had fell through the crack. The Administrator said she was aware the Ombudsman had requested a care plan meeting, but the resident had refused the meeting at the time the facility wanted to conduct the meeting. The Administrator said Resident #1 wanted things including care plan meetings done on his time. The Administrator said it was important for residents to attend care plan meetings to be able to voice their opinions and to be able to take part in their own care. Record review of the facility's undated Care Planning and Care Plan Meeting Workflow policy indicated, .The Care Plan Meeting (Initial and Quarterly): Scheduling the Care Plan Conference: The date and time are confirmed with the resident and responsible representative. The care conference is scheduled in the Resident Calendar. Invitations to the Care Plan Meeting: .This care plan invitation can be delivered to the resident and/or mailed to the resident's responsible representative .Documenting the Care Plan Meeting: . Notes-Summarize the IDT progress discussed at the care conference and the plan for the next 90 days . 455831 Page 2 of 6 455831 08/10/2023 Paris Healthcare Center 610 Deshong Dr Paris, TX 75460

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 interview, and record review, the facility failed to develop and implement a comprehensive person- centered care plan that included measurable objectives and timeframes to meet a resident's needs for 1 of 6 residents reviewed for care plans. (Resident #2) The facility did not ensure Resident #2's care plan addressed interventions for provisions of medication on dialysis days and transportation arrangements for dialysis per facility policy. This failure could place residents at risk for unmet care needs. Findings included: Record review of the face sheet dated 8/10/23 indicated Resident #2 was a [AGE] year-old female admitted to the facility on [DATE] diagnoses including depression, lack of coordination, pain, dependence on renal dialysis (when a person had permanent kidney failure that requires dialysis for kidney function), and end stage renal disease (when the gradual loss of kidney function reaches an advanced stage). Record review of the physician orders dated 5/10/23-8/10/23 indicated Resident #2 had an order start 6/28/23 to adjust routine medication administration to accommodate dialysis schedule. Record review of the MDS dated [DATE] indicated Resident #2 understood others and was understood by others. The MDS indicated Resident #2 had a BIMS of 15 and was cognitively intact. The MDS indicated Resident #2 required supervision with ADLs. The MDS indicated Resident #2 received dialysis treatments. Record review of the care plan revised on 8/09/23 indicated Resident #2 had hemodialysis on Monday, Wednesday, and Friday related to renal failure. The care plan indicated interventions were regular, no salt on try, double meat portion with each meal, explore with resident reasons for non-compliant behavior, instruct in diet restrictions, monitor shunt in the left arm every shift, and restrict intake of fluids. During an interview on 8/10/23 at 2:00 p.m. the DON said she was responsible for ensuring care plan were completed. The DON said care plans were completed/revised on admission, quarterly, and with a change of condition. The DON said if the facility policy indicated an intervention would be in the care plan it should be in the care plan if applicable. The DON said she was not aware that facility's dialysis policy indicated care plans would address interventions for provisions of medication on dialysis days and transportation arrangements for dialysis. The DON said it was important to included interventions in the care plan that the facility policy indicated would be included because it was policy. During an interview on 8/10/23 at 2:18 p.m. the Administrator said care plans were performed on admission, quarterly, and with a change in condition. The Administrator said she expected the policies to be followed in regard to care plans and care plan interventions. The Administrator said it was important to follow the policies so everyone would know all the interventions. 455831 Page 3 of 6 455831 08/10/2023 Paris Healthcare Center 610 Deshong Dr Paris, TX 75460

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of the facility's Care Planning Special Needs-Dialysis policy dated 2022 indicated, The facility will provide the necessary care and treatment, consistent with professional standards of practice, physician orders, the comprehensive person-centered care plan, and the resident's goals and preferences, to meet the special medical, nursing, mental, and psychosocial needs of residents receiving dialysis. Comprehensive care plans will be developed based on the resident assessments, goals, and preferences in accordance with assessment and care plan procedures .Interventions will include, but not limited to .g. Provision of medications on dialysis treatment days .h. Transportation arrangements . 455831 Page 4 of 6 455831 08/10/2023 Paris Healthcare Center 610 Deshong Dr Paris, TX 75460

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 ensure necessary services to maintain grooming and personal hygiene were provided for 2 of 6 residents reviewed for ADLs (Residents #3 and Resident #4 ) Residents Affected - Few The facility failed to ensure Resident #3's fingernails were clean and trimmed. The facility failed to ensure Resident #4's fingernails were trimmed. These failures could place residents at risk of not receiving services/care, decreased quality of life, and decreased self esteem Findings Included 1. Record review of a face sheet dated 8/10/23 indicated Resident #3 was a [AGE] year-old male, admitted to the facility on [DATE] with diagnoses including Parkinson's disease (a disorder of the central nervous system that affects movement, often including tremors), lack of coordination, dementia, and weakness. Record review of the most recent quarterly MDS dated [DATE] indicated Resident #3 usually understood others and was usually understood by others. The MDS indicated Resident #3 had a BIMS score of 04 indicating he was severely cognitively impairment. The MDS indicated Resident #3 was not resistive to evaluation or care. The MDS indicated Resident #3 required extensive assistance with bed mobility, transfers, dressing, personal hygiene, and toileting. The MDS indicated Resident #3 required total dependence with bathing. Record review of the care plan last updated on 8/09/23 indicated Resident #3 would have the following tasks documented in the facility's plan of care (POC) system with approach including nail care on shower days (Tuesdays, Thursdays, and Saturdays on the 2:00 p.m.-10:00 p.m. shift). Record review of the POC History dated 8/01/23 through 8/10/23 indicated Resident #3 showers were not given on 8/02/23, 8/06/23, 8/07/23, 8/08/23, 8/09/23, and 8/10/23. Per the care plan schedule Resident #3 should have received a shower on 8/01/23, 8/03/23, 08/05/23, 08/08/23, and 08/10/23. The POC History indicated Resident #3 did not receive nail care on shower days on 8/06/23, 08/07/23, 8/08/23, 8/09/23, and 8/10/23. During an observation and interview on 8/09/23 at 10:32 a.m. Resident #3 had jagged fingernails with dark brown substance under them. Resident #3 said he would allow staff to trim and clean his fingernails. During an interview on 8/10/23 at 11:00 a.m. CNA B said CNAs were responsible for giving showers and performing nail care. CNA B said Resident #3 would refuse showers. CNA B said the importance of residents receiving their showers and nail care was to be clean, prevent skin breakdown, and for infection control. 2. Record review of a face sheet dated 8/10/23 indicated Resident #4 was a [AGE] year-old male, admitted to the facility on [DATE] with diagnoses including diabetes, weakness, lack of coordination, dementia, and schizoaffective disorder (a mental health disorder including schizophrenia and mood disorder symptoms). 455831 Page 5 of 6 455831 08/10/2023 Paris Healthcare Center 610 Deshong Dr Paris, TX 75460

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of the physician orders dated 6/08/23 through 8/10/23 indicated Resident #4 had an order for nail care on shower days (Tuesdays, Thursdays, and Saturdays on the 2:00 p.m. to 10:00 p.m. shift) by skilled nurse due to diagnoses of diabetes starting 7/13/23. Record review of the most recent comprehensive MDS dated [DATE] indicated Resident #4 understood others and was understood by others. The MDS indicated Resident #5 had a BIMS score of 09 indicating he was moderately cognitively impaired. The MDS indicated Resident #4 was not resistive to evaluation or care. The MDS indicated Resident #4 required supervision with bed mobility, transfers, dressing, and toileting. The MDS indicated Resident #4 required limited assistance with [personal hygiene. The MDS indicated Resident #4 required total dependence with bathing. Record review of the care plan last updated on 8/08/23 indicated Resident #4 would have the following tasks documented in the facility's POC system with approach including I prefer to take my bath/shower on Tuesdays, Thursdays, and Saturdays during the 2:00 p.m.-10:00 p.m. shift. Record review of the POC History dated 8/01/23 through 8/10/23 indicated Resident #4 did not received a shower on 8/01/23 and 8/10/23 was unanswered. During an observation and interview on 8/09/23 at 10:30 a.m. Resident #4 had jagged fingernails. Resident #4 said staff did not trim and clean his fingernails. Resident #4 said he would allow trim and clean his fingernails. During an interview on 8/10/23 at 10:50 a.m. RN A said the CNAs were responsible for giving resident showers and performing nail care. RN A said if a resident was diabetic it was the nurse's responsibility to perform nail care. RN A said Resident #4 refused showers at times. RN A said the importance nail care was performed was for infection control. During an interview on 8/10/23 at 2:00 p.m. the DON said nail care should be performed with showers. The DON said CNAs were responsible for giving showers. The DON said she expected CNAs to give showers and perform nail care on residents as scheduled. The DON said the importance of nail care was skin integrity and infection control. During an interview on 8/10/23 at 2:18 p.m. the Administrator said nail care was to be performed on shower days. The Administrator said all direct care staff, but especially CNAs, were responsible for showers and nail care. The Administrator said the importance of nail care was hygiene. Record review of the facility's Activities of Daily Living policy dated 2022 indicated, The facility will, based on the resident's comprehensive assessment and consistent with the resident's needs and choices, ensure resident's abilities on ADLs do not deteriorate unless deterioration is unavoidable. Care and services will be provided for the following activities of daily living: 1. Bathing, dressing, grooming, and oral care .A resident who is unable to carry out activities of daily living will receive the necessary services to maintain good nutrition, grooming, and personal and oral hygiene . 455831 Page 6 of 6