Health inspection·September 28, 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 7 residents (Resident #1, Resident #2, and Resident #3) reviewed for care plans. The facility did not have a quarterly care plan meetings to discuss Resident #1, Resident #2, or Resident #3'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 included: 1. Record review of the face sheet dated 9/28/23 indicated Resident #1 was admitted to the facility on [DATE] with diagnoses including dementia, muscle weakness, bipolar disorder (a disorder associated with episodes of mood swings ranging from depressive lows to manic highs), lack of coordination, and history of falling. Record review of the MDS dated [DATE] indicated Resident #1 was understood by others and understood others. The MDS indicated Resident #1 had a BIMS of 10 and was moderately cognitively impaired. The MDS indicated Resident #1 required supervision with bed mobility, transfers, dressing, eating, toileting, and personal hygiene. Record review of the care plan last revised 9/25/23 indicated Resident #1 had been identified as having Mental Illness PASRR positive status related to bipolar disorder/major depressive disorder/mood disorder. The care plan indicated she was currently receiving routine case management and individual skills training. Record review of the care conference report dated 9/28/23 indicated Resident #1's last three care conferences were held on 1/03/23, 7/06/22, and 7/15/20. During an interview on 9/27/23 at 2:33 p.m. Resident #1 said the last care plan meeting/care conference she had was approximately a year ago. Resident #1 said she would definitely want to be invited to her care plan meetings. Resident #1 said she felt the facility should give her a schedule she could put on her door telling her how often her care plan meetings were being held, on what days, and at what time so she could remember and attend. Page 1 of 3 455831 455831 09/28/2023 Paris Healthcare Center 610 Deshong Dr Paris, TX 75460

F 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 2. Record review of the face sheet dated 9/28/23 indicated Resident #2 was admitted to the facility on [DATE] with diagnoses including reduced mobility, weakness, narcissistic personality disorder (a disorder in which a person has an inflated sense of self-importance), lack of coordination, and anxiety disorder. Record review of the MDS dated [DATE] indicated Resident #2 was understood by others and understood others. The MDS indicated Resident #2 had a BIMS of 15 and was cognitively intact. The MDS indicated Resident #1 required supervision with bed mobility, transfers, dressing, eating, toileting, and personal hygiene. Record review of the care plan last revised 8/10/23 indicated Resident #2 did not adjust easily to changes in routine related to manipulative behaviors associated with narcissistic personality disorder. Record review of the care conference report dated 9/28/23 indicated Resident #2 had not had a care conference since admission to the facility. During an interview on 9/27/23 at 2:30 p.m. Resident #2 said she did not know what a care plan meeting/care conference was and asked surveyor to explain it. After explaining a care plan meeting was a meeting including nursing, activities, therapy, management, etc. to discuss a resident's goals and care Resident #2 said she had not had a care plan meeting. Resident #2 said she would be interested in attending her care plan meetings. Resident #2 said the facility was aware of what her goals were as she had expressed them when throwing a fit. 3. Record review of the face sheet dated 9/28/23 indicated Resident #3 was admitted to the facility on [DATE] with diagnoses including cerebral infarction (stroke), muscle weakness, unsteadiness on feet, lack of coordination, and generalized anxiety disorder. Record review of the MDS dated [DATE] indicated Resident #3 was understood by others and understood others. The MDS indicated Resident #3 had a BIMS of 12 and was moderately cognitively impaired. The MDS indicated Resident #3 required limited assistance with toileting and personal hygiene. The MDS indicated Resident #3 required supervision with bed mobility, transfers, and dressing. Record review of the care plan last revised on 9/28/23 indicated Resident #3 was at risk for injury from decrease in activities of daily living. Record review of the care conference report dated 9/28/23 indicated Resident #3's last three care conferences were 6/08/22, 7/23/20, and 5/22/19. During an interview on 9/27/23 at 2:25 p.m., Resident #3 said she had not had a recent care plan meeting. Resident #3 said the last care plan meeting she remembered having was after she moved into the facility. Resident #3 said she would like the opportunity to attend her care plan meetings and have a say in her care. During an interview on 9/28/23 at 9:49 a.m., the DON said the AD was responsible for scheduling care plan meetings. The DON said the AD invited residents and their families to the care plan meetings. The DON said care plan meetings are held weekly on Wednesdays. The DON said each resident should have a quarterly care plan meeting. The DON said residents and their families were supposed to be invited to all care plan meetings. The DON said the facility had been behind on care plan meetings as 455831 Page 2 of 3 455831 09/28/2023 Paris Healthcare Center 610 Deshong Dr Paris, TX 75460

F 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some they had not had an MDS coordinator. The DON said after the facility was cited for residents not being invited to care plan meetings and part of their POC was to get care plan meetings caught up. The DON said the AD had taken over scheduling care plan meetings at that point. The DON said the facility was working on getting all care plans up to date. During an interview on 9/28/23 at 10:07 a.m., the AD said she and the DON took over care plan meetings and scheduling them after being cited by state approximately a couple months ago. The AD said she invited the residents in person to their care plan meetings and called the families to invite them to the care plan meetings. The AD said care plan meetings were held weekly at the facility. The AD said each resident should have a quarterly care plan meeting. Record review of facility's Care Plans, Comprehensive Person-Center policy dated 2001 indicated, A comprehensive, person centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial, and functional needs is developed and implemented for each resident .The Interdisciplinary Team in conjunction with the resident and his/her family or legal representative, develops and implements a comprehensive, person-centered care plan for each resident .Each resident's comprehensive, person-centered care plan will be consistent with the resident's rights to participate in the development and implementation of his or her plan of care, including the right to: a. Participate in the planning progress. b. Identify individuals or roles to be included. c. Request meetings. d. Request revisions to the plan of care. e. Participate in establishing the expected goals and outcomes of care. f. Participate in determining the type, amount, frequency, and duration of care .The care planning process will: a. Facilitate resident and/or representative involvement .The interdisciplinary Team must review and updated the care plan: .d. At least quarterly, in conjunction with the required quarterly MDS assessment . Record review of the facility's Resident Participation-Assessment/Care Plans revised February 2021 indicated, The resident and hir or her representative are encouraged to participate in the resident's assessment and in the development and implementation of the resident's care plan. The resident and his or her legal representative are encouraged to attend and participate in the resident's assessment and in the development of the residents person-centered care plan . 455831 Page 3 of 3