Health inspection·September 29, 2025

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and records review the facility failed to ensure that residents (Resident #1) environment remains as free of accident hazards. The facility failed to ensure Resident #1 was free of accidents and hazards, as Resident #1 spilled a hot liquid onto her leg. Resident #1 sustained a second-degree burn to her left thigh. This failure placed residents at risk of serious harm and injuries which could result in hospitalization and a diminished quality of life. Findings included: Observations on 9/26/2025, at 10:00 a.m. revealed no hot water dispensers were observed in the halls of the facility. Observation and interview on 09/26/2025, at 12:25 p.m. revealed Resident# 1 was observed lying in bed and watching TV. Resident#1 stated she expressed that she is doing well overall. While she did mention having a burn on her leg, she said she was not in pain, and that she felt safe in the facility. Resident #1 mentioned that she was aware that the water dispenser provided hot water and had used it in the past without any issues. Additionally, Resident #1 expressed interest in having a coffee machine available for use. Record Review of Resident #1's face sheet, revealed an [AGE] year-old-female, with a current admit date of 01/02/2024. Resident #1's face sheet further revealed diagnoses including senile degeneration of the brain, arthritis, unspecified dementia, and mobility issues. Review of Resident #1's Minimum Data Set (MDS) dated [DATE], for Resident #1 indicated a BIMS score of 10, suggesting moderate cognitive impairment.Record Review of Resident # 1's Provider Investigation Report, reflects on 9/21/2025 the Resident let CMA know she had spilled hot water on her lap. The water machine was immediately unplugged, and the resident was assessed. POA, Physician and DON were notified. Record Review of Resident #1's progress dated and timed 09/22/2025 at 10:04 PM (p.m.), revealed, the resident was seen today after she spilled hot water on her leg causing a burn. The resident was seen sitting in her wheelchair, able to stand to remove pants for assessment. No pain with standing. The exam showed Resident with a second degree burn to Resident #1's thigh and a Left lateral upper leg with 2 open areas from hot water burn. Record Review of Resident #1's wound care notes created and signed by PA-C - 1, date and timed 09/23/2025 at 07:11 PM, revealed, an [AGE] year-old English speaking female was being seen today for wound(s). At the request of a thorough wound care assessment and evaluation was performed today. Exam showed Resident #1 sustained burns to her left thigh on 9/21/25 when she spilled 180 degrees F water onto her lap. Reports moderate pain. Comprehensive wound care orders require the application of Silvadene to wound beds. Layer with xeroform. Secure with dry dressing or bordered dressing. Record review of Resident #1's physician's orders, dated 9/25/2025, revealed Resident #1's injury was being treated with Silvadene External Cream 1 %. Record review for Resident# 1 in the assessment section of PCC revealed a Hot liquid Assessment was not found. Interview on 9/26/2025, at 1:32 pm CNA A stated she had been employed at the facility for 10 years and attended an in-service training session yesterday. She received training on handling hot beverages as well as protocols related to abuse and neglect. CNA A was knowledgeable about Page 1 of 3 455917 455917 09/29/2025 Deer Creek Nursing and Rehabilitation 555 Ranch Rd 3237 Wimberley, TX 78676

F 0689 Level of Harm - Actual harm Residents Affected - Few the proper reporting procedures for incidents and understood the importance of safety regarding hot beverages. She utilized the EMR to verify which residents were permitted to have hot drinks and knew to consult with the nurse for any further clarification on this matter. Interview on 9/26/2025, at 1:41pm CNA B stated her commitment to resident safety. CNA B participated in monthly in-service training on abuse and neglect and understood the importance of reporting any incidents to the administration. CNA B recently completed training focused on beverage temperatures, ensuring that they remain below 135 F. When a resident requested a hot drink, CNA B took the necessary precautions by holding the item for them and confirming that it was safe. CNA B also checked the computer for any restrictions related to hot items for residents. Interview on 9/26/2025, at 1:53pm RN A stated she actively participated in monthly in-service trainings focused on preventing abuse and neglect and was well-versed on the procedures for reporting incidents to administration. Recently, RN A completed an in-service training session on the safe preparation and serving of hot beverages, including teas and coffee. This training highlighted the importance of checking beverage temperatures to ensure resident safety. She emphasized the necessity of assessing each resident's abilities to determine their safety in performing specific activities. Interview on 9/26/2025, at 1:56pm the DON stated that all staff members received in-service training on abuse and neglect in August of 2025. An upcoming in-service session focused on the safe handling of beverages and snack drinks was scheduled for Monday, October 1, 2025. The DON shared a recent incident in which a Resident # 1 accidentally spilled a drink. Resident# 1 had placed the cup between her leg and the wheelchair, resulting in a spill on her leg. The DON emphasized the facility's commitment to continuous education and the safety and well-being of both residents and staff. Interview on 9/26/2025, at 1:56pm, with the DON stated that she has neither seen nor heard of a hot liquid assessment related to hot beverages. She indicated that decisions regarding beverage safety were typically based on the residents' diagnosis and functional abilities. When asked about the potential impact of such an assessment on residents, she acknowledged uncertainty, as she was not familiar with its specifics. The DON confirmed that there has been no implementation of a hot beverage assessment at the facility.Hot Liquid Safety Policy Provided on 9/27/2025:Hot liquids are to be served at proper (safe and appetizing) temperatures using appropriate safety precautions.Definitions:Proper (safe and appetizing) temperature means both appetizing to the resident and minimizing the risk forscalding and bums.Scalding is a bum caused by spills, immersion, splashes, or contact with hot water, food and hot beverages,or steam.Policy Explanation and Compliance Guidelines:1. Hot liquids can cause scalding and bums. The degree of injury depends on the temperature, the amount ofskin exposed, and the duration of exposure. Refer to the table attached to this policy for an illustration ofthe time required for a bum to occur at various temperatures.2. The temperatures of hot liquids will be checked in the dietary department prior to distribution to thenursing units. If the temperature is greater than 140 degrees Fahrenheit, hold the liquid in the dietarydepartment until it reaches an appropriate: temperature.3. All residents are assessed for their ability to handle containers and consume hot liquids. Residents withdifficulties will receive appropriate supervision and use of assistive devices in order to consume hotliquids. Interventions will be individualized and noted on the resident's plan of care. Interventions include,but are not limited to:a. Wide-based cupsb. Cups with lids and handlesc. Limit Styrofoam cups to residents with no difficultiesd. Apronse. Disallow hot liquids while lying in bed4. Staff shall respond immediately to spills or other accidents with hot liquids to minimize the risk for burns.Follow procedures regarding incidents/accidents should anyone experience exposure to hot liquids.5. Monitor residents for at least 24 hours following exposure to hot liquids, as redness or blisters may notappear initially.6. General safety 455917 Page 2 of 3 455917 09/29/2025 Deer Creek Nursing and Rehabilitation 555 Ranch Rd 3237 Wimberley, TX 78676

F 0689 Level of Harm - Actual harm Residents Affected - Few precautions when serving hot liquids include, but are not limited to:a. Make sure residents are alert and in proper positioning to consume hot liquids.b. Use cups, mugs, or other containers that are appropriate for hot beverages.c. Do not overfill containers.d. Regulate temperature of hot liquids to which residents have direct access.e. Place filled containers directly on table. Do not hand them directly to residents.f. Keep hot liquids away from edges of the table.g. Do not refill containers while the resident is holding the container. 455917 Page 3 of 3