Health inspection·February 7, 2023

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview and record review, the facility failed to ensure that drugs and biologicals used in the facility were secured properly for 1 of 6 medication carts (Hall 100 nurse medication cart) reviewed for drug storage. The facility failed to ensure Hall 100 medication cart was secured when not in use or unattended. This failure could place residents who reside in the facility at risk of possible drug diversion. The findings included: During an observation and interview on 2/5/23 at 8:50 a.m. the Hall 100 nurse medication cart was unlocked and across the hall from a room on Hall 100 and LVN D was in the room speaking with a resident with her back to the cart. The medication cart was not in her sight and no staff was in the hall within eyesight. LVN D returned to the medication cart and said she just went to the resident and said she should have locked the cart to prevent any of the residents from getting into her cart. The medication cart contained insulin, cards of prescription medications, and over the counter medications. During an observation and interview on 2/5/23 at 11:38 a.m. to 11:43 a.m., the Hall 100 nurse medication cart in front of the nurse's station on Hall 100 and was unlocked and contained insulin, cards of prescription medications, and over the counter medications. There were no nursing staff in sight and after observing the unlocked and unattended medication cart. During an observation and interview on 2/5/23 at 11:44 a.m., the DON was walking towards the unlocked medication cart and LVN D opened a door and walked out of a room behind the nurse's station. LVN D said yes that the unlocked medication cart was hers. LVN D said no one else had the keys and she must have left it unlocked again. LVN D said she had been trained to secure her medication cart any time it was not in her eyesight. During an interview on 2/5/23 at 11:46 a.m., The DON said the nurses were responsible for securing their carts. Record review of Security of Medication Cart policy dated April 2007 indicated The medication cart shall be secured during medication passes. 1. The nurse must secure the medication cart during the medication pass to prevent unauthorized entry. 2 The medication cart should be parked in the doorway of the resident's room during the medication pass. 3. The cart must be locked before the nurse Page 1 of 3 455952 455952 02/07/2023 Cleveland Health Care Center 903 E Houston St Cleveland, TX 77327

F 0761 enters the resident's room. 4. Medication carts must be securely locked at all times when out of the nurse's view. 5 When the medication cart is not being used, it must be locked and parked at the nurse's station . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 455952 Page 2 of 3 455952 02/07/2023 Cleveland Health Care Center 903 E Houston St Cleveland, TX 77327

F 0805 Level of Harm - Minimal harm or potential for actual harm Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Based on observation, interview and record review, the facility failed to provide food in a form designed to meet individual needs for residents reviewed for food form. Residents Affected - Few The facility failed to ensure the residents who required a pureed textured diet, received the appropriate food form to meet their needs on 02/05/23 for the noon meal. The pureed food had lumps of food not fully pureed and was thick and dry in consistency. This failure could place the residents at risk of aspiration and choking. Findings included: During observation of a test tray on 02/05/23 at 12:55 p.m., the pureed chili, pureed corn chips and pureed refried beans contained small lumps of partially pureed food particles and were thick and dry in consistency. The food items were not of pudding consistency and were not easily swallowed. During an interview on 02/05/23 at 12:57 p.m. [NAME] A said he was the person responsible for pureeing the food. During a taste test, he said the pureed food did have lumps of food that had not been fully pureed and was thick, dry and not of pudding consistency. He said the residents could possibly have difficulty swallowing the food. During an interview on 02/06/23 at 3:10 p.m., DM B said she had come from a sister facility that morning to in-service [NAME] A on how to puree food and the correct consistency of pureed food. She said she did in-service [NAME] A on the consistency of the pureed food that morning. She said the pureed food should be of pudding consistency. She said the possible negative outcome of the pureed food not being the correct consistency would be the residents could choke. During an interview on 02/06/23 at 3:30 p.m., the administrator said the pureed food should be the appropriate texture for the diet the resident was ordered. She said the possible negative outcome would be the resident could aspirate. She said her expectations were for the residents to receive the food in the correct consistency. During an interview on 02/06/23 at 3:40 p.m., DM C said the pureed food should be of baby food consistency, not too thick or dry. She said the possible negative outcome of the pureed food being too thick and dry was the residents could choke. She said she had trained [NAME] A on how to puree food and the dietitian had trained her. She said her expectations were for the residents to receive the correct form of food as ordered. Record review of the diet roster dated 02/06/23 indicated 8 residents received a pureed diet. Review of the undated IDDSI- Level 4 Pureed policy indicated: Definition: A diet used in the dietary management of dysphagia with food texture modification described as foods that are smooth and lump-free, not firm or sticky, require no chewing or bolus formation, fall off of the spoon as an intact spoonful, and hold shape on a plate . A column titled Foods not Recommended indicated any item that is not pureed or has lumps. Protein foods not pureed into smooth, lump free items. 455952 Page 3 of 3