Health inspection·December 14, 2023

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review the facility failed to ensure the resident had the right to be free from abuse or neglect for 1 of 5 residents (Resident #2), reviewed for abuse. The facility failed to ensure Resident #2 was free from verbal abuse/neglect by CNA B. The failure could place residents at risk for abuse/neglect, humiliation, intimidation, fear, shame, agitation, and psychological damage. Findings included: Record review of Resident #2's face sheet dated 12/13/23 indicated she was a [AGE] year-old female admitted on [DATE] with diagnoses of neuroleptic induced parkinsonism (tremor and rigidity), Meniere's disease (ear disorder), anxiety disorder (intense and excessive worry), post-traumatic stress disorder (triggered intrusive events), muscle wasting and atrophy (decrease in muscle size). Record review of Resident #2's quarterly Minimum Data Set (MDS) dated [DATE] documented that Resident #2 was understood and had a BIMS (Brief Interview for Mental Status) score of 15, which indicated intact cognition. Record review of the care plan dated 09/12/23 indicated Resident #2 was frequently incontinent of bladder related to urinary urgency (bladder control problem) and occasionally of bowel. During an interview on 12/12/23 at 3:18p.m, Resident #2 stated CNA B has been making her feel very ashamed and depressed on multiple occasions. Resident #2 explained she has urinary urgency and cannot control her bladder. On one occasion CNA B told her; she was nasty and disgusting. She felt bad and told CNA B she cannot help herself. Resident #2 noted her roommate was present when CNA B said she was nasty and disgusting for peeing on her brief. She felt bad and did like being called names because of her illness. She said CNA B shouts at her when she wets her brief. Resident #2 stated she don't understand why CNA B is mean to her. She explained she asked CNA B for water. The aide told her to go get it herself. In an interview with Resident #3 on 12/12/23 at 3:30p.m, she said she has been in the facility for 7 months and roommate of Resident #2. Resident #3 was alert, oriented to name, place, time and situations. Review of her MDS revealed a BIMS score of 15 indicating she was not cognitively impaired. Resident #3 stated she was present when CNA B told Resident #2 that she was nasty and disgusting because she had wet her brief. She said she don't like the way CNA B treats Resident #2. The aide makes Page 1 of 6 455961 455961 12/14/2023 Palo Pinto Nursing Center 200 Southwest 25th Ave Mineral Wells, TX 76067

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident #2 feel bad and depressed. She said she is tired of it. Resident explained the aide should come in and do his jobs instead all the talking and shouting. She feels it saves everybody the headache if he can come and do his job and leave without all the drama. Resident #3 explained the CNA B is very hard on Resident #2, calling her names, complaining about taking care of her. She wishes he will just shut up and do his job. When she heard CNA B call Resident #2 nasty and disgusting, she told CNA C but nothing was done about it. Resident #3 said she remembered one day Resident #2 asked CNA B for water. He told her to go get it herself. She is tired of listening to the aides complain about Resident #2. She said Resident #2 is incontinent and cannot help her bowel and bladder. Resident #3 explained she goes to dialysis three days a week and is not here to hear their complaints but seem like she hears it every day. During interview with CNA B on 12/12/23 at 4:19pm, he was asked what verbal abuse was. He explained verbal abuse was cussing at residents and calling them names. CNA B stated he was familiar and responsible for Resident #2 during the afternoon shifts. He denied calling Resident #2 nasty and disgusting. CNA B explained he said the word nasty and disgusting in presence of Resident #2 but was referring to her brief not the resident. CNA B was also asked why he refused to get water for Resident #2 when she requested it. CNA B explained he was told by the facility to let the resident do more for herself. He believed Resident #2 can get her own water. However, when resident asked for water, he told her he will get it after making up her bed. He stated he did get her the water. In an interview with HK E on 12/14/23 at 10:10a.m, she said she was a housekeeper for the facility. HK E stated he works on hall 4 where Resident #2 resides. She explained she has observed CNA B get mad at Resident #2 when she wets her brief. HK E stated CNA B yells and shouts at Resident #2 just because she cannot control her bladder. On one occasion, CNA B left Resident #2 wet in bed. She decided to help clean the resident and got her a dry new gowns. CNA B stated to her hearing she just a nasty person. HK E explained she can tell Resident #2 feels bad about the way CNA B treats her. HK E was asked if she reported this incident. She said CNA C reported the incident and nothing has been done about it. During an interview on 12/13/23 at 3:36 p.m. with CNA C, she said she was employed for 5 years but no longer works for the company. She explained she left the facility because the Administration was playing favorites and refused to investigate issues of resident abuse. CNA C stated Resident #3 informed her that CNA B called Resident #2 nasty and disgusting. She immediately reported to the ADM. CNA C explained the ADM said she didn't believe CNA B did that and refused to investigate. She was promoted to activity director but quit because the Administration was not paying attention to the resident's welfare. In an interview with ADM on 12/13/23 at 10:12p.m she was informed this surveyor was investigating verbal abuse of Resident #2 by CNA B. The ADM said she was not aware of report of abuse by CNA B. She explained CNA B is good with residents and didn't think he could abuse any resident. Further interview with ADM on 12/13/23 at 3:15p.m revealed she had talked to Resident #2 and Resident #3 and validated the incident. She explained she has reported the abuse to HHSC and have initiated abuse/neglect in-services. The ADM was asked if CNA C informed her of the abuse as reflected on her interviewed. She said CNA C did not report abuse to her. Record review of the facility's policy and procedure titled, Abuse, Neglect and Exploitation. 455961 Page 2 of 6 455961 12/14/2023 Palo Pinto Nursing Center 200 Southwest 25th Ave Mineral Wells, TX 76067

F 0600 Policy: Level of Harm - Minimal harm or potential for actual harm It is the policy of this facility to provide protections for the health, welfare, and rights of each resident by developing, and implementing written policies and procedures that prohibit and prevent abuse, neglect, exploitation and Residents Affected - Some misappropriation of resident property. Verbal abuse: Verbal Abuse means the use of oral, written or gestured communication or sounds that willfully includes disparaging and derogatory terms to residents or their families, or within their hearing distance regardless of their age, ability to comprehend, or disability. Policy Explanation and Compliance Guidelines: 1. The facility provides resident protection that include: a) Prevention/prohibit resident abuse, neglect, and exploitation and misappropriation of resident property. b) Investigation of all allegations listed above and c) Training for new and existing staff on activities that constitute abuse, neglect, exploitation, and misappropriate of resident property, reporting procedures, and dementia management and resident abuse prevention; and d) QAPI program includes review and evaluation of all allegations resident abuse, neglect, and exploitation and misappropriation of resident property. 2. The facility's Abuse Prevention Coordinator is responsible for reporting allegations or suspected abuse, neglect, or exploitation to the state survey agency and other officials in accordance with state law. 3. The facility provides ongoing oversight and supervision of staff in order to assure that its policies are implemented as written. The components of the facility abuse prohibition plan are discussed herein: I. Screening A. Potential employees will be screened for a history of abuse, neglect, exploitation, or misappropriation of resident property. 455961 Page 3 of 6 455961 12/14/2023 Palo Pinto Nursing Center 200 Southwest 25th Ave Mineral Wells, TX 76067

F 0880 Provide and implement an infection prevention and control program. 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 maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable disease and infections for one (Resident #1) of two residents reviewed for infection control practices. Residents Affected - Few CNA A failed to perform proper hand hygiene and glove changes while providing incontinence care to Resident #1. This failure could place residents at risk for the spread of infection. Findings included: Review of Resident #1's face sheet dated 12/13/23, revealed a 39- year- old female admitted to the facility on [DATE] with diagnoses including Constipation, contracture of muscle, hemiplegia (partial or total paralysis), and diabetes mellitus. Review of Resident #1's Quarterly MDS assessment dated [DATE] revealed Resident #1 required total assistance with most activities of daily living (ADLs). Resident #1 was frequently incontinent of bowel and bladder. Review of Resident #1's Care Plan dated 08/15/23 revealed he had bowel and bladder incontinence related to impaired mobility from cerebral infarction (brain lesion). Its goal stated Resident will remain free from skin breakdown due to incontinence. Observation of incontinence care for Resident #1 on 12/13/23 at 11:04 a.m. revealed CNA A washed her hands prior to donning gloves. CNA A removed Resident #1's brief that was soiled with urine and fecal matter. CNA A wiped the resident from front to back. CNA A changed gloves after repositioning Resident #1. She continued to clean the resident. CNA A's gloves were visibly soiled with urine and fecal matter. She did not wash her hands, change gloves, or perform hand hygiene before retrieving Resident #1's clean brief and placing it underneath the resident and fastening. She removed her gloves and picked up the trash. CNA A washed her hands before leaving Resident #1's room. In an interview on 12134/23 at 11:23 a.m. with CNA A, she revealed she should have changed her gloves before retrieving a clean brief and placing it underneath Resident #1. CNA A stated she has been in the facility for 7 years and received infection control training about a week ago. She said the resident could acquire an infection when she did not follow good infection control practices including changing gloves before retrieving the clean brief. During an interview with the DON on 12/13/23 at 3:22 p.m., she revealed she was aware of some of the concerns raised about infection control. She stated she expected the aides to follow the facility protocols during care, one of which was to ensure hand washing and change of gloves as needed while providing care. Review of the facility's incontinent care policy dated 04/17/14 reflected: Purpose: 455961 Page 4 of 6 455961 12/14/2023 Palo Pinto Nursing Center 200 Southwest 25th Ave Mineral Wells, TX 76067

F 0880 To outline a procedure for cleansing the perineum and buttocks after an incontinence episode. Level of Harm - Minimal harm or potential for actual harm Procedure: 1. Assemble equipment Residents Affected - Few 2. Knock on door and request entrance 3. Introduce self, explain procedure, and provide privacy. Note: it is important to describe, as feasible, each step to the patient prior to care provision in order to reduce fear and promote comfort and dignity. 4. Wash hands 5. Put on non-sterile, latex-free gloves 6. Place linen or under pad beneath hips 7. Position on side turned away from caregiver 8. If feces present, remove with toilet paper or disposable wipe by wiping from front of perineum toward rectum. Discard soiled materials and gloves. Wash hands. 9. Put on non-sterile, latex-free gloves 10. Position on back with knees flexed and feet flat on bed ( care may also be provided with patient. sitting on commode or shower chair or in a standing position) 11. Cleanse pen-area and buttocks with cleansing agent wiping from front of perineum toward rectum. Turn patient side to side to cleanse entire affected area, as needed. Rinse with water, If needed or per incontinent product manufacturer's instructions. Page 1 of2 12. Dry pen-area and buttocks from front to back 13. Apply skin protectant products, if needed and, or as ordered, per manufacturer's instructions 455961 Page 5 of 6 455961 12/14/2023 Palo Pinto Nursing Center 200 Southwest 25th Ave Mineral Wells, TX 76067

F 0880 14. Remove linen/under pad and discard Level of Harm - Minimal harm or potential for actual harm 15. Remove and discard gloves 16. Wash hands Residents Affected - Few 17. Apply clean linen/under pad, brief or other incontinent products, as needed 18. Reposition for comfort with call light in reach and provide additional care as needed as requested by patient 19. Return equipment to designated area and clean/dispose as indicated 455961 Page 6 of 6