Health inspection·February 21, 2024

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure all drugs were stored in a locked compartment and only accessible by authorized personnel for 1 of 12 (Resident #1) residents reviewed for medication storage. The facility failed to keep medication being administered under the direct observation of the person administering medications. Resident #1 had a medication cup with 1 tablet and 1 capsule sitting on top of his bedside table on 02/15/2024. This failure could place residents at risk for health complications and not receiving the intended therapeutic benefit of their medication. Findings included: During an observation on 02/15/2024 at 12:29 PM revealed Resident #1 had a clear plastic medication cup with 1 tablet and 1 capsule sitting in a clear plastic medication cup on the bedside table. Resident #1 stated the medication belonged to him. Resident #1 stated the medication was to make his leg feel better. Record review of face sheet, dated 02/20/2024, revealed Resident #1 was an [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses which included cerebral infarction (occurs as a result of disrupted blood flow to the brain due to problems with the blood vessels that supply it), hemiplegia and hemiparesis of right side (muscle weakness or partial paralysis on one side of the body that can affect the arms, legs, and muscles), specified dementia with behavior disturbance (mental disorder in which a person loses the ability to think, remember, learn, make decisions, and solve problems.), chronic obstructive pulmonary disease (a group of lung disease that blocks airflow and makes difficult to breath). Record review of Resident # 1's care plan, dated 11/03/2021, did not address medications left at bedside. Record review of the MDS Comprehensive Assessment, dated 12/26/2023, indicated Resident #1 had a BIMS score of 5 (severely impaired cognition). The assessment indicated Resident #1 did not reject care necessary to achieve the resident's goals for health or well-being. Record review of the Order Summary Report dated 02/20/2024, indicated Resident #1 was ordered to Page 1 of 4 675020 675020 02/21/2024 Greenville Health & Rehabilitation Center 4910 Wellington St Greenville, TX 75402

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few receive Gabapentin Oral Capsule 100 mg by mouth three times a day related to pain in right ankle and joints of right foot. Tylenol Extra Strength Oral Tablet 500 mg by mouth four times a day for right foot pain. Record review of the Medication Administration Record dated 02/15/2024, indicated Resident #1 was received Gabapentin Oral Capsule 100 mg by mouth three times a day related to pain in right ankle and joints of right foot. Tylenol Extra Strength Oral Tablet 500 mg by mouth four times a day for right foot pain. During an interview on 02/15/2024 at 02:00 PM., MA B stated the requirement for a resident to be able to self-administer medications was that they must know what medications they take, the strength of the medication, what the medication was for, and how to take the medication. MA B stated residents who were unable to self-administer medications should not have them at bedside. MA B stated she has never left medications at bedside before the incident. MA B stated she had observed Resident #1 put the cup with the medication to his mouth and she was called out into the hall. MA B stated she left the room and failed to follow back up to ensure the resident had taken the pills. MA B stated it was important to not keep medication at the bedside in case of overdose or the potential of not achieving a therapeutic level for the resident's pain if medication not taken properly and timely. MA B stated if another resident could take the medication resulting in harm or death. During an interview on 02/15/2024 at 02:35 PM, the DON stated to ensure medications were not left at bedside different department heads would make rounds. The DON stated the department heads made Quality of Life Rounds at 9:00 AM. The DON stated she expects staff to ensure medications aren't left at bedside by ensuring the resident takes the medication or the medication was disposed of properly with physician and family notified appropriately. The DON stated department heads would monitor that medications were not left sitting at bedside by making rounds in the morning. The DON stated each department head will take a hall after every med pass to ensure no medication was left. The DON said an inservice was in progress regarding the 5 Rights of Medication Administration. Record review of the 'Medication - treatment Administration and Documentation Guidelines policy, revised date 04/06/2023, indicated verify and provide medication or treatment focused assessment i.e. BP. P wound measurement as indicate by manufactures guidelines or physician orders. Administer the medication according to the physician order. Document initials and/or signature for medication administration on the MAR or TAR immediately following administration. 675020 Page 2 of 4 675020 02/21/2024 Greenville Health & Rehabilitation Center 4910 Wellington St Greenville, TX 75402

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record reviews the facility failed to establish and 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 diseases or infections and the facility failed to ensure linens were handled, stored, processed, and transported to prevent the spread of infection for 3 of 4 halls (100 hall, 200 hall, and 400 hall), and 3 out of 79 employees (CNA C, CNA D, CNA E) reviewed for infection control practices. Residents Affected - Few 1. The facility did not ensure the clean linen carts (on 100 hall, 200 hall, and 400 hall) were completely covered on 02/15/2024 while not being used. 2. The facility did not ensure CNA E placed soiled linen and trash in the appropriate barrels after providing care on 02/21/2024. These failures could place residents at increased risk for infection or cross-contamination that could diminish the resident's quality of life. The findings included: During an observation 02/15/2024 between 01:15 - 02:30PM, the clean linen cart on 100 hall was open, with the front cover laying on top of the clean linen cart. Dirty linen and trash barrels were approximately 3 feet from the open clean linen cart. During an observation on 02/15/2024 between 01:30 PM - 2:45 PM the clean linen cart on 200 hall and 400 hall was open, with the front cover laying on top of the clean linen cart. During an observation on 02/21/2024 between 09:00 AM to - 09:30 AM, the clean linen cart on 100 hall was open, with the front cover laying on top of the clean linen cart. Dirty linen and trash barrels were approximately 3 feet from the open clean linen cart. The dirty linens were carried on top of the barrels in clear bags down 100 hall by CNA D. During an interview on 02/15/2024 at 2:30 PM, CNA C stated clean linen carts should have been kept covered. CNA C stated she forgot to close the clean linen cart on 400 hall because she was helping out on 200 hall also. CNA C stated it was important to ensure clean linen carts remained closed with barrels of dirty items kept separated from the clean linen cart because of infection control. During an interview on 02/15/2024 at 2:45 PM, CNA E stated clean linen carts should have been covered and the front cover should have been down. CNA E stated she forgot to pull it down on 100 hall. CNA E stated it was important to ensure clean linen carts remained closed and dirty barrels from the clean items because it could have caused cross-contamination. During an interview on 02/21/2024 at 09:37 AM, CNA D stated clean linen carts should have been kept covered. CNA D stated she put the front cover down when she realized it was up on 100 hall. CNA D stated it was important to ensure clean linen carts remained closed to prevent cross-contamination. CNA D stated the items carried on top of the barrel were contaminated/contagious that was why she did not place inside the barrel for transport down 100 hall. During an interview on 02/21/2024 at 10:25 AM, the DON stated she expected the nursing staff to 675020 Page 3 of 4 675020 02/21/2024 Greenville Health & Rehabilitation Center 4910 Wellington St Greenville, TX 75402

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few ensure clean linen carts were kept covered. The DON stated that was monitored by random checks. The DON stated it was important to ensure linen carts were kept covered, the dirty barrels kept away from clean linen carts, and to transport the contaminated/contagious dirty items in a yellow bag inside the barrels to prevent the spread of infection or cross-contamination. Record review of the Infection Prevention and Control Program policy, revised 04/12/2023, indicated 4. Standard Precautions: b. Hand hygiene shall be performed in accordance with our facility's established hand hygiene procedures. The policy further revealed 11. Linens: d. Linen shall be stored on all resident care units on covered carts, shelves, in bins, drawers, or linen closets. E. Soiled linen shall be collected at the bedside and placed in a linen bag. When the task is complete, the bag shall be closed securely and placed in the soiled utility room. Soiled linen shall not be kept in the resident's room or bathroom. 675020 Page 4 of 4