Health inspection·November 14, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 ensure residents who were unable to carry out activities of daily living received necessary services to maintain personal hygiene for two (Resident #1 and Resident #2) out of five residents reviewed for showers, in that: Residents Affected - Some The facility failed to provide showers to Resident #1 and Resident #2 in compliance with their shower schedules. This failure placed residents at risk of a decline in hygiene, at risk of skin breakdown, level of satisfaction with life, and feelings of self-worth. Findings included: Review of Resident #1's undated face sheet reflected a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including end-stage renal disease, type II diabetes, chronic obstructive pulmonary disease (a type of progressive lung disease), and depression. Review of Resident #1's admission MDS assessment, dated 11/13/23, reflected a BIMS of 13, indicating no cognitive impairment. Section G (Functional Status) reflected she required extensive assistance with all ADLs. Review of Resident #1's admission care plan, dated 11/08/23, reflected she had a physical functioning deficit with transfers and required assistance of two people. Review of Resident #1's bathing task in her EMR, from 11/05/23 - 11/14/23, reflected no documentation that a shower/bath had been given. Review of the facility's shower sheets for the month of November 2023, reflected one documented shower sheet for Resident #1 dated 11/09/23. During and observation and interview on 11/14/23 at 9:02 AM revealed Resident #1 was in her room sitting on her bed with her head down. She stated she was upset because she felt dirty. She stated when she was given a shower it was always rushed but she rarely got one. She stated she could not remember the last time she received one and it made her feel bad. Review of Resident #2's undated face sheet reflected an [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including unspecified dementia, muscle wasting and atrophy (wasting away), bed confinement, need for assistance with personal care, and age-related physical Page 1 of 2 675075 675075 11/14/2023 Diversicare of Luling 208 Maple St Luling, TX 78648

F 0677 debility. Level of Harm - Minimal harm or potential for actual harm Review of Resident #2's admission MDS assessment, dated 09/20/23, reflected a BIMS of 14, indicating no cognitive impairment. Section G (Functional Status) reflected she was totally dependent for ADL care. Residents Affected - Some Review of Resident #2's admission care plan, dated 09/28/23, reflected she had an ADL self-care performance deficit related to lateral sclerosis (a nervous system disease that affects nerve cells in the brain and spinal cord) with lower extremity paraplegia (paralysis of all or part of your trunk, legs, and pelvic organs) with an intervention of extensive assistance from 1-2 staff with ADLs. Review of Resident #2's bathing task in her EMR, from 10/14/23 - 11/14/23, reflected she received four bed baths on 10/17/23, 10/26/23, 11/02/23, and 11/07/23. Review of the facility's shower sheets for the month of November 2023, reflected no documented shower sheets for Resident #2. During an observation and interview on 11/14/23 at 9:09 AM revealed Resident #2 in bed watching television. Her hair and face were greasy. She stated the aides used to give her bed baths, which she prefers, but they stopped weeks ago. She stated she know obtained her own wipes and tried to wash her chest and arm pits but that was all she could reach. She stated not getting a full bed bath regularly made her feel bad and not too clean. During an interview on 11/14/23 at 10:22 AM, CNA A stated she felt like they were short-staffed and it was hard to get all showers completed and there were some days residents would go without. She stated the aides documented showers in the kiosk and filled out shower sheets. During an interview on 11/14/23 at 12:26 PM, the DON stated it was her responsibility to ensure showers were being given and shower sheets were filed in the binder at the nurses' station. She stated she tried to review the binder every couple of days. She stated the aides were supposed to document showers in the kiosk and on the shower sheets. She stated if a resident refused a shower, the aides were to notify the nurses so they could try encouraging the resident and could document the refusal in their chart. She stated refusals were also to be documented on shower sheets. She stated a potential outcome of not receiving showers regularly was there would be a higher risk of infection. She stated they did not have a policy on ADL care or showers. 675075 Page 2 of 2