Health inspection·January 19, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident that included measurable objectives and timetables to meet a resident's medical and nursing needs for one (Resident #1) of four residents reviewed for care plans, in that: The facility failed to develop a care plan for Resident #1's sacrum (a shield shaped bony structure that is located at the base of the lumbar vertebrae and that is connected to the pelvis) stage four pressure ulcer and the care plan did not address his non-compliance with treatment. This failure could place residents at risk for not having their individual care needs met, errors in providing care, poor wound healing/worsening wound condition. Findings included: Review of Resident #1's Face Sheet dated 1/4/2024 reflected a [AGE] year-old male admitted to the facility on [DATE] and readmitted on [DATE] with the following diagnoses Adult failure to thrive (older adult has a loss of appetite, eats and drinks less than usual, and is less active than normal), Osteomyelitis of vertebrae (painful bone infection that develops from bacteria or fungi, is itself rare), Chronic Obstructive Pulmonary Disease (chronic condition in which a patient's lungs are susceptible to infections and moreover, the infections show exaggerated symptoms in the patients. Hence there is higher risk of morbidity and mortality in the patients suffering from COPD (as compared to normal people), and chronic respiratory failure (when the lungs cannot get enough oxygen into the blood or eliminate enough carbon dioxide from the body). Review of Resident #1's Quarterly MDS dated [DATE] reflected Resident #1 was assessed to have a BIMS score of 13 indicating cognition was intact. Resident #1 was assessed to be dependent on staff for ADL assistance. Resident #1 was assessed to have unhealed pressure ulcer and a wound infection. Resident #1 was on routine pain medications. Review of Resident #1's Comprehensive Care Plan dated from 12/04/2023 to 01/04/2024 reflected a focus area revised on 12/21/2023 Resident #1 had pain. Resident #1 had COPD. Resident #1 was assessed for intolerance related to imbalance between supply oxygenation needs. Resident #1 pressure ulcer to the sacrum was not assessed on the current care plan dated 12/21/2023. Review of Resident #1's Consolidated Physician orders dated from 12/04/2023 to 01/04/2024 reflected an order dated 09/26/2023 reflected daily wound treatment: Stage 3; clean with NS/NC; pat dry: apply skin prep to wound edges; apply honey alginate calcium to wound bed; cover with foam silicone Page 1 of 2 675132 675132 01/19/2024 Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629

F 0656 bordered dressing QD (every day) and PRN (as needed). Order was d/c (discharged ) on 12/07/2023. Level of Harm - Minimal harm or potential for actual harm Review of Resident #1's Consolidated Physician Orders dated from 12/04/2023 to 01/04/2024 reflected an order dated 11/08/2023 with an end date of 11/23/2023 reflected daily wound treatment: special instructions: alginate calcium apply once daily for 15 days. Foam silicone bdr (do not know acronym for bdr) and faced apply once daily for 15 days once a day. Residents Affected - Few Review of Resident #1's Consolidated Physician Orders dated from 12/04/2023 to 01/04/2024 reflected an order dated 12/07/2023 reflected daily wound treatment to sacrum. Superabsorbent gelling fiber pad apply once daily for 16 days; Sodium hypochlorite gel (anasept) apply once daily for 30 days. Order was d/c on 01/05/2024. Review of Resident #1's Consolidated Physician Orders dated from 12/04/2023 to 01/04/2024 reflected an order dated 12/29/2023. Daily wound treatment: sacrum; negative pressure wound therapy apply three times per week for 30 days: 125 mm hg, black or green foam in wound bed, bridge to either hip. Change TIW the bone in the wound bed just slightly larger than the wound cavity. End date 01/30/2024. *Review on 01/19/2023 of Resident #1's Care Plan Conference Summary reflected the issue of non-compliance with repositioning was discussed with family and family offered support for encouraging the resident. Review on 01/19/2024 of Resident #1's Care Plan reflected no interventions to address resident's non-compliant with treatment. In an interview on 01/04/2023 at 3:30 PM the ADON stated the facility was trying to update all the documents into the new electronic medical records. She stated all the documents related to Resident #1 were reviewed by her and she thought the pressure ulcer was on the care plan. She stated it was her responsibility to complete care plans and she did not know why the wound for Resident #1 was not on the care plan. She stated all medical, emotional, behavior issues with a resident were expected to be on the care plan. The ADON stated the care plan was how all staff knew what type of care a resident has been identified by the interdisciplinary team. She stated there was a possibility a resident may not receive the appropriate care during their stay at the facility. In an interview on 01/04/2024 at 4:00 PM the Administrator stated the ADON was responsible for care plans and he did not understand why Resident #1's wound was not on the care plan. He stated he did not know what to say about the care plans. He stated all residents' medical needs were expected to be on the care plan. He stated the resident may not get the care needed. In an interview on 01/04/2024 at 4:10 PM requested a care plan policy from the Administrator and it was not provided at the time of exit. 675132 Page 2 of 2