Health inspection·January 18, 2024

F 0551 Give the resident's representative the ability to exercise the resident's rights. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to ensure that the resident representative had the opportunity to exercise the resident's rights for 3 of 7 residents (Resident #s 2, 3, and 10) reviewed for resident rights in that: Residents Affected - Some The facility failed to inform the residents ' responsible parties that the heater on A hall was not working and offer the choice to move the residents to another room or sister facility. This deficient practice could affect residents and place them at risk for hypothermia and/or decline in health due to exposure to low temperatures. Findings included : Observation, on 1/17/24 at 12:44 pm, of thermostat on the A hall revealed the temperature was 67 degrees Fahrenheit. During an interview on 1/17/24 at 12:40 pm, the Administrator said the heater on A hall went out on 1/14/24. He said the residents on A hall were offered to be moved to another room or their sister facility on 1/15/24. The Administrator said the residents that were currently on the A hall refused to be moved to their sister facility. Record review of Resident #2's admission Record, dated 1/17/24, revealed Resident #2 was admitted to the facility on [DATE] with the following diagnoses: Displaced fracture of greater trochanter (protuberance by which muscle is attached to the upper part of the thigh bone) of right femur (thigh bone), dementia (group of thinking and social symptoms that interferes with daily functioning), muscle weakness, lack of coordination, major depressive disorder, hypertension (high blood pressure), and osteoporosis (weak/brittle bones). Further review of this record revealed Resident #2 had RPs. Record review of Resident #2's MDS assessment, dated 11/9/23, revealed Resident #2 had a BIMS score of 8, suggesting moderately impaired cognition. Record review of Resident #2's Care Plan, dated 1/17/24, revealed Resident #2 had elected to remain on A hall while the heater was being repaired. Record review of Resident #2's nursing progress note written by LVN A, dated 1/17/24, revealed she spoke to Resident #2's RP to inform her of Resident #2's decision to stay in her room while the heater was being repaired. Page 1 of 3 675134 675134 01/18/2024 Whispering Oaks Rehab & Nursing 105 Hospital Dr Cuero, TX 77954

F 0551 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Observation of the thermostat in Resident #2's room revealed the temperature of the room was 68.7 degrees Fahrenheit. During an interview with Resident #2 on 1/17/24 at 1:02 pm, she said that it was cold, she added the facility offered to have her moved to another room or sister facility but did not want to move while the heater was repaired. During an interview with Resident #2's RP on 1/17/24 at 4:24 pm, she said the facility notified her, on 1/17/24, the heater went down, and Resident #2 was asked if she wanted to move but she refused. Record review of Resident #3's admission Record, dated 1/17/24, revealed Resident #3 was admitted to the facility on [DATE] with the following diagnoses: Alzheimer's Disease (disease affecting memory and other important mental functions), psychosis, muscle weakness, dementia (group of thinking and social symptoms that interferes with daily functioning) hypertension (high blood pressure), and anxiety. Further review of this record revealed Resident #3 had an RP. Record review of Resident #3's MDS assessment, dated 10/13/23, revealed Resident #3 had a BIMS score of 1, suggesting severely impaired cognition. Record review of Resident #3's Care Plan, dated 1/17/24, revealed Resident #3 had elected to remain on A hall while the heater was being repaired. Record review of Resident #3's nursing progress note written by LVN A, dated 1/17/24, revealed she spoke to Resident #3's RP to inform him Resident #3's room was cold, but the resident stated he was fine. During an interview with Resident #3 on 1/17/24 at 12:59 pm, he said he was fine and did not want to move while the heater was repaired. During an interview with Resident #3's RP on 1/17/24 at 3:55 pm, he said the facility notified him, on 1/17/24, the heater was not working. He added the facility did not mention moving Resident #3 to another room or sister facility. Resident #3's RP said he preferred if Resident #3 was transferred to the sister facility because the temperature outside was not getting better , and Resident #3 would be closer to the RP. Record review of Resident #10's admission Record, dated 1/17/24, revealed Resident #10 was admitted to the facility on [DATE] with the following diagnoses: Lack of coordination, cognitive deficit, dysphagia (difficulty swallowing), hyperlipidemia (high cholesterol), hypertension (high blood pressure), and end stage renal disease. Further review of this record revealed Resident #10 had an RP. Record review of Resident #10's MDS assessment, dated 12/1/23, revealed Resident #10 had a BIMS score of 3, suggesting severely impaired cognition. Record review of Resident #10's Care Plan, dated 1/17/24, revealed Resident #10 had elected to remain on A hall while the heater was being repaired. Record review of Resident #10's nursing progress note written by LVN A, dated 1/17/24, revealed Resident #10's RP was called to be notified of resident's decision to stay in his room . 675134 Page 2 of 3 675134 01/18/2024 Whispering Oaks Rehab & Nursing 105 Hospital Dr Cuero, TX 77954

F 0551 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 1/17/24 at 1:49 pm, LVN A said all the residents on A hall were their own RPs, with the exception of Resident #3 and Resident #2. She added that Residents #2 and #3 refused to move while the heater was being repaired. LVN A said she called all the affected residents' RPs on 1/17/24. She added the residents were offered to move on Monday (1/15/24) in the afternoon but did not call the RPs on that day. LVN A said there was no specific person responsible for making notification to the RPs, but nobody called. She added notification of changes to the RPs was important because they needed to be notified about their loved ones' condition. On 1/18/24 at 10:15 am, LVN A said the facility policy did not specify a timeframe to make notification of changes to the RPs. During an interview on 1/17/24 at 2:13 pm, the DON said that most of the residents on A hall that decided to stay in their rooms while the heater was repaired were their own RPs. She added that when she realized the RPs should have been notified, the facility began making notifications. The DON said there was no responsible party for making notifications in a situation such as the heater not working because the was not a clinical change. During an interview on 1/18/24 at 10:28 am, the Administrator said the nursing staff was responsible for making notifications of changes. He added there was no time frame on the notification requirement, but the expectation was it be done within a reasonable amount of time . Review of website Weather.com revealed the following temperatures: 1/14/24, 36 degrees Fahrenheit with a low of 19 degrees Fahrenheit; 1/15/24, 26 degrees Fahrenheit with a low of 18 degrees Fahrenheit; 1/16/24, 36 degrees Fahrenheit with a low of 15 degrees Fahrenheit; 1/17/24, 50 degrees Fahrenheit with a low of 42 degrees Fahrenheit. Record review of facility policy titled, Notification of Changes, dated 7/13/15, revealed the following: These rights include the resident's right to: .be notified of his or her medical condition and of any changes in his or her condition. Policy: To provide guidance on when to communicate acute changes in status to MD, NP, and/ responsible party. The facility will immediately inform the resident; consult with the resident's physician; and if known, notify the resident's legal representative or appropriate family member(s) of the following .4. The need to significantly alter the resident's treatment . 6. A change in room or roommate assignment . 675134 Page 3 of 3