Health inspection·May 25, 2023

F 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 that a resident who needed respiratory care, including tracheostomy care, was provided such care, consistent with professional standards of practice for one (Resident #1) of four residents reviewed for respiratory care. Residents Affected - Few RT B failed to follow the procedure for tracheostomy care for Resident #1 when he failed to maintain a sterile/clean field for supplies necessary for care and failed to change his gloves and perform hand hygiene before applying a clean trach drainage sponge and before suctioning the resident. These failures could place residents with tracheostomies at risk for respiratory infections and the risk of lung infections. Findings include: 1. Review of Resident #1's Face Sheet dated 05/24/23 reflected a [AGE] year-old male with an admission date of 04/26/23. Review of Resident #1's comprehensive MDS assessment, dated 05/02/2023, reflected the resident was unable to participate in the interview for cognition. His active diagnoses included respiratory failure, dependence on respirator [ventilator] status, and tracheostomy status. In Section O-Special Treatments, Procedures, and Programs it revealed that he required tracheostomy care (a surgical opening in the neck providing a direct airway through the trachea), suctioning, oxygen therapy and Invasive Mechanical Ventilator. Review of Resident #1's Physician orders summary dated May 2023, reflected, .Clean trach site and change dressing every shift with a start date of 04/30/23 .change inner cannula daily and prn as needed with a start date of 04/27/23 . Review of Resident #1's care plan dated 04/27/23, reflected, .The resident has a tracheostomy r/t respiratory failure .Goal .The resident will have clear and equal breath sounds bilaterally through the review date .Interventions .Suction as necessary .Use universal precautions as appropriate An observation on 05/24/23 at 11:29 AM revealed RT B entered Resident #1's room to provide tracheostomy care. RT B placed the tracheostomy kit on the resident's bedside table. RT B performed hand hygiene and donned gloves. RT B removed the old tracheostomy drainage sponge from around the resident's tracheostomy and discarded it in the trash can. RT B removed and discarded the dirty gloves. Without performing hand hygiene, RT B opened the tracheostomy care kit (holds sterile supplies for cleaning tracheostomy). RT B without performing hand hygiene he donned sterile gloves; RT B held the (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 675212 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)