Health inspection·October 14, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure each resident was treated with respect, dignity, and care, in a manner and in an environment that promotes the maintenance or enhancement of their quality of life, recognizing each resident's individuality. The facility failed to protect and promote the rights of the resident for 1 (Resident #2) of 6 residents observed for dignity. The facility failed to ensure Agency CNA B provided Resident #1 with privacy during a bed bath and brief change. This failure could place residents at risk for diminished quality of life and loss of dignity and self-worth. The findings included: Record review of Resident #1's face sheet, printed on 10/14/23, revealed a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses of hemiplegia and hemiparesis following cerebral infarction affecting right dominant side (paralysis of partial or total body function on one side of the body), cerebral infarction (stroke), muscle weakness, dysarthria following cerebral infarction, lack of coordination, glaucoma, essential hypertension, muscle wasting and atrophy, right and left shoulder, memory deficit, type 2 diabetes mellitus, and major depressive disorder. Record review of Resident #1's annual MDS assessment, dated 09/27/23, revealed Resident #1 had a BIMS score of 12, indicating Resident #1 had moderate cognitive impairment. Section G of the assessment revealed Resident #1 required extensive two-person physical assistance with ADLs of bed mobility, transfers, dressing, toilet use, personal hygiene and required total one-person assistance in bathing. Record review of Resident #1's care plan, initiated on 11/04/22 revealed a goal of I have an ADL Self Care Performance Deficit r/t CVA with interventions to include BATHING: I require moderate assistance with bathing/showering 1 staff member. In an observation of room [ROOM NUMBER] on 10/14/23 at 4:03 p.m., surveyor knocked on the rooms open door and began to ask residents present permission to enter the room. At this time CNA B yelled patient care, surveyor paused at the threshold to ensure no residents privacy was jeopardized. CNA B then walked to the foot of the bed, which was visible from the hall, stated patient care again and pulled Resident #1's privacy curtain to partially cover half of her bed. CNA B asked surveyor if she need to speak with Resident #1 or the resident in the B bed, who was standing on the B side of the Page 1 of 3 675212 675212 10/14/2023 The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few room. The room divider curtain was not drawn. As surveyor stood in the hall outside of room [ROOM NUMBER], for approximately 5 minutes, CNA B was observed to be providing care to Resident #1, emptying a water basin, leaving the room to obtain incontinent supplies from the supply cart and returning to Resident #1, without closing the door. In an interview attempt on 10/14/23 at 4:10 pm, Resident #1 stated she was well but declined to further speak with surveyor. In an interview on 10/14/23 at 4:12 p.m., CNA B stated she was an agency aide, and it was her second time working in the facility. CNA B stated she had provided Resident #1 a bed bath and was finishing up when surveyor knocked on the open door of room [ROOM NUMBER]. CNA B stated when personal care was provided to residents, the curtain should be pulled to protect the resident. CNA B stated she did not pull Resident #1's curtains because they were stuck, she stated she did not close the door because Resident #1's roommate was in and out of the room. CNA B stated she received training from her staffing agency and had not been apart of any facility held in-services. CNA B stated providing personal care with the door and curtains open could expose the resident to people in the hallway. In an interview on 10/14/23 at 4:15 p.m., LVN C stated she was the nurse for the 600 hall. LVN C stated she was not aware Resident #1 received personal care with the curtains and door open. LVN B stated when a resident received care, the door and curtains should be pulled to protect the resident's privacy. LVN B stated it was the responsibility of the staff member providing care to protect the resident's privacy and not doing so could cause a resident to lose their sense of self and dignity. In an interview on 10/14/23 at 6:07 p.m., the ADON stated she was made aware of the surveyors' observation and stated CNA B should have staff should have knocked on the door introduced herself, obtained verbal consent for the care being provided, pulled the curtain for privacy, closed the door and provide the care. The ADON stated any nursing staff member who provided care were responsible for ensuring the privacy of the resident was protected. The ADON stated not ensuring the residents privacy was protected while they received care could cause emotional distress. The ADON stated they have begun to in-service all nursing staff on privacy and have placed CNA B on the do not return list, barring her from selecting shifts at the facility in the future. In an interview on 10/14/23 at 6:40 p.m., the RDCO stated nursing staff should be closing doors and privacy curtain and should be cognizant of the resident's privacy, as it was their responsibility. The RDCO stated not closing doors and privacy curtains could affect the resident's sense of dignity and would restrict their privacy. The RDCO stated she and the ADON have started to in service nursing staff on privacy and dignity and will conduct hall audits to ensure resident privacy was protected at all times in the future. In an interview on 10/14/23 at 7:00 p.m., the AADMIN stated it was expected for nursing staff to provide and respect the rights of any residents who receive care. the AADMIN stated staff are continually educated on resident rights and in services were started following this incident. The AADMIN stated hall sweeps would be conducted at random to ensure residents privacy was protected. Review of the facility's policy entitled Dignity, revised in February 2021, read in part: Policy Statement: Each resident shall be cared for in a manner that promotes enhances his or her of well-being, level of satisfaction with life, and feelings of self-worth and self-esteem. Policy Interpretation and Implementation: 1. Residents are treated with dignity and respect at all times .11. 675212 Page 2 of 3 675212 10/14/2023 The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020

F 0550 Staff will promote, maintain, and protect resident privacy, including bodily privacy during assistance with personal care and during treatment procedures . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 675212 Page 3 of 3