Health inspection·December 8, 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 observation, interview, and record review the facility failed to ensure the resident had a right to be treated with respect and dignity for 1 of 3 (Resident #2) residents reviewed for urinary catheter care. The facility failed to place Resident #2's urinary catheter in a privacy bag. This failure could place residents at risk of low self-esteem resulting in a diminished quality of life. Findings include: Record review of the MDS dated [DATE] revealed Resident #2 was a [AGE] year old female admitted [DATE], with a BIMS score of 12 indicating mild cognitive impairment. Medical Diagnoses include nausea with vomiting, muscle weakness, muscle wasting and atrophy, obesity, pressure ulcer of sacral region and cellulitis. Record review of Residents #2 Care Plan dated 10/16/23, Category Urinary Incontinence, stated 'store collection bag inside a protective dignity pouch'. Observation and interview on 12/7/23 at 9:51 a.m., revealed Resident #2 lying in bed watching tv, the urinary catheter bag was placed on the right side down by the foot of the bed, no privacy cover and urinary catheter bag can be seen from hallway. Resident #2 stated she did not know the catheter bag did not have a privacy cover and stated she would like for it to be covered. In an interview with the DON on 12/7/23 at 10:18 a.m., the DON stated she expected that all catheter collection bags on beds and Page 1 of 4 675259 675259 12/08/2023 Avir at Cisco 1404 Front St Cisco, TX 76437

F 0550 wheelchairs be covered by privacy pouch. The DON stated the failure of not placing catheter collection bags in privacy pouches Level of Harm - Minimal harm or potential for actual harm could compromise a residents' dignity. Residents Affected - Few Observation on 12/7/23 at 11:00 a.m., Resident #2 catheter bag was placed in privacy pouch. A policy on catheter care was requested but was not provided by the time of exit. 675259 Page 2 of 4 675259 12/08/2023 Avir at Cisco 1404 Front St Cisco, TX 76437

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 needs respiratory care, is Residents Affected - Few provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, the residents' goals and preferences for 1 of 3 residents (Resident #6) reviewed for respiratory care. The facility failed to ensure Resident #6's nebulizer tubing was kept in bag while not in use. These failures could place residents at risk for respiratory infections. The findings include: Record review of Resident #6's MDS admission assessment dated [DATE], revealed Resident #6 was admitted to the facility on 10/27/23. Section C: Cognitive Patterns revealed a BIMS score of 14 (cognitive). Section I: Active diagnosis revealed Congestive heart failure. Section O did not include the use of nebulizer. Record review of Resident #6's prescription order start date 12/4/23, Resident #6 was to receive, ipratropium-albuterol solution for nebulization; 0.5 mg-3 mg (2.5 mg base)/3 mL; amt: 1; inhalation 2x daily, once during the day and once during the night. Record review of Resident #6's Care Plan revealed reoccurring episodes of wheezing, Goals: improve by Respiratory by changing tubing weekly per facility policy. In an observation and interview on 12/7/23, at 9:30 a.m., Resident #6 was lying in bed watching tv, the nebulizer was sitting on the nightstand on the right-side of the bed, the nebulizer tube and cup was not in a plastic bag for storage when not in use. Resident #6 stated that the last treatment was last night on 12/6/23 at 9:30pm. In an interview with the DON on 12/7/23 at 10:18 a.m., the DON stated she expected the nebulizer cup and tubing be changed once per week, dated, and stored in baggie when not in use. The DON stated the failure to store 675259 Page 3 of 4 675259 12/08/2023 Avir at Cisco 1404 Front St Cisco, TX 76437

F 0695 nebulizer cup and tubing properly could Level of Harm - Minimal harm or potential for actual harm result in infection. The DON provided facility policy and procedure. Residents Affected - Few Record review of the policy titled Respiratory Therapy- Prevention of Infection, 2001 MED-PASS, Inc. (Revised November 2011) Indicated: Section: Infection Control Consideration Related to Medication Nebulizer/Continuous Aerosol: Step 7. Store the circuit in plastic bag between uses. 675259 Page 4 of 4