Health inspection·November 30, 2023

F 0914 Provide bedrooms that don't allow residents to see each other when privacy is 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 be designed or equipped to assure full visual privacy for 1 (room [ROOM NUMBER]) of 6 residents' rooms reviewed for visual privacy. Residents Affected - Few -The facility failed to provide a complete window covering to ensure Resident #1's full visual privacy. This failure could have placed residents at risk of exposure while care was being provided. The findings included: Record review of Resident #1's admission Record, dated 11/29/2023, revealed a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #1's diagnoses included cerebral infarction (stroke), type 2 diabetes mellitus (high blood sugar) without complications, history of falling, peripheral vascular disease (condition that affects the blood vessels outside of the heart and brain), and zoster (shingles) with other complications. Record review of Resident #1's quarterly MDS assessment, dated 10/06/2023, revealed a BIMS score of 0, indicating a severe cognitive impairment. Further review revealed resident was dependent with toileting, showering/bathing, and dressing. Record review of Resident #1's care plan, undated, revealed he had ADL self-care performance deficits. Resident #1 was a two-person total assist with bathing and transferring and a one-person total assist with bed mobility, dressing, and toileting. Observation and interview on 11/29/2023 at 10:11 a.m., revealed Resident #1 was sitting in his wheelchair watching television. The resident's bed was located next to the bedroom window. The window had a set of mini-blinds that was missing the bottom half of the plastic slats. On the other side of the window was a view to the outside of the facility. Resident #1 was able to answer questions with a yes and/or no. He said yes he was doing okay. He said yes they helped changed his brief and changed him when he was lying in bed. In an interview on 11/29/2023 at 4:16 p.m., the Maintenance Supervisor, said she had been working at the facility for approximately 21 years. She said one of her job responsibilities was to maintain the window coverings in the residents' rooms. She said she replaced the mini-blinds as soon as she could. She said the facility used a computer platform system to enter and track maintenance work orders. She said she did not know when the last work order to replace Resident #1's mini-blinds was last submitted but the blinds were last changed approximately 4 months ago. She said the last time she Page 1 of 3 675420 675420 11/30/2023 Paradigm at the Brazos 2127 Preston St Richmond, TX 77469

F 0914 Level of Harm - Minimal harm or potential for actual harm changed them was because she noticed they were missing some of the plastic slats. She said no one brought it to her attention that they needed to be replaced again. She said the facility's policy was for staff to submit a work order through the computer platform system. She said no work orders were submitted in the past 4 months to replace any mini-blinds for any of the residents. She said a resident not having a full covering on their window could potentially create a privacy and dignity issue for them. Residents Affected - Few In an interview on 11/30/2023 at 7:24 a.m., CNA A said she had been working at the facility since January 2023. She said she worked with Resident #1 before and knew the mini-blinds in his bedroom were messed up. She said she did not recall when she first noticed they were missing the plastic slats. She said she did not report it to anyone because she thought maybe someone else maybe had reported them. She said she did not check with other staff members to see if someone reported the blinds were messed up and/or if a work order was submitted. She said work orders were submitted through a system that was through their online computer system. She said the work order got sent to the Maintenance Director once it was entered. She said Resident #1 required maximum assistance with toileting and it was provided to him while he lied in bed. She said the potential risk to a resident when there was not full visual privacy on their window was it could affect their privacy. Record review of the facility's Environmental: Resident's Room, Resident's Right policy, revised 06/2019, reflected in part .It is the policy of this facility that the facility provides the resident with an environment that preserves dignity, privacy and contributes to a positive self-image .5) Each resident bedroom must be designed or equipped to assure full visual privacy for each resident. a. Full visual privacy means that residents have a means of completely withdrawing from public view, without staff assistance, while occupying their bed (e.g. curtain, moveable screens, private room) . 675420 Page 2 of 3 675420 11/30/2023 Paradigm at the Brazos 2127 Preston St Richmond, TX 77469

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, interview and record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for 1 (B Hall) of 3 halls reviewed for environment. -The facility failed to ensure the B Hall did not have a strong odor of urine. This failure could place residents at risk for a diminished quality of life. The findings included: Observation on 11/29/2023 at 10:10 a.m., revealed a strong odor of urine in B Hall. Observation on 11/29/2023 at 10:29 a.m., revealed a strong odor of urine in room B-12. In the corner of the room and along the side of the wall where the window was located, the floor was stained a medium to yellowish-brownish color. The floor tile in the corner of the room was warped and appeared to begin detaching from the floor. Observation on 11/30/2023 at 8:00 a.m., revealed a strong odor of urine in B Hall. In an interview on 11/30/2023 at 9:34 a.m., the DON said the resident in room B-12 urinated on his bedroom floor and in his trashcan. She said staff took him to the restroom every 2-3 hours, but he had dementia and Alzheimer's. She said sometimes he used the restroom and sometimes he did not. In an interview on 11/30/2023 at 11:06, the Interim Administrator said she had been working at the facility for 2 weeks. She said she occasionally noticed an intermittent odor of urine in the building. She said it was her understanding there was a resident who had a behavior of urinating in his room. She said she was going to follow-up with corporate to see if the tiles could be replaced and it was already in process. Record review of the facility's Environmental: Resident's Room, Resident's Right policy, revised 06/2019, revealed in part .13) The facility must provide a safe, functional, sanitary, and comfortable environment for residents, staff and the public . 675420 Page 3 of 3