Health inspection·September 18, 2023

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated the resident's nails were long and her right hand smelled bad. The odor emanating from her hand was pungent and sour. The DON acknowledged a fingernail was digging into the Resident's right hand but there were no open areas. The DON stated Resident #1's fingernails should have been clipped by the CNAs or the charge nurse if she was a diabetic. She stated she should have caught that her nails were longer during the skin assessment she performed on 09/15/2023. She further stated nails should be trimmed at least weekly after a bath. In an interview on 09/18/2023 at 1:43 PM, NA B stated fingernails should be cut and cleaned unless the resident is a diabetic and then the nurse should do it. She stated she should have washed inside Resident #1's right hand. In an interview on 09/18/2023 at 1:46 PM, NA A stated nails should be cleaned and clipped. She stated she and NA B were running a little behind with their assigned duties and had other residents to get up which was why they did not complete the personal care for Resident #1. She stated the water in the pan used for bathing was dirty and could not be used to clean Resident #1's hands. She stated when a resident complains of pain, or they are a diabetic and need their nails trimmed, she reports it to the ADON. She stated she had reported Resident #1's fingernails needed to be trimmed to her charge nurse RN C. In an interview on 09/18/2023 at 1:52 PM, RN C stated she had been working at the facility since April 2023 and one of her duties was making nursing rounds on her assigned patients. She stated she did not look at fingernails. She stated the nurses' aides for Resident #1 did not notify her that Resident #1's fingernails were long and needed trimming. She stated the nurses perform nail care for residents with a diagnosis of Diabetes. She further stated she was responsible for overseeing the work completed by the nurses' aides and they should let the charge nurse know when there is an issue with a Resident. She stated that even if the Resident is receiving a bed bath their hands can be cleaned. In an interview on 09/18/2023 at 1:01 PM, the DON stated Resident #1's nails should have been clipped by the aides or nurse if she was a diabetic. She stated she should have noticed that her nails were long on Friday the 12th when she completed her skin assessment. She further stated nails should be trimmed and cleaned at least weekly after a bath. In an interview on 09/18/2023 at 2:46 PM, the DON stated it was her expectation that aides would provide resident care and proper hygiene to include bathing and nail care. She said Resident #1 stated her right hand had been bothering her for three days and she called the Dr. to get an order for an antifungal powder for the inside of her hand. She stated Resident #1 had a diagnosis of Diabetes, so it was the charge nurse's responsibility to ensure her nails were trimmed. She further stated the aides should have noticed the long fingernails on Resident #1 and cleaned the inside of her hand. She staed it was her responsibility to ensure everyone was fulfilling their job duties In an interview on 09/18/2023 at 2:50 PM, ADON D stated she had worked at the facility for one year. She stated she was responsible for overseeing the care on Resident #1's hall. She stated it was her responsibility to ensure ADLS were completed but she could not say she looked at fingernails on a regular basis. She was aware that Resident #1 had a contracture of her right hand, but she did not check her hands last week or this week. She further stated she had filed Resident #1's nails two weeks ago. In an interview on 09/18/2023 at 3:54 PM, the ADM stated her expectation was for aides to provide (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675434 If continuation sheet Page 2 of 3 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 675434 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Pines Nursing and Rehabilitation Center 503 Old Austin Highway Bastrop, TX 78602 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)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete most of the resident nail care unless the resident had a diagnosis of Diabetes. She stated any staff could notice if a resident's nails were long and a nurse should be notified if the resident refused care or was experiencing pain. She stated the facility had completed a nail audit and was giving staff one to one reeducation. Record review of a facility Policy and Procedure dated 10/24/2022 and titled Activities of Daily Living reflected The facility will, based on the resident's comprehensive assessment and consistent with the resident's needs and choices, ensure a resident's abilities in ADL's do not deteriorate unless deterioration is unavoidable. Care and services will be provided in the following activities of daily living. 1. Bathing dressing, grooming and oral care. Policy explanation and Compliance Guidelines: 3. A resident who is unable to carry out activities of daily living will receive the necessary services to maintain good nutrition, grooming and personal and oral hygiene. Event ID: Facility ID: 675434 If continuation sheet Page 3 of 3