Health inspection·December 1, 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 provide respect, dignity and care in a manner and in an environment that promoted maintenance or enhancement of quality of life for 1 of 7 residents reviewed for resident rights. (Resident #1) The facility did not ensure the window blinds were closed during incontinent care exposing Resident #1. This failure could place residents at risk for diminished quality of life, loss of dignity and self-worth. Findings included: 1. Record review of the face sheet dated 12/02/23 indicated Resident #1 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including dementia, chronic pain, and cerebral infarction (stroke). Record review of the Quarterly MDS dated [DATE] indicated Resident #1 usually understood other and was usually understood by others. The MDS indicated Resident #1 had a BIMS of 08 and was moderately cognitively impaired. The MDS indicated Resident #1 was dependent for toileting, personal hygiene, and bed mobility. Record review of the most recent care plan updated on 9/30/23 indicated Resident #1 had impaired physical mobility related to hemiplegia (paralysis to one side of the body) or hemiparesis (weakness to one side of the body) and limited joint mobility. The care plan indicated Resident #1 had a self-care deficit related to stroke and was dependent on stall for all activities of daily living. During an observation on 11/29/23 at 1:47 p.m. CNA A performed continent care on Resident #1. Resident #1 was observed to be in her bed next to the window. CNA A did not close the blinds to the outside window prior to beginning incontinent care. During incontinent care CNA A left the room leaving the blinds to the outside window open. During an observation on 11/29/23 at 1:56 p.m. RN F entered Resident #1's room with CNA A. RN F walked over to the window and closed the blinds. During an interview on 11/29/23 at 2:01 p.m. RN F said she closed the blinds to provide privacy to Resident #1. RN F said the windows at the facility could be seen into from the outside. RN F said Page 1 of 9 675444 675444 12/01/2023 Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503

F 0550 people sometimes used the walkway outside of Resident #1's room. Level of Harm - Minimal harm or potential for actual harm During an interview on 11/29/23 at 2:07 p.m. CNA A said she had worked at the facility for 3 months. CNA A said she had been a CNA for 3 years. CNA A said the issue with leaving the blinds open when performing incontinent care on a resident was privacy. CNA A said it was important to provide privacy to residents, so they felt comfortable in their own home. Residents Affected - Few During an interview on 11/30/23 at 2:59 p.m. CNA B said blinds should be closed, doors should be closed, and privacy curtains should be pulled to provided privacy for residents when providing care. CNA B said the importance of providing privacy was for the resident's dignity. During an interview on 12/01/23 at 10:08 a.m. CNA C said the resident should be provided privacy when providing care by closing the blinds and pulling the privacy curtain. CNA C said the importance of privacy was to prevent from exposing the resident. During an interview on 12/01/23 at 10:42 a.m. LVN D said privacy should be provide during care. LVN D said privacy was provided by pulling the privacy curtains, closing the blinds, and shutting doors. LVN D said the importance of providing privacy was for the resident's dignity. During an interview on 12/01/23 at 10:46 a.m. RN E said privacy was provided during resident care by knocking prior to entering, closing the door, pulling the privacy curtain, and closing the blinds. RN E said the importance of closing the blinds was to ensure no one outside walking by could see into the room and expose the residents. RN E said the importance in providing privacy during care was for dignity. During an interview on 12/01/23 at 11:28 p.m. the DON said she expected staff to pull the privacy curtains and blinds when providing incontinent care to a resident. The DON said the importance of providing privacy during incontinent care was dignity. During an interview on 12/01/23 at 12:17 p.m. the Administrator said she expected staff to provided privacy to residents for care tasks that could affect their dignity. The Administrator said privacy should be provided by closing the door, puling the privacy curtain, and closing the blinds. The Administrator said the importance of providing privacy was for dignity. Record review of the facility's Perineal Care (cleaning the private areas of a patient) Policy revised on 4/10/23 indicated, Staff will provide perineal care in accordance with the standards of practice to prevent skin breakdown and infection .Drape residents with linen to provide privacy. Keep resident covered throughout procedure, exposing areas as needed . 675444 Page 2 of 9 675444 12/01/2023 Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 a resident who was unable to carry out activities of daily living received the necessary services to maintain grooming and personal hygiene were provided for 2 of 6 (Resident #2 and Resident #3) residents reviewed for ADLs. Residents Affected - Some The facility did not provide scheduled showers for Resident #2 and Resident #3. These failures could place residents at risk of not receiving services/care and decreased quality of life. Findings Include: 1. Record review of the face sheet dated 12/01/23 indicated Resident #2 was a [AGE] year-old female, admitted to the facility on [DATE] with diagnoses including diabetes, weakness, hypertension (elevated blood pressure), and acute kidney failure (a condition where the kidneys suddenly cannot filter wastes from the blood). Record review of the comprehensive MDS dated [DATE] indicated Resident #2 understood others and usually was understood by others. The MDS indicated Resident #2 had a BIMS of 11 and was moderately cognitively impaired. The MDS indicated Resident #2 was dependent for showering/bathing, toileting, and bed mobility. Record review of the care plan updated 11/23/23 indicated Resident #2 had impaired physical mobility. Record review of the Results List (list that showed shower documentation for the resident) dated October 2023 indicated Resident #2 received 1 shower/bath from 10/03/23 through 10/31/23 on 10/13/23. Record review of the Results List dated November 2023 indicated Resident #2 received 4 of her 7 scheduled showers from 11/1/23 through 11/16/23 and 11/23/23 on 11/02/23, 11/04/23, 11/7/23, and 11/16/23. 2. Record review of face sheet dated 12/01/23 indicated Resident #3 was a [AGE] year-old male, admitted to the facility on [DATE] with diagnoses including dementia, hypertension, age-related physical debility, and diabetes. Record review of the MDS dated [DATE] indicated Resident #3 sometimes understood others and was usually understood by others. The MDS indicated Resident #3 had a BIMS of 02 and was severely cognitively impaired. The MDS indicated Resident #3 required substantial/maximal assistance with showering/bathing and personal hygiene. Record review of the comprehensive care plan updated 11/20/23 indicated Resident #3 was at risk for/had actual skin breakdown. Record review of the Results List dated October 2023 indicated Resident #3 did not receive a shower/bath from 10/01/23 through 10/31/23. 675444 Page 3 of 9 675444 12/01/2023 Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of the Results List dated November 2023 indicated Resident #3 received 6 of his 12 scheduled showers/baths from 11/01/23 through 11/30/23 on 11/4/23, 11/7/23, 11/9/23, 11/14/23, 11/18/23, and 11/25/23. During an observation and interview attempt on 11/30/23 at 11:00 a.m. Resident #3 was clean with no offensive odors. Resident #3 was confused and unable to be interviewed. During an interview on 11/30/23 at 2:59 p.m. CNA B said the CNAs were responsible for giving showers. CNA B said residents received showers 3 times a week. CNA B said showers were documented on shower sheets and in the computer. CNA B said if a resident refused a shower the CNA should report it to the nurse. CNA B said the importance of resident's receiving their showers was for hygiene. During an interview on 12/01/23 at 10:08 a.m. CNA C said CNAs were responsible for giving showers. CNA C said showers were given as needed and as scheduled. CNA C said if a resident refused a shower, it should be reported to the nurse and the resident should be reapproached at a later time. CNA C said the importance of ensuring residents received their showers was to prevent sores, prevent the resident from smelling, and for hygiene. During an interview on 12/01/23 at 10:42 a.m. LVN D said CNAs and nurses were responsible for giving resident showers. LVN D said showers were given every other day. LVN D said if a resident refuses a shower, it should be documented. LVN D said the importance of ensuring residents received their showers was hygiene and cleanliness. During an interview on 12/01/23 at 10:46 a.m. RN E said nurses delegated shower responsibilities to the CNAs. RN E said residents received showers 3 times a week. RN E said if a resident refused a shower, it should be documented, and the resident should be reapproached at a later time. RN E said the importance of the residents receiving their scheduled showers was to prevent the resident from smelling bad, to allow for additional skin observations, and for hygiene. During an interview on 12/01/23 at 11:28 a.m. the DON said CNAs were responsible for giving the residents their showers. The DON said showers should be given as scheduled and requested. The DON said if a resident refused their shower, she expected them to reapproach the resident at a later time. The DON said the importance of the residents receiving their scheduled showers was for cleanliness and skin integrity. During an interview on 12/01/23 at 12:17 p.m. the Administrator said CNAs were responsible for giving the residents their showers. The Administrator said residents' showers were scheduled for 3 times a week unless the resident requested otherwise. The Administrator said if a resident refused their shower, it should be documented, or the shower should be given at a later time. The Administrator said if a resident continued to refuse showers, she expected staff to find out why the resident was refusing. The Administrator said the importance residents receiving their showers was for cleanliness and infection control. Record review of the facility's Bathing (not partial or completed bed bath) policy dated 1/20/23 indicated, Staff will provide bathing services for residents within standard practice guidelines .Tasks commonly completed during the bathing process: Inspect skin, especially those that are showing redness or signs of breakdown, Observe Range of Motion during the bathing process, If discomfort is 675444 Page 4 of 9 675444 12/01/2023 Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503

F 0677 present, ask the resident to describe and rate the discomfort, Record the procedure in the record, and Report abnormal findings to the nurse in charge or the health care provider . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 675444 Page 5 of 9 675444 12/01/2023 Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation and interview the facility failed to ensure all drugs were stored in a locked compartment, only accessible by authorized personnel for 2 of 4 (600 Hall Nurse/Medication and the Treatment Cart) medication carts and 1 of 2 (LVN G) nurses observed for medication storage. The facility did not ensure the medication carts were secured and unable to be accessed by unauthorized personnel. The facility failed to ensure medications were not left at the nurse's station unattended. These failures could place residents at risk for not receiving drugs and biologicals as needed, medications being used passed their effective or expiration date, and a drug diversion. Findings include: 1. During an observation on 11/29/23 at 2:13 p.m. a Nurse/Medication cart on the 600 hall was unattended and unlocked. The MDS nurse, an LVN, and 2 other people walked by the unlocked cart and did not lock it while the surveyor was standing at the nurse's station. During an observation on 11/29/23 at 2:15 p.m. LVN G walked up and locked the unattended and unlocked medication cart. 2. During an observation on 11/30/23 at 10:45 a.m. 13 medication cards and multiple IV medications sitting on the nurse's station in the rehab unit unattended. During an interview on 11/30/23 at 10:52 am LVN G said the medication cards were sitting on the nurse's station because he was getting ready to discharge a resident. LVN G said the IV medications had recently been delivered and he had not had time to put them up. LVN G said he left the medications unattended when he went to show someone in the medication room something on the stat lock box. LVN G said someone could have taken any of the medication while they were unattended. 3. During an observation on 11/30/23 at 3:07 p.m. the treatment cart was unlocked and unattended. The Maintenance Supervisor and a CNA were both observed walking in the hallway past the treatment cart. During an interview on 11/30/23 at 3:08 p.m. the Wound Care Nurse said she left her cart unlocked and unattended because she went outside to tell the charge nurse something about a resident. The Wound Care Nurse said she did not usually leave her treatment cart unlocked, unattended, and in the middle of the hall. The Treatment Nurse said it was important not to leave the treatment cart unlocked and unattended, so no one got into it and harmed themselves. During an interview on 12/01/23 at 10:42 a.m. LVN D said when walking away from the medication cart it should be locked. LVN D said the medication carts should never be left unattended and unlocked. LVN D said medications should not be left out in the open and unattended including at the nurse's station. LVN D the importance of ensuring the medication carts were locked and medications were not left unattended was so no one took any of the medications thinking they were candy. 675444 Page 6 of 9 675444 12/01/2023 Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 12/01/23 at 10:46 a.m. RN E said medication carts should be locked when left unattended. RN E said medication should never be left out in the open and unattended including at the nurse's station. RN E said the importance of locking med carts and not leaving medications unattended was to prevent medication from going missing. During an interview on 12/01/23 at 11:28 a.m. the DON said she expected staff to lock the medication carts if they were leaving them unattended. The DON said medications should not be left unattended. The DON said the importance of locking medication carts when they were left unattended and not leaving medications unattended at the nurse's station was so residents did not get medications that were not theirs and to prevent drug diversions. During an interview on 12/01/23 at 12:17 p.m. the Administrator said she expected staff to lock medication carts when they were left unattended and to ensure all medications were secured. The Administrator said medications should not be left unattended at the nurse's station. The Administrator said the importance of locking unattended medication carts and not leaving medications unattended was safety of the residents. Record review of the facility's Medication Storage policy dated 1/2023 indicated, Medications and biologicals are stored properly, following manufacturer's or provided pharmacy recommendations, to maintain their integrity and to support safe effective drug administration. The medication supply shall be accessible to only licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications .In order to limit access to prescription medications, only licensed nurses, pharmacy staff, and those lawfully authorized to administer medications (such as medication aides) are allowed to access the medication carts. Medication rooms, cabinets, and medication supplies should remain locked when not in use or not attended by persons with authorized access . 675444 Page 7 of 9 675444 12/01/2023 Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 of 3 staff (CNA A) viewed for infection control. Residents Affected - Few The facility failed to ensure CNA A changed gloves and perform hand hygiene while providing incontinent care. These failures could place residents and staff at risk for cross-contamination, spread of infection and could potentially affect all others in the building. Findings Include: 1. During an observation on 11/30/23 at 1:47 p.m. CNA A was performing incontinent care on Resident #1. CNA rolled up a dirty draw sheet, did not change gloves, then grabbed clean rag and wiped Resident #1's side off. CNA A placed a rag back in soapy water, did not change gloves, picked the call light up out of the floor, pulled the privacy curtain more closed, then exited room with the gloves on. CNA A entered the room without gloves on, did not perform hand hygiene, placed gloves on her hands, and removed the soiled linen from the bed. CNA A did not change gloves after removing the soiled linen, retrieved the rag out of the soapy water, wiped feces off Resident #1's side/buttock, changed gloves, and did not perform hand hygiene after taking off the gloves and prior to putting on clean gloves. CNA A opened several drawers in the room (bedside table, chest of drawer, plastic storage drawers), took out barrier cream, did not change gloves, and applied barrier cream to the perineal area (private area). CNA A removed her gloves. During an interview on 11/30/23 at 2:07 p.m. CNA A said she had worked at the facility for 3 months. CNA A said she had been a CNA for 3 years. CNA A said gloves should be put on or changed prior to touching a patient, when going from dirty to clean, after touching anything else in the room, and when exiting the room. CNA A said she changed her gloves some during Resident #1's incontinent care, but not every time she should have. CNA A said hand hygiene should be performed after taking off gloves and before putting on another pair of gloves. CNA A said she had performed hand hygiene prior to the surveyor requesting to watch incontinent care and prior to walking back into the room after she exited. CNA A said the importance of performing hand hygiene between glove changes and proper glove changes was infection control. During an interview on 11/30/23 at 2:59 pm CNA B said when performing incontinent care gloves should be put on prior to beginning incontinent care and after performing hand hygiene. CNA B said gloves should be changed when going from dirty to clean or after picking anything up off the floor. CNA B said hand hygiene should be performed prior to putting gloves on, between glove changes, and after providing patient care. CNA B said the importance of changing gloves and proper hand hygiene was infection control. During an interview on 12/01/23 at 10:08 a.m. CNA C said gloves should be worn during incontinent care. CNA C said gloves should be changed when going from dirty to clean, when they were visibly soiled, and after picking something up off the floor. CNA C said hand hygiene should be performed all the time. CNA C said hand hygiene should be performed between glove changes. CNA C said the importance of proper glove changing and hand hygiene was to prevent the spread of bacteria. 675444 Page 8 of 9 675444 12/01/2023 Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 12/01/23 at 10:42 a.m. LVN D said hand hygiene should be performed prior to entering a room, when exiting a room, and between glove changes. LVN D said the importance of proper hand hygiene was to prevent the spread of bacteria and to prevent cross contamination. During an interview on 12/01/23 at 10:46 a.m. RN E said hand hygiene should be performed when entering a room, exiting a room, prior to putting on gloves, and between glove changes. RN E said the importance of hand hygiene was infection control. During an interview on 12/01/23 at 11:28 a.m. the DON said she expected staff to change their gloves when providing care when they go from clean to dirty, dirty to clean, and after picking something up off the floor. The DON said hand hygiene should be performed prior to providing care, when care was complete, and between glove changes. The DON said the importance of proper glove changes and hand hygiene was to prevent the spread of infection. During an interview on 12/01/23 at 12:17 p.m. the Administrator said she expected staff to change their gloves when they went from soiled to clean and after touching any surface other than the resident. The Administrator said she expected hand hygiene to be performed prior to providing care, after providing care, and when staff changed gloves. The Administrator said the importance of performing proper hand hygiene and glove changes was for infection control and to prevent cross contamination. Record review of the facility's Hand Hygiene for Staff and Residents updated 1/2022 indicated, To reduce the spread of infection with proper hand hygiene. Proper hand hygiene technique is completed whenever hand hygiene is indicated. Hand Hygiene is the most important component for preventing the spread of infection. Maintaining clean hands is important for residents/visitors as well as staff. 1.Hand hygiene is done: Before: A. resident contact, B. eating or handling food, C. starting work, D. Smoking, E. Applying lip balm, F. Touching your eyes, nose, or mouth, G. taking part in a medical or surgical procedure. After: A. contact with soiled or contaminated articles, such as articles that are contaminated with body fluids, B. resident contact, C. contact with a contaminated object or source where there is a concentration of microorganisms, such as, mucous membranes, non-intact skin, body fluids or wounds. D. toileting or assisting, others with toileting, or after personal grooming, E. smoking or eating, F. coughing, sneezing, or blowing the nose, G. handling uncooked animal products, such as, raw meat, or raw fish, H. removal of medical/surgical or utility gloves. NOTE: Wash hands at end of procedures where glove changes are not required. For procedures in which change of gloves, e.g., clean gloves to sterile gloves, is indicated follow the specific standard of practice. If glove hands become contaminated as gloves are changed hands can be washed. I. Contact with a resident's intact skin (e.g., taking a pulse or blood pressure, performing physical examinations, lifting the resident in bed), J. Contact with environmental surfaces in the immediate vicinity of resident . 675444 Page 9 of 9