Health inspection·November 1, 2023

F 0837 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility. Based on observation, interview and record review the facility failed to ensure that the governing body, or designated persons functioning as a governing body, that was legally responsible for establishing and implementing policies regarding management and operation of the facility appointed an Administrator who was licensed by the State, responsible for management of the facility and reports to and was accountable to the governing body. The governing body did not appoint a licensed Nursing Home Administrator who was licensed by the State and had been without an Administrator since 7/15/2023. This deficient practice could have resulted in the facility not being managed in a responsible manner, which could affect the health and safety of all residents and risk of their needs not being met. Findings Include: Observation on 11/1/23 at 11:00 AM, during a facility walkthrough revealed no facility Administrator (AD) license was posted. During an interview with the Director of Nursing (DON) on 11/1/2023 at 10:55 AM, she stated the facility did not currently have an Administrator (AD) and she had been covering as many of those duties as she could. During an interview with the Director of Operations (DO) on 11/1/2023 at 2:20 PM, she stated it had been a month or maybe two since the last Administrator left. She stated she traveled to all of the buildings and tried to pop in at this facility once a week to check in. She stated there was not an interim Administrator for this facility. She stated she would check to see when the last Administrator left but stated I think we have 30 days to appoint a new administrator and she thought they were over that timeframe . During an interview with the DO on 11/1/23 at 2:42 PM, she stated the facility has not had an Administrator since 7/15/2023 as the last AD walked out right before their annual survey. She stated she had been interviewing for months but had not found a replacement. She stated the facility was in a very rural area and it was a challenge to try and find a replacement Administrator. She stated she was the AD at another facility and got promoted to DO. She stated, my license still hangs on the wall over at [other facility] so I can't be the AD of record over here. She stated she was the one responsible for hiring the new Administrator . Page 1 of 2 675468 675468 11/01/2023 Hico Nursing and Rehabilitation 712 Railroad Ave Hico, TX 76457

F 0837 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many During an interview with the DO on 11/1/2023 at 6:20 PM, she stated the problem of not having an Administrator was that something potentially could be missed for the residents. She went on to say, I don't feel as if anything was missed by not having an AD. In the same interview, the DON stated she had been in communication with the DO on a regular basis about facility matters and she did not feel anything was missed or the residents had not had good care. The DON stated, I had to do the full book survey myself since the AD walked out .I had the support of all the regional staff, and it all went well. A record review of an email sent by the DO on 11/1/2023 at 4:34 PM, reflected an initial job posting to a third-party platform for Administrator of the facility was posted with an open date of 7/10/2023 with a closing date of 10/3/2023. The email from the DO stated the initial job was posted July 10 and I updated the ad and reposted it 20 days ago. Record review of the facility policy Administration of Facility, dated, copyright 2023 reflected This facility will provide policies and systems to ensure that it is administered in a manner that will focus on attaining and maintaining the highest practicable physical, mental and psychosocial well-being of each resident .6: An appropriately licensed Administrator, in good standing with the state in which the facility resides, will be appointed by the governing body to be responsible for the management and overall operation of the facility. Record review of the facility policy Governing Body dated copyright 2023 reflected The facility will have a governing body, or designated persons functioning as a governing body, that is legally responsible for establishing and implementing polices regarding the management and operation of the facility .1. The governing body will appoint an administrator who is: a. Licensed by the state where required., b. Responsible for management of the facility., c. Reports to and is accountable to the governing body. Record review of Texas Unified Licensure Information Portal (TULIP), NFA license search reflected the former Administrator and license was still listed for the facility with an effective date of 6/7/2021 and an expiration date of 4/26/2023. This was previous to the AD that walked out in July of 2023. 675468 Page 2 of 2