Health inspection·September 21, 2023

F 0583 Keep residents' personal and medical records private and confidential. 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 residents have the right to personal privacy and confidentiality of his or her personal and medical records for 3 (Resident #10, #64, and #67) of 9 residents reviewed for medication administration. Residents Affected - Few Resident #10's personal and medical information was left exposed on the computer screen on top of the North Hall Medication cart in the resident hallway unattended while LVN A administered Resident #10's medications. Resident #64's personal and medical information was left exposed on the computer screen on top of the North Hall Medication cart in the resident hallway unattended while LVN A administered Resident #64's medications. Resident #67's personal and medical information was left exposed on the computer screen on top of the North Hall Medication cart in the resident hallway unattended while LVN A administered Resident #67's medications. This failure could place resident at risk for having their personal medication information exposed. Finding include: Resident #10: Record review of Resident #10's face sheet dated 09-20-2023 revealed he was a [AGE] year-old male resident admitted to the facility originally on 08-17-2015 and readmitted on [DATE] with diagnoses to include sepsis (a life-threatening complication of an infection), bipolar disorder(a disorder associated with episode of mood swings ranging from depressive lows to manic highs), peripheral vascular disease(a circulatory condition in which narrowed blood vessels recue blood flow to the limbs), generalized anxiety disorder(a mental health disorder characterized by feeling of worry, anxiety, or fear that are strong enough to interfere with one's daily activities), malnutrition(lack of proper nutrition), and dementia (a group of thinking and social symptoms that interferes with daily functioning). Record review of Resident #10's 07-07-2023 quarterly MDS assessment revealed he had a BIMS score of 14 indicating he was cognitively intact, and he had a functionality of independent with most of his activities of daily living with occasional assistance x 1 person. Page 1 of 12 675478 675478 09/21/2023 Prairie House Living Center 1301 Mesa Dr Plainview, TX 79072

F 0583 Resident #64: Level of Harm - Minimal harm or potential for actual harm Record review of Resident #64's face sheet dated 09-20-2023 revealed she was a [AGE] year-old female resident admitted to the facility originally on 09-13-2022 and readmitted on [DATE] with diagnoses to include cerebral infarct(occurs as a result of disrupted blood flow to the brain due to problems with the blood vessels that supply it). , malignant neoplasm(a fast-growing cancer that can spreads to other areas), difficulty walking, history of fall, muscle weakness, obesity(a disorder involving excessive body fat that increase the risk of health problems), anxiety disorder(a mental health disorder characterized by feeling of worry, anxiety, or fear that are strong enough to interfere with one's daily activities, chronic obstructive pulmonary disease(a group of lung diseases that block airflow and make it difficult to breath), and osteoarthritis(a type of arthritis that occurs when flexible tissue at the ends of bones wears down). Residents Affected - Few Record review of Resident #64's 08-08-2023 quarterly MDS revealed she had a BIMS of 14 indicating she was cognitively intact, and she has a functionality of independent with most of his activities of daily living with occasional assistance x 1 person. Resident #67: Record review of Resident #67's face sheet dated 09-20-2023 revealed he was a [AGE] year-old male resident admitted to the facility on [DATE] with diagnoses to include metabolic encephalopathy(a chemical imbalance in the blood that causes problems in the brain), malignant neoplasm of the frontal lobe(a fast-growing cancer of the brain that spreads to other areas of the brain and spine), difficulty walking, dysphagia (difficulty swallowing food or liquids arising from the throat or esophagus), morbid obesity(a disorder involving excessive body fat that increase the risk of health problems), epilepsy(a disorder in which nerve cell activity in the brain is disturbed, causing seizures), and cerebral infarction(occurs as a result of disrupted blood flow to the brain due to problems with the blood vessels that supply it). Record review of Resident #67's 07-21-2023 quarterly MDS revealed he had a BIMS of 11 indicating he was moderately cognitively impaired, and he had a functionality of independent with most of his activities of daily living with occasional assistance x 1 person. During an observation on 09-20-2023 at 08:28 AM LVN A was observed administering medication to Resident #10. LVN A left the North Hall Medication cart once to assist a resident in the hallway with a request for chewing tobacco, LVN A returned to the North Hall Medication cart, LVN A left the North Hall Medication cart to enter Resident #10's room to obtain Resident #10's vital signs, then returned to the North Hall Medication cart, LVN A obtained Resident #10's medications then LVN A entered Resident #10's room and administered Resident #10's medications. The three times LVN A left the North Hall Medication cart LVN A left the computer on top of the North Hall Medication cart open with Resident #10's personal information exposed to include Resident #10's code status, allergies, date of birth , gender, room number, age, and 4 different medications to include Imodium, ProAir, Clonidine, and Acetaminophen. This surveyor noted 4 residents and 5 staff that were in the hallway that could have accessed the information. During further medication administration this surveyor noted that LVN A left two more residents (Resident #64 and Resident #67's) information exposed in the hallway on the open computer screen while LVN A was in Resident #64 and Resident #67's room administering their medications. This occurred on 9-20-2023 from 08:28 AM to 08:44 AM. During an interview on 9-20-2023 at 08:52 AM LVN A verified that LVN A had left the three residents 675478 Page 2 of 12 675478 09/21/2023 Prairie House Living Center 1301 Mesa Dr Plainview, TX 79072

F 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few information exposed on LVN A computer screen and that LVN A should not have left the resident information exposed, that LVN A did not protect the resident's privacy. LVN A reported that someone could access the resident's information and they could steal the residents identity. During an interview on 09-21-2023 at 09:53 AM the DON and the RNC were present, the RNC reported that if HIPPA is violated then a resident's personal records can be compromised, and that residents' personal records should be protected. The DON reported that a staff member reported that another staff member was noted on 9-20-2023 leaving resident information exposed on a computer screen in a resident's hallway when they were away from the computer, that that employee was not present to protect the resident information, that resident information should not be left on a computer screen unattended, and that that staff member had been written up and reeducated. The DON reported that if resident information is not protected then confidentiality will not be maintained. The DON provided the LVN A's disciplinary memorandum, the in-service, and the facility policy. Record review revealed that LVN A did receive a disciplinary memorandum on 09-20-2023 with the following corrective actions: Employee will lock computer when she walks ways form it. Any resident identifier will be secured and not exposed. Resident rights and HIPAA will be followed at all times. Record review of the facility provided policy titled, Resident Rights reviewed 02-20-2021, revealed the following: 7. Privacy and Confidentiality. The resident has a right to personal privacy and confidentiality of his or her personal and medical records. b. The resident has the right to secure and confidential personal and medical records. -Policy was signed by LVN A 09-20-2023 675478 Page 3 of 12 675478 09/21/2023 Prairie House Living Center 1301 Mesa Dr Plainview, TX 79072

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. Based on observation, interview, and record review the facility failed to ensure each resident was treated with respect and dignity and care for each resident in a manner and in an environment that promoted maintenance or enhancement of his or her quality of life, recognizing each resident's individuality for 7 of 10 anonymous residents reviewed for resident rights. The facility failed to promptly resolve grievances that were addressed in resident council meetings . This failure could place residents at risk of weight loss, as well as experiencing feelings of anger, frustration, and a decreased quality of life. Findings include: Observation on 9/19/2023 at 12:35 PM of anonymous resident in the middle of the dining room at a table by himself, had a trash can sitting beside him. Every few minutes he was observed coughing loudly and spitting into the trash can beside him . During the Resident Council meeting on 9/20/2023 at 9:00 AM five out of the 10 residents who were in attendance commented on how they were frustrated with the man in the dining room who continued to spit into a trash can. Residents stated they would not eat in the dining room because of his spitting ruined their appetite. In an observation on 9/20/23 at 02:20 PM revealed same anonymous resident sitting in the dining room at the middle table during an ice cream social, coughing and spitting into a trash can beside him . Interview with anonymous resident on 9/20/23 at 2:20pm who was exiting the dining room stated the dining room was loud and the man who coughed and spit was disgusting but the staff would not move him or do anything about it. During an interview on 09/20/23 at 11:12 AM the SW stated she was in the resident council meeting last week recording the minutes, and she was aware of the concerns about the man who spits in the trash can in the dining room. She stated that was the resident has the right to be in the dining room as well as the other residents. When asked what was being done about those grievances that were gathered in the resident council meeting, she stated they were given to the Administrator. In an interview with the ADM on 09/20/23 at 11:35 AM the ADM stated she was not aware of any complaints from residents not wanting to eat in the dining room due to the resident who spits. The ADM stated she had not thought about moving the resident away from the middle of the room so it didn't disturb the other residents. In an interview on 9/20/23 at 2:25 PM, LVN B stated he has been assisting in the dining room at breakfast, lunch, and dinner for about a year and was aware of the resident who sat in the middle of the room and spits. LVN B stated the spitting has been an issue with other residents for as long as he had been working in the dining room, and he heard a lot of complaints about the resident. He went on to state the resident used to spit on the floor, which was why there was a trash can there and the 675478 Page 4 of 12 675478 09/21/2023 Prairie House Living Center 1301 Mesa Dr Plainview, TX 79072

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some resident refused to eat in his room and that the resident doesn't have a physical ailment, just a habit of spitting. LVN B stated a possible negative outcome about the situation would be it could start fights and issues between the residents. Interview with an anonymous resident revealed she ate in the dining room daily and the man who spit in the trashcan was gross and she complained to staff about it. Record review of the resident council minutes revealed a complaint from the meeting minutes on 9/11/2023. The complaint stated, the man at the table that is in the middle of the dining room just keeps spitting. That is gross is he not able to move. The man that keeps spitting and the other guy that spits in a cup and just leaves it on the table, while I am eating . Record review of the facility policy and procedure titled Resident Rights, revised on 2/20/2021, revealed, . a) Voice grievances to the facility or other agency or entity that hears grievances without discrimination or reprisal. Such grievances include those with respect to care and treatment which has been furnished as well as that which has not been furnished; and the behavior of staff and of other residents; and other concerns regarding their LTC facility stay. b) The resident has the right to, and the facility must make prompt efforts by the facility to resolve grievances the resident may have. 675478 Page 5 of 12 675478 09/21/2023 Prairie House Living Center 1301 Mesa Dr Plainview, TX 79072

F 0637 Assess the resident when there is a significant change in condition Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure a comprehensive assessment after a significant change was completed within 14 days after the facility determined or should have determined there had been a significant change in the resident's physical or mental condition for 1 of 18 (Resident #41) residents reviewed for comprehensive assessments. Residents Affected - Few The facility failed to complete a MDS assessment on Resident #41 within 14 days after the resident was admitted into hospice, which triggered a significant change of condition. This failure could place residents at risk of not receiving quality care for a significant condition, quality of life, and access to services or care appropriate for the change of condition. Findings Include: Record review of Resident #4's face sheet, dated 9/19/23, revealed a [AGE] year-old male who was admitted to the facility on [DATE] and readmitted on [DATE]. Resident #41 had diagnoses which included Alzheimer's, Congestive Heart Failure, Dementia, muscle weakness, and lack of coordination. Record review of Resident #41's orders, dated 9/7/23, indicated the resident was admitted into hospice on 8/8/23 triggering a Significant Change of Condition. Record review of Resident #41's Significant Change of Condition MDS, dated [DATE], revealed an RN signature below item Z0500 on 8/26/23. The signature was located on a MDS assessment for Significant Change of Condition. An interview on 9/21/23 at 12:27 PM with MDS Coordinator revealed a MDS for Significant Change of Condition was completed within 14 days . MDS Coordinator stated that the time the resident was admitted to hospice on 8/8/23 to a completed MDS for significant change was not within the 14-day window. MDS Coordinator stated the MDS was not completed until 8/26/23. This date is 18 days after Resident #41 was admitted to hospice. MDS Coordinator stated a negative outcome would be patient care. Record review of the Resident Assessment Instrument manual, dated October 2019, page 2-24, bullet point later than 14 days after the determination that the criteria for SCSA were met. No policy was obtained for protocol on facility documentation. 675478 Page 6 of 12 675478 09/21/2023 Prairie House Living Center 1301 Mesa Dr Plainview, TX 79072

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, interview, and record review; the facility failed to ensure medications were stored in accordance with currently accepted professional principles for 1 (the medication room) of 3 medication areas reviewed for medication storage. The facility stored 11 medications in the medication room refrigerator that was documented at or below freezing 6 times between 9-13-2023 and 9-22-2023. The facility's failure to ensure medications were stored in accordance with currently accepted professional principles could result in a resident receiving a medication that would be ineffective for their treatment resulting in exacerbation of the resident's condition and disease processes. Findings include: During an observation completed on 09-20-2023 at 08:57 AM of the facility's medication room with ADON B the following medications were noted in the refrigerator: 1-Forteo filled 9-16-2023: noted instructions printed on the medication box not to freeze. 4-Lantaprost filled 8-26-2023: manufacturer storage instructions to store unopened bottle under refrigeration at 36-46 degrees. Tymlos filled 9-11-2023: noted instruction printed on the medication box to store between 36-46 degrees 1-Lantus Solostar filled date of 9-4-2023: manufacturer storage instructions to store under refrigeration at 36-46 degrees. 3-Humalog filled dated of 3-10-2023, 7-4-2023, and 7-30-2023: manufacturer storage instructions to store under refrigeration at 36-46 degrees. 2-Toujeo filled date of 7-30-2023 and 9-4-2023: manufacturer storage instructions do not freeze new pens. Refrigerate pens until expiration dated. 3-Trulicity filled dated of 8-13-2023, 9-2-20203, and 9-7-2023: noted instructions printed on the medication to store between 36-46 degrees In the Nexis kit stored in the refrigerator was the following. 3-Lispro filled 7-18-2023, 8-22-2023, and 9-19-2023: manufacturer storage instructions to store under refrigeration at 36-46 degrees. 1-Aspart with no fill date: manufacturer storage instructions to store under refrigeration at 36-46 degrees. 2-Levemir filled 6-20-2023 and 8-22-2023: manufacturer storage instructions to store under 675478 Page 7 of 12 675478 09/21/2023 Prairie House Living Center 1301 Mesa Dr Plainview, TX 79072

F 0761 refrigeration at 36-46 degrees. Level of Harm - Minimal harm or potential for actual harm 1-Aspart with no fill date: manufacturer storage instructions to store under refrigeration at 36-46 degrees. Residents Affected - Some 1-Basaglar filled date of 7-18-2023: manufacturer storage instructions to store under refrigeration at 36-46 degrees. -also noted was a sign posted on the refrigerator's door that read temperatures should be between 38-48 degrees. The Temperature Log posted on the upper refrigerator door that read as follows: Refrigerator Med Room: Month-September 2023 Daily Temp Log Refrigerator: Target range 40 degrees Days:13th-30 degrees 14th-30 degrees 15th-30 degrees 17th-32 degrees 18th-32 degrees 20th-32 degrees During an interview on 09-20-2023 at 08:14 AM ADON B reported that if medications were not stored correctly, they would not be effective, that it would affect the effectiveness of the medication. ADON B reported that it would affect a resident condition such as with a diabetic and their insulin not being effective, and their blood sugars could be raised or lowered if their medication had to be adjusted as a result of their blood sugars being affected. During an interview on 09-20-2023 at 11:48 AM the RNC and DON presented the facility policy and CDC guidelines that stated that medications should be stored between 36-46 degrees and reported that the printed information on the refrigerator was incorrect. The RNC reported that she felt the thermometer in the refrigerator was not reading correctly and that the facility was supposed to have a new thermometer but was awaiting approval from corporate to purchase one. RNC reported that she was going to just purchase one today without approval because she felt the refrigerator has been in the proper range and that none of the medications had been stored improperly. The DON reported that she had talked with the PC and that the PC had reported that the medications could be stored safely at lower temperatures and would send an email to verify this. The DON reported that she would print the email for this surveyor. During an interview on 09-21-2023 at 08:27 AM the PC reported that she had spoken to the Tymlos manufacturer and that they reported that Tymlos was safe to store as long as it did not go below 32 degrees no more than 7 days. The PC reported that any insulins exposed to freezing temperatures would 675478 Page 8 of 12 675478 09/21/2023 Prairie House Living Center 1301 Mesa Dr Plainview, TX 79072

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some need to be discarded. The PC reported that the insulins would not be as effective, and the residents would not receive therapeutic treatment. During an interview on 09-21-2023 at 09:59 AM the DON and RNC were present and the RNC reported that they had noticed that new staff had been documenting the lower temperatures on the refrigerator monitoring and suspected that the new staff may have been doing it incorrectly, that they have replaced the current thermometer with a digital thermometer so it would be easier to read. The RNC reported that they were going to replace all the insulin medications because they could not ensure that they did not freeze and become ineffective. The DON reported that if the medications are not stored correctly, the medications effectiveness will be compromised. The DON reported that all staff have been trained on how to properly store and check medications to include refrigerated medication as to the proper temperatures. The DON reported that the former DON and ADON were responsible for the training of staff. The DON reported that they delegated current training to be the responsibility of the current ADON who started a new training 9-20-2023. Record review of the facility provided printed manufacturer instructions provided by the PC for the medication Tymlos revealed the following: The materials provided may contain information outside of the product labeling approved by the US Food and Drug Administration (FDA). It should not be regarded as a recommendation by Radius of r the us of our product in any manner inconsistent with FDA-approved Prescribing information. Tymlos Storage and Handling: -Before first use, store Tymlos pens in the refrigerator between 36-46 degrees -Do not freeze the Tymlos pen or exposed it to heat. Tymlos allowable temperature excursions during storage and transport Between -4 to 26 degrees: 7 days-Okay for use. Record Review of the facility provided policy titled Storage of Medications effective 9-2018, revealed the following: Temperatures: c. Refrigerated: 36-46 degrees with a thermometer to allow temperature monitoring. 675478 Page 9 of 12 675478 09/21/2023 Prairie House Living Center 1301 Mesa Dr Plainview, TX 79072

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with the professional standards for food service safety for 1 of 1 kitchen reviewed for kitchen sanitation. The facility failed to ensure items in the freezer, pantry and refrigerator were properly stored, labeled, and dated. The facility failed to ensure items that were expired were disposed of and out of circulation. These failures could place residents at risk of food-borne illness. Findings include: Observation of the deep freeze on 9/19/23 at 9:24 AM revealed the following: 1. (1) bag of California vegetables had, no manufacturer use by date, sell by date, or best by date and no facility received date documented on the package. 2. (1) bag of stir fry vegetables, had no manufacturer use by date, sell by date, or best by date and no facility received date documented on the package. The vegetables in the bag had a thin layer of ice on them. Observation of the walk-in pantry on 9/19/23 at 9:34 AM revealed the following: 1. (1) bag of spaghetti opened to the air with no open date. The spaghetti was in a clear storage bin that was not sealed or labeled. 2. (1) bag of macaroni noodles with a hole in the packaging., Macaroni noodles had fallen out in a clear 675478 Page 10 of 12 675478 09/21/2023 Prairie House Living Center 1301 Mesa Dr Plainview, TX 79072

F 0812 storage bin that was not labeled or sealed. Level of Harm - Minimal harm or potential for actual harm 3. (1) small Ziplock bag with colorful sprinkles were half full and was not labeled or dated. Residents Affected - Many Observation of the standup freezer on 9/19/23 at 9:43 AM revealed the following: 1. (1) 3-gallon container of open vanilla ice cream had no manufacturer use by date, sell by date, best by date, and no facility received or open date on the package. 2. (1) 3-gallon container of open strawberry ice cream with no manufacturer use by date, sell by date, best by date and no facility received or open date on the package. 3. (1) open box of frozen crab cakes were not sealed and was open to the air was not dated or labeled. Observation of the refrigerator on 9/19/2023 at 9:50 AM revealed the following: 1. (1) clear pitcher of red sauce had no identifying label. 2. (1) expired container of Dessert Sauce with a use by date of April 1, 2023. 3. (1) expired container of Dessert Sauce with a use by date of June 6, 2023. Observation and interview on 09/20/23 at 8:30 AM, revealed the RDS took the bag of California vegetables and looked the bag over in its entirety. The RDS stated she could not find the manufacturer's use by date, sell by date, or best by date or the facility received by date. In an interview on 9/20/23 at 9:29 AM, the DS stated the negative outcome for not having labeled items in the pantry, refrigerator or freezer could cause residents to get sick and die . In an interview on 9/20/2023 at 11:20 AM, the DA stated if she found an item in the kitchen that 675478 Page 11 of 12 675478 09/21/2023 Prairie House Living Center 1301 Mesa Dr Plainview, TX 79072

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many wasn't labeled properly or expired, she would throw the item away. DA stated that all staff are responsible for checking labels for expired/labeled foods. The DA stated a possible negative outcome for residents eating expired or unlabeled foods could cause the residents to get sick. Record review of the Frozen and Refrigerated Foods Storage Policy and Procedures, revision date, 12/5/2017, revealed the following: 1. Items stored in the refrigerator must be dated upon receipt, unless they contain a manufacturer use by, sell by, best by date, or a date delivered. 2. All refrigerated and frozen items in storage will contain a minimum label of common name and product and dated. 3. All items past use by date are discarded. 4. Packaged frozen items that are opened and not used in their entirety must be properly sealed, label and dated for continued storage. Record review of the Dry Food and Supplies Storage policy and Procedure, revision date 11/15/2027, revealed the following: 1. All opened products must be resealed effectively and properly labeled, dated, and rotated for use. 2. Use by, best by and sell by dates should routinely be checked to ensure that items which have expired are discarded appropriately. 675478 Page 12 of 12