Health inspection·May 10, 2023

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 residents who were unable to carry out activities of daily living received necessary services to maintain personal hygiene for one (Resident #1) out of seven residents reviewed for ADLs, in that: Residents Affected - Few The facility failed to provide showers to Resident #1 in compliance with their shower schedules. This deficient practice placed residents at risk of a decline in hygiene, at risk of skin breakdown, and reduced feelings of self-worth. Findings include: In a confidential interview on 05/09/2023 at 12:17 pm, it was revealed Residents complained of not getting showers for up to 21 days. It was also revealed that not receiving showers was a recurring issue, the lack of showers would get fixed for a week and back to not receiving showers as scheduled. It was revealed to follow up with Resident #1 due to not getting regular showers. Review of Resident #1's face sheet undated revealed a [AGE] year-old-male with admission date of 01/15/2019. Diagnoses include legal blindness as defined in the USA, chronic kidney disease, other cerebral infarction, generalized muscle weakness. Review of Resident #1's MDS assessment dated [DATE] revealed a BIMS score of 15 indicating no cognitive impairment. It also revealed Resident #1 required 1-person physical assist with personal hygiene, dressing and transfer. Review of Resident #1's Care Plan revised 04/26/2022 revealed a risk for falls related to being blind, chronic kidney disease, weakness due to disease process, and an ADL Self Care Performance Deficit. Review of facility's grievances from 02/09/2023 to 05/09/2023 reflected the following: Resident Council report several residents only get 1 shower a week dated 04/11/2023. Resident #1 complained of not getting showers. Review of Resident Council minutes from 02/28/2023 to 05/09/2023 reflected the following: On 03/14/2023 the residents complained of not getting showers. Page 1 of 4 675536 675536 05/10/2023 Hill Country Heights 810 Industrial Ave Copperas Cove, TX 76522

F 0677 On 04/11/2023 the residents complained of one shower a week. Level of Harm - Minimal harm or potential for actual harm 05/09/2023 residents have concerns with showers Residents Affected - Few During an interview on 05/09/2023 at 1:17 pm, the Resident Council President stated showers were so bad that she had to contact the Ombudsman. She also stated, at one point in time, Resident #1 did not get showered for 21 days. She stated showers had improved since the Ombudsman's visit in March of 2023. She stated to ask Resident #1 beacuse there was always problems with his showers and dialysis schedules. She stated, I am a president for a reason, to advocate for the other residents. They are afraid to speak, and I tell them to speak up because everything that happens in the meeting stays there. During an interview on 05/09/2023 at 1:44 pm, Resident #1 stated the last time he got a shower was 05/02/2023. He stated, I stopped asking for showers because it is the same thing over and over. I take showers when the staff ask me. No skin damage issues. I like it when they give me a shower, it is refreshing but I don't see why must I remind them to give me a shower all the time? I have the sink and body wash; I do a spit bath myself; I have no skin issues. Resident #1 stated, we complained, the problem was fixed for few days and back to the same problems of not getting showers for the next weeks to months. Observation on 05/09/2023 at 1:44 pm revealed Resident #1 being well groomed, no body odor noted. Record review of facility's shower schedule revealed Resident #1's shower days were Tuesdays, Thursdays and Saturdays. Record review of Resident #1's shower documentations for the last 30 days (04/13/2023 to 05/09/2023) in the POC reflected Resident #1's did not get showered on 04/18/23 (, 04/27/2023 (Thursday), 05/04/23 (Thursday), and last shower was done on Tuesday, 05/02/2023. During an interview on 05/09/2023 at 2:14 pm Shower A stated there was a shower schedule, the first 6 rooms are given shower on Mondays, Wednesdays, and Fridays while the rest of the rooms are done on Tuesdays, Thursdays, and Saturdays. Shower aide A stated Resident #1's shower days were on Tuesdays, Thursdays, and Saturdays. Shower aide A stated she worked on Resident #1's hall on Thursday, 05/04/2023 and she did not give Resident #1 a shower because she was the only shower aide working. She stated, she did not work on Saturday, 05/06/2023. During an interview on 05/09/2023 at 2:48 pm, the DON stated the facility had no complaints on showers in the last 2-3 months. She stated there were complains of showers from resident council meetings, but it was not specific. She stated staff were in-serviced on showers. She stated Residents should be getting showers as scheduled, it was not the residents' responsibilities to remind the staff of their showers. She stated the staff are aware of the shower schedules. During an interview on 05/09/2023 at 3:34 pm, the ADON stated he and the DON do routine sweeps to ensure documentation was completed when care was provided. He stated a random sweep was made and it was found out that residents were getting their showers as scheduled; a significant improvement was made. He stated grievance are addressed based on the department of concerns and they try to address grievances as soon as possible. During an interview on 05/10/2023 at 12:55 pm the Activity Director stated Resident Councils are 675536 Page 2 of 4 675536 05/10/2023 Hill Country Heights 810 Industrial Ave Copperas Cove, TX 76522

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few held at least once a month. She stated when the are minutes taken the Residents are asked how they want me to discuss their concerns. She stated she documented complaints/concerns and presented them to the department head and if the department head was not available it is was given to the social worker. She stated on 03/14/2023 Resident #1 was concern about showers and his dialysis schedule conflicting with shower his shower schedules. She stated she spoke with the ADON regarding Resident #1's shower schedule and Resident #1's showers were changed from Monday/Wednesdays/Fridays to Tuesdays/Thursdays/Saturdays. She stated she spoke with the nursing department, the ADON, and she did not write out a grievance for residents concerns. She also stated on 04/11/2023 during the Resident Council meeting, the Council president spoke in general from what she has been hearing from her peers regarding showers. The Activity Director stated she did a follow up on showers 04/25/2023 and residents stated showers had improved. She stated, during the 05/09/2023 Resident Council meeting the residents complained of not getting showers again. She ended by saying the ADON handled most of the nursing related grievances. During an interview on 05/10/2023 at 12:35 pm the Interim Administrator stated he started at the facility on 03/29/2023. He stated he was made aware of shower problems on his first day at the facility. He stated the shower was old business and it had improved. He also stated Residents should get showers appropriately. He also stated Resident #1 should have gotten shower as scheduled. Review of facility's in-services reflected the following: 03/10/2023---showers-shower aides are to be present for all scheduled shift from 7a-7p, are to adhere to a shower schedule that ensures residents are showered per their schedule shower days, in a timely fashion. 04/26/2023, Showers-please make sure that showers are being initiated in the shower book to ensure that tracking can occur. 05/10/2023, showers-shower aide schedules are from 7a-7p. please ensure all showers are being offered/given as appropriate . Review of facility's policy tilted Bath, shower/tub revised February 2018 reflected: The purpose of this procedure is to promote cleanliness, provide comfort to the resident and to observe the condition of the resident's skin. .Notify the supervisor if the resident refuses the shower/tub bath. Review of facility's policy tilted Activities of Daily Living (ADL), Supporting revised March 2018 reflected: Residents will be provided with care, treatment, and services as appropriate to maintain or improve their ability to carry out activities of daily living (ADLs). Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. .appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with: a. 675536 Page 3 of 4 675536 05/10/2023 Hill Country Heights 810 Industrial Ave Copperas Cove, TX 76522

F 0677 hygiene (bathing, dressing, grooming, and oral care); Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 675536 Page 4 of 4