Health inspection·August 16, 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, interviews, and record reviews, the facility failed to ensure a resident received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 1 (Resident #1) of 5 residents reviewed for showers/baths. Residents Affected - Few -Resident #1 did not receive showers as scheduled. This failure affected one resident and placed 88 residents requiring assistance with baths and showers at risk of not having the assistance with personal care which could cause skin breakdown and low self-esteem. Findings include: Record review of the admission Record (printed 08/16/2023) for Resident #1 revealed she was [AGE] years old, andold and was admitted to the facility on [DATE]. Diagnoses included, but were not limited to, encephalopathy (disease that alters brain function), muscle weakness, and dementia. Record review of the quarterly MDS assessment dated [DATE] revealed no entry for Resident #1's cognitive status. The MDS reflected the resident required extensive assist of two persons for bed mobility, transfers, toilet use, and personal hygiene. She required physical help in part of the bathing activity. The resident weighed 244 pounds at the time of the assessment. Record review of the Care Plan (revised 04/05/2023) revealed Resident #1 required extensive to total assist with bathing. The Care Plan reflected the resident was to receive a sponge bath when a full bath or shower could not be tolerated. Observation on 08/16/2023 at 10:10 p.m. revealed Resident #1 to be in her room. She was lying in her bed. She was not interviewable. Observation on 08/16/2023 at 11:00 a.m. revealed CNA A and CNA B provided incontinent care for Resident #1. Observation revealed the resident required extensive assist from both staff to reposition. Interview on 08/16/2023 at 12:30 p.m. Resident #1's family member revealed the resident was not receiving showers or baths. She said one night she stayed and asked a CNA to give Resident #1 a shower. She said the CNA did not know which chair to use. She said she told the DON her concern that the resident was not receiving showers. Observation and interview on 08/16/2023 at 2:35 p.m. the DON said the shower sheets were kept in a Page 1 of 4 675538 675538 08/16/2023 Sugar Land Health Care Center 333 Matlage Way Sugar Land, TX 77478

F 0677 book at the nurses' station. Level of Harm - Minimal harm or potential for actual harm Review of the C-Hall shower schedule revealed Resident #1 was scheduled to have a shower every Tuesday, Thursday, and Saturday in the evening. Residents Affected - Few Interview and review on 08/16/2023 at 2:40 p.m. revealed the shower sheets book at the nurses' station contained only four sheets total; none were for Resident #1. The DON said she would gather the shower sheets for Resident #1. Review on 08/16/2023 at 3:30 p.m. the August 2023 shower sheets revealed Resident #1 only received three showers during the month of August. The resident received showers on 08/01/2023, 08/09/2023, and 08/12/2023. Review of the August 2023 calendar revealed the resident should have received 7 showers during that time period. Record review of the facility policy Bath, Shower (revised February 2018) revealed the staff providing the shower or bath was to document the date and time the shower was provided, the names of the persons assisting, and if the resident refused. 675538 Page 2 of 4 675538 08/16/2023 Sugar Land Health Care Center 333 Matlage Way Sugar Land, TX 77478

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the clinical record were maintained in accordance with accepted professional standards and practices and were complete and accurately documented for 1 (Resident #1) of 5 residents records reviewed for medication and treatment documentation. -The nurse documented Resident #1 had pain patches applied, but they were not available. -The nurse documented Resident #1 had on compression hose on both legs, but the resident did not. The failure could place residents at risk for unaddressed pain, increased swelling, and risk of blood clots. Findings include: Record review of the admission Record (printed 08/16/2023) for Resident #1 revealed she was [AGE] years old and was admitted to the facility on [DATE]. Diagnoses included, but were not limited to, encephalopathy (disease that alters brain function), muscle weakness, and dementia. The most recent diagnoses (06/13/2023) were acute embolism and thrombosis (blood clots) of unspecified deep veins of both lower extremities, and pulmonary embolism (blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream). Record review of the quarterly MDS assessment dated [DATE] revealed no entry for Resident #1's cognitive status. The MDS reflected the resident required extensive assist of two persons for bed mobility, transfers, toilet use, and personal hygiene. Record review of the Care Plan (revised 03/27/2023) revealed Resident #1 required extensive to total assistance with ADLs. The Care Plan reflected the resident was dependent on staff for meeting physical needs. The Care Plan did not address pain. Record review of Resident #1's Physician's Order dated 08/11/2023 at 10:05 a.m. read in part .Compression stockings Apply in the morning and remove every night. Every morning and at bedtime for prophylaxis; swelling awaiting delivery. Record review of Resident #1's August 2023 MAR revealed the resident was to have Lidocaine pain patches applied to her left knee and left thigh at 9:00 a.m. every morning. Observation on 08/16/2023 at 10:10 a.m. revealed Resident #1 in her room lying in her bed. She was not interviewable. She did not have pain patches on her left knee, and she did not have on compression stockings. Her left thigh was not visible. Observation on 08/16/2023 at 11:00 a.m. revealed CNA A and CNA B provided incontinent care for Resident #1. Observation revealed the resident required extensive assist from both staff to reposition. The resident did not have pain patches on her left knee or her left thigh, and she did not have on compression stockings. Record review of Resident #1's MAR revealed LVN C had initialed that she had applied Lidocaine pain 675538 Page 3 of 4 675538 08/16/2023 Sugar Land Health Care Center 333 Matlage Way Sugar Land, TX 77478

F 0842 patches to the resident's left thigh and left knee on 08/16/2023. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #1's MAR revealed LVN C had initialed that the compression stockings were on the resident on 08/16/2023. Residents Affected - Few In an interview on 08/16/2023 at 12:30 with a family member of Resident #1 she said there were supposed to be pain patches on both knees and the left thigh. She pointed out they were not on the resident. She said the compression stockings were too small and were not being used by the facility. They were in a drawer. In an interview on 08/16/2023 at 12:45 p.m. LVN C said the Lidocaine patches were not available when she was to apply them. She said the compression stockings were removed by the CNAs when they provided incontinent care. The surveyor informed her that he was present when the CNAs provided incontinent care, and the compression stockings were not on. When asked shy she signed the two items in the MAR, LVN C said the patches and the compression stockings were not available, but she signed for them when she passed medications. In an interview on 08/16/2023 at 2:35 p.m. the DON said when the LVN noticed the patches and compression hose were not available she should have notified the Physician and documented in the NN that they were not available. Record review of the facility policy Documentation of Medication Administration (revised April 2007) read in part .Administration of medication must be documented immediately after (never before) it is given. 675538 Page 4 of 4