Health inspection·October 5, 2023

F 0641 Ensure each resident receives an accurate assessment. 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 accurately assess each resident's status for 1 of 3 Residents (Resident #1) reviewed for assessment accuracy in that: Residents Affected - Few Resident #1's Annual MDS dated [DATE] did not have Section N (under Gradual Dose Reduction) coded correctly to reflect that the resident has received a Gradual Dose Reduction and that the medication is not contraindicated. This failure could place residents at risk of not receiving the proper care and services due to inaccurate records. Finding included: Record review of Resident #1's Face Sheet, dated 05/05/2023, revealed a [AGE] year-old male, re-admitted to the facility on [DATE] with admitting diagnosis of bipolar disorder (mood swings that range form from depressive lows to manic highs) and major depressive disorder (persistent depressed mood or loss of interest in activities, causing significant impairment in daily life). Record review of the Annual MDS assessment, dated 03/28/2023, revealed the following: Section C- BIMS score of 15 out of 15, which indicated the resident was cognitively intact. Section I- active diagnosis of anxiety (state of anxiousness), depression (feeling of sadness), bipolar disorder (mood swings that range from depressive lows to manic highs), major depressive disorder (persistent depressed mood or loss of interest in activities, causing significant impairment in daily life) and schizophrenia (relapsing episodes of psychosis). Section N- Did the resident receive antipsychotic medications since admission/entry or reentry or the prior OBRA assessment, whichever is more recent- Yes. Has a gradual dose had not been attempted- No. Has a physician documented gradual dose reduction as contraindicated- No. Record review of Resident 1's Physician Orders dated 02/24/2023 revealed orders for Risperdal (antipsychotic) 2 mg tablet: twice daily. Record review of Resident #1's Physician notes dated 02/24/2023 revealed that a GDR was not indicated (the medication was gradually reduced) at this time, as patient is stable on current dose. Record review of Resident #1's Care Plan, last revised on 09/12/2023, revealed care plans for: uses psychotropic medications; antidepressant and antipsychotic related to bipolar disorder, schizoaffective disorder, depression, and anxiety. The resident will remain free of drug related complications, Page 1 of 3 675554 675554 10/05/2023 Grace Care Center of Nocona 306 Carolyn Rd Nocona, TX 76255

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few including movement disorder, discomfort, hypotension, gait disturbance, constipation/impaction, or cognitive/behavioral impairment. During an interview with the MDS coordinator on 10/05/2023 at 2:28 PM, revealed that she was new in the position, and was completed prior to her entering the position. She revealed after reviewing the records with the DON, section N was completed inaccurately. In an interview on 10/05/2023 at 3:00 PM with the DON revealed that the Annual MDS was completed inaccurately and should have been coded the gradual dose reduction as being contraindicated in Section N. She revealed this failure could place the residents at risk of receiving inaccurate assessments and inadequate plans of care. Request for the facility policy covering MDS accuracy of Assessments was not provided at the time of exit and was told they use the RAI manual as a reference. 675554 Page 2 of 3 675554 10/05/2023 Grace Care Center of Nocona 306 Carolyn Rd Nocona, TX 76255

F 0812 Level of Harm - Minimal harm or potential for actual harm 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 professional standards for food service safety in 1 of 1 kitchen reviewed. Residents Affected - Some 1. The floors were soiled with food particles and grease beneath the appliances and stainless-steel shelf units throughout the kitchen. This failure could place residents at risk for foodborne illness and a decline in health status. The findings included: Observation on 10/03/2023 at 9:25 AM revealed food particles on the floor in the dry storage area and grease on the floor beneath the appliances and stainless steel shelf units throughout the kitchen. In an interview on 10/03/23 at 9:35 AM the Dietary Manager stated, the dietary staff is supposed to follow a daily cleaning schedule and initial the form after completing the cleaning tasks and I follow up to ensure the tasks are completed. She further stated, kitchen sanitation is important because it prevents foodborne illness. Record review of daily cleaning logs dated September 2023, used for all the kitchen cleaning duties revealed all cleaning duties for the morning of 10/3/23 had been completed and initialed by the kitchen staff that completed the cleaning. In an interview on 10/05/23 at 2:10 PM, the DON stated, I expect the dietary staff to follow their cleaning schedule and company policy. In an interview on 10/05/23 at 2:15 PM, the Administrator stated, dietary staff is supposed to follow company policy. Review of the facility's Policy titled Sanitation dated, June 2016 revealed [in-part]: The facility strives to promote good sanitation practices in order to protect its residents/patients and employees from foodborne illness. The facility sanitation system will ensure a clean, safe environment for its residents/patients and staff. The Nutrition services staff maintains clean and sanitary kitchen facilities and equipment. Walls, floors, ceilings, equipment, and utensils are clean and/ or sanitized, and maintained in good working order. The Nutrition Services staff follows infection control procedures including maintaining personal hygiene and handling foods to prevent contamination. 675554 Page 3 of 3