Health inspection·September 18, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for hall 300, 400 and room [ROOM NUMBER]. The facility failed to ensure the carpet in the hallway between room [ROOM NUMBER] and 304, was in good repair. The facility failed to ensure the carpet in the doorway to room [ROOM NUMBER] was in good repair. The facility failed to ensure the flooring in the doorway into room [ROOM NUMBER] was in good repair. The facility failed to ensure the flooring on 400 hallway was kept in good repair. These failures could place residents at risk for diminished quality of life due to the lack of a well-kept environment and equipment. Findings included: An observation on 09/16/24 at 10:30 a.m., revealed snags in the carpet near room [ROOM NUMBER], a snag in the carpet in the entry way to room [ROOM NUMBER]. An observation on 09/16/24 at 10:33 a.m., revealed worn and stained carpet in the 300 halls. The stained carpet was visible in the remaining carpeted rooms on the 300 halls. An observation on 09/16/2024 at 10:45 am, on the 400-hall revealed deep staining in several areas throughout the entire hallway. An observation on 09/17/24 at 10:00 a.m., revealed the flooring on room [ROOM NUMBER] did not reach the threshold molding and was slightly curled at the end. Interview on 09/17/24 at 9:40 a.m., with a housekeeping aide revealed that they clean the floors as best they can, they sweep and vacuum every day. She stated that they are unable to get all of the stains from the carpet. They can get some stains up, but they are unable to get the deep stains out. She stated recently started working here but they stains were here when she came to work here. Interview on 09/18/24 at 10:23 a.m., with the Maintenance Supervisor revealed he was aware of the Page 1 of 5 675581 675581 09/18/2024 The Village at Heritage Oaks 3002 W 2nd Ave Corsicana, TX 75110

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some issues with the carpet on 300 and 400 halls. He stated that facility has put in an RFP for new flooring. He stated that RFP had an estimate for the replacement of the flooring. He stated that they have not heard anything back from corporate at this time. He stated he was not exactly sure when this request was sent in, and he was not able to provide a specific date. Interview on 09/18/ 24 at 10:27 a.m., with the Maintenance tech stated that they have been using tape in bad places in the carpet. He stated he just does what he is told to do and does not know what goes on above him. He stated he has not noticed the areas of snagged carpet shown to him. He stated that he would cover the areas with tape. He stated that they try to keep the carpet as clean as possible but at this point there is little they can do to help the appearance as this may be original to the building. He stated that the threshold in room [ROOM NUMBER] may need to be replaced, but he could put tape there to secure the flooring until it can be fixed permanently. He stated that he understands it could pose as a tripping hazard to residents, who live or walk thru those areas. Interview on 09/18/24 at 1:25 p.m., with the DON revealed that she was aware the carpet was stained and faded but was unaware of the snags in the carpet. She was also unaware of the issue with the flooring in room [ROOM NUMBER]. She stated she understood a resident could suffer a break, tear or death from a fall from for the snags in the carpet and loose flooring. Interview on 09/18/24 at 2:15 p.m., with the Administrator revealed that the facility is leased, and they have requested repairs to the carpet but are waiting on the landlord to approve the decision. She stated that she is aware of the condition of the carpet as far as wear and the staining in different areas of the carpet. She stated that she understands a resident or staff member may injured if they were to catch something on the carpet or flooring. 675581 Page 2 of 5 675581 09/18/2024 The Village at Heritage Oaks 3002 W 2nd Ave Corsicana, TX 75110

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record review, the facility failed to maintain an effective pest control program so that the facility was free of pests for four of four halls (Halls 100, 200, 300, and 400) and the nurse's station, conference room, lobby, and main dining room reviewed for pest control program. Residents Affected - Some The facility had live flies and gnats in areas of the facility including the nurse's station, Halls 100, 200, 300, 400, nurse's station, conference room, lobby, and the main dining room. This failure could place residents at risk for spread of infection, cross-contamination, and decreased quality of life. Findings included: An observation on 09/16/24 at 9:00 a.m., revealed in the front lobby there were three gnats flying around the front door. The food service carts were sitting outside of the kitchen door. There were three flies flying around the closed food carts. The flies landed and started crawling on the closed food carts. An observation on 09/16/24 at 9:15 a.m., revealed a live fly and a gnat flying in the conference room. An observation on 09/16/24 at 9:20 a.m., revealed a gnat crawling on top of the nurse's station. An observation on 09/16/24 at 9:20 a.m., revealed as the surveyor entered Hall 400 a live fly flew past down the hallway. An observation on 09/16/24 at 9:30 a.m., revealed three live flies flying down Hall 300 and a group of five gnats at the end of Hall 300. An observation on 09/16/24 at 10:00 a.m., revealed a live fly flying down Hall 100 and at the end of the hallway a live fly was crawling on the exit door. An observation on 09/16/24 at 10:45 a.m., revealed a live mosquito flying in the Administrators office. An observation and interview on 09/16/24 at 12:15 p.m., revealed a live fly crawling on a table in the dining room with a glass of juice on it. The fly lit on the lip of the glass. The resident returned to the table. The surveyor informed the staff in the dining room there had been a fly on the lip of the glass, the staff got a new glass of juice. Interview with MA A revealed it was the time of the year for the flies to be bad, the MA stated they come in the door that is in the dining room that goes outside and the front door. MA A stated there was a book at the nurses' station to write the fly sightings in, but she had not written anything in it lately. An observation on 09/16/2024 at 12:25 p.m., revealed a live fly flew out the main door of the dining room. An observation on 09/17/24 at 8:20 a.m., revealed a live fly crawling on the linen cart on Hall 675581 Page 3 of 5 675581 09/18/2024 The Village at Heritage Oaks 3002 W 2nd Ave Corsicana, TX 75110

F 0925 100. Level of Harm - Minimal harm or potential for actual harm In a confidential group meeting on 09/17/24 at 10:10 a.m., revealed a resident stated there were mosquitoes in the facility. Residents Affected - Some An interview on 09/17/24 at 2:40 p.m., CNA B revealed there was a pest control book at the nurse's station, as she took the surveyor and showed her the book. CNA B stated if we see any pest we are to write in here. CNA B stated she had not seen any pest, but she had seen the pest control man here. An interview on 09/17/24 at 3:15 p.m., CNA C revealed there was a pest control log at the nurse's station. CNA C stated she would write in that book if she saw pest. CNA C stated she had not seen any flies. Record review of the pest control book reflected a log with no notations of flies, gnats, or mosquitoes. An observation on 09/17/24 at 4:00 p.m., in the men's bathroom located near the nurse's station revealed a large cloud of gnats swarmed in and out of the drain located in the middle of the bathroom. An interview on 09/17/24 at 7:45 a.m., LVN D revealed there was a pest control book at the nurse's station. LVN D stated she had seen some bugs recently and had documented in the pest control book and the pest control man had come. The pest was not flies, they were roaches, she stated she had not seen any more of them lately. LVN D stated the residents will also tell us and we will document in the pest control logs. An interview on 09/18/2024 at 1:21 p.m., Resident #47 revealed she had seen a mosquito in her room, she could not recall when that was, but she knew it was a mosquito, buzzing around her face. Resident #47 stated she did not think to tell anyone, it went away, and she did not see it anymore. An interview on 09/18/24 at 1:27 p.m., the Administrator revealed the pest control services was just here on the past Monday. The Administrator stated the pest control company would be contacted to come. The staff is supposed to document in the pest control log at the nurse's station. The Administrator stated if the pest were not controlled, they could spread germs. Record review of facility provided pest control visits revealed, in part, dates and treatments as follows: Treatment dates and services performed: -09-04-2024-after inspection . verified active fruit fly and gnat activity in kitchen, drains need to be cleaned better, built up food . treated the kitchen drains. -8-23-2024- after inspection . treated hallways, in kitchen . dish sink area drains flies . -06-28-2023- after inspection . targeted pest throughout the facility treated . drain flies, flies, gnats, fruit flies, and mosquitoes . treated hallways, reception, office areas, laundry, kitchen storage sink area, restrooms, recreation storage area for small and large flies, serviced fly light station. 675581 Page 4 of 5 675581 09/18/2024 The Village at Heritage Oaks 3002 W 2nd Ave Corsicana, TX 75110

F 0925 Level of Harm - Minimal harm or potential for actual harm Record review of the facility's policy revised, April 2024 and titled Pest control Program reflected it is the policy of this facility to maintain an effective Pest control program that eradicates and contains common household pest and rodents .definition . effective pest control program is defined as measures to eradicate and contain common household pests (e.g., bed bugs, lice, roaches, ants, mosquitoes, flies, mice, and rats). Residents Affected - Some 675581 Page 5 of 5