Health inspection·January 19, 2024

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive for 1 (Resident #197) of 3 residents reviewed for enactment of advance directives in that:. Resident #197 did not have any documentation in her electronic record as what her wishes were concerning whether or not she would like CPR (cardiopulmonary resuscitation) or life saving measures if she stopped breathing. This failure could put residents at risk of not having their end of life wishes honored. Findings include: Record review of Resident #197's Profile tab in the electronic record, accessed on [DATE], revealed Resident #197 was a [AGE] year-old female, admitted to the facility on [DATE]. Record review of Resident #197's Diagnosis Report, dated [DATE] revealed a primary diagnosis of cerebral infarction due to occlusion or stenosis of small artery (stroke - disruptive blood supply to the brain). Record review of Resident #197's electronic record failed to identify her advance directive or what her wishes were if she were to stop breathing or have cardiac arrest. In an interview on [DATE] at 10:00 AM, the DON said all of management was responsible to make sure advance directives were in a resident's electronic chart. Resident #197's Advance Directive should have been looked at upon admission by the admitting nurse. Management has clinical standard meetings on Wednesday to review all new admissions and it would have been mostly likely caught at that time but there was not a meeting this week. She said a negative potential outcome would be the resident's end of life wishes would not be honored, an example would be CPR would be done if she was a DNR (do not resuscitate). Record review of the facility policy Advance Directives, dated as revised [DATE], revealed the following [in part]: Policy Statement: Advance directives will be respected in accordance with state law and facility policy. Page 1 of 7 675596 675596 01/19/2024 Barton Valley Rehabilitation and Healthcare Center 4501 Dudmar Dr Austin, TX 78735

F 0578 Policy Interpretation and Implementation: Level of Harm - Minimal harm or potential for actual harm 1. Upon admission, the resident will be provided with written information concerning the right to refuse or accept medical treatment and to formulate an advanced directive if he or she chooses to do so. Residents Affected - Few 7. Information about whether or not the resident has executed an advance directive shall be displayed in the medical record. 675596 Page 2 of 7 675596 01/19/2024 Barton Valley Rehabilitation and Healthcare Center 4501 Dudmar Dr Austin, TX 78735

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 housekeeping and maintenance services to maintain a sanitary, orderly, and comfortable interior for 4 (Resident #67, Resident #197, Resident #92 and Resident #63) of 11 Resident's bathrooms observed for environment as evidence by: Resident #67, Resident #197, Resident #92 and Resident #63's toilets were dirty with black fungus and/or feces. This failure could place residents at risk for a diminished quality of life and a diminished clean, homelike environment. Findings include: Record review of Resident #67's Quarterly MDS, dated [DATE] revealed a [AGE] year-old female, admitted to the facility on [DATE]. Resident was not able to complete a BIMS assessment (severe impairment). In an observation on 01/17/2024 at 9:21 AM, during initial rounds, Resident #67 was lying in her bed but was not interviewable. An observation in resident's bathroom revealed the toilet had a black slimy ring in the toilet bowl at the waterline. Record review of Resident #197's Profile Page in the electronic records, revealed a [AGE] year-old female, admitted to the facility on [DATE]. Her admission MDS had not been completed to indicate a BIMS score but the resident was interviewable. In an interview and observation during initial rounds on 01/17/2024 at 9:31 AM, Resident #197 said she was recently admitted , and her toilet had been dirty since admission. An observation of Resident #197's toilet revealed a black slimy ring in her toilet bowl at the water line. Record review of Resident #92's admission MDS, dated [DATE] revealed a [AGE] year-old male, admitted to the facility on [DATE]. The resident had a BIMS score of 3 (severely impairment). In an interview and observation during initial rounds on 01/17/2024 at 10:36 AM, Resident #92 said he didn't know if his toilet was dirty or not. In an observation Resident #92's toilet bowl was covered in hard, dried feces. Record review of Resident #63's Quarterly MDS, dated [DATE], revealed a [AGE] year-old male, admitted to the facility on [DATE]. The resident had a BIMS score of 12 (moderately impaired). In an interview and observation during initial rounds on 01/17/2024 at 11:20 AM, Resident #63 stated he didn't want to get involved when asked if his toilet was dirty. In an observation of Resident #63's bowl revealed dried feces on the inside of the toilet bowl. In an interview on 01/19/2024 at 10:27 AM, the Administrator and DON said they were unaware of the dirty toilets and were going to complete a sweep of the facility and look at all the toilets. 675596 Page 3 of 7 675596 01/19/2024 Barton Valley Rehabilitation and Healthcare Center 4501 Dudmar Dr Austin, TX 78735

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an interview on 01/19/2024 at 3:06 PM, the Housekeeping Supervisor and Administrator stated 11 toilets had been identified and marked for replacement during the sweep of the facilities bathrooms that was conducted earlier this morning. The Housekeeping Supervisor said the blank ring of mold was due to toilets not being flushed on a regular basis. When asked about the dried feces on the toilets and why it was not cleaned, he failed to answer and stated it was his expectation for toilets to be cleaned daily by the housekeepers. A potential negative outcome identified was the spread of germs. Record review of the facility policy titled Resident Room Cleaning Procedure, revealed the following [in part]: Purpose: To show housekeeping employees the proper cleaning method to sanitize a Residents Room . Disinfect: Using disinfectant solutions, sanitize all horizontal surfaces (as you enter the room, work clockwise around the room hitting all surfaces). To include tabletops, dressers, headboards, bed rails, windowsills, A/C units, chairs, and toilets. 675596 Page 4 of 7 675596 01/19/2024 Barton Valley Rehabilitation and Healthcare Center 4501 Dudmar Dr Austin, TX 78735

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop a comprehensive care plan within 7 days after completion of the comprehensive assessment for 1 of 15 residents (Resident #88) whose records were reviewed for assessments and care plans, as well as having an IDT team present at the care conference. The facility failed to ensure that Resident #88 had care plan developed and updated within 7 days following the completion of the MDS as well as having an Intradisciplinary Team present at the care conference. This failure could place residents at risk of not have having their care plans completed accurately and timely. Findings included: Record review of Resident #88's face sheet dated 01/17/2024, revealed resident was a[AGE] year-old male who was admitted to the facility 04/28/2023 and a re-entry on 10/07/2023. Resident #88 had diagnoses which included sepsis (a life-threatening complication of an infection), seizures (sudden uncontrolled burst of electrical activity in the brain), dysphagia (difficulty swallowing), ileus (inability of the intestine (bowel) to contract normally and move waste out of the body and schizophrenia (mental disorder characterized by reoccurring episodes of psychosis. Record review of Resident #88's Annual MDS assessment, dated 10/14/2023, revealed the following: Section C revealed the resident had a BIMS score of 03 (severe cognitive impairment). Record review of Resident #88's electronic Care Conference record did not have an IDT care plan meeting until 11/14/2023. In an interview on 01/18/2024 at 2:00 PM, the DON revealed that she was not responsible for the care plans, the MDS was after completion of the MDS assessment. She revealed that even though they were not completed timely and in full, she still ensured that residents received the care and there were no issues with quality of care. She said that she attends the IDT meetings or has an RN attend in her place. In an interview on 01/19/2024 at 2:30 AM, the MDS-LVN coordinator revealed that Resident #88's IDT meeting got missed. She stated that they realized it was late and it was completed as soon as possible, even thought it was almost a month late. She said that it was accidently missed, but she was not sure how. She said this failure would place the residents at risk for inaccurate care plans and assessments which could cause a quality-of-care issue. She revealed that even though the care plans were not completed correctly, they still took care of the residents. Record review of the facility's policy titled: Care Plan, Comprehensive Person-Centered dated January 2023, revealed the following: Policy statement: A comprehensive, person-centered care plan that includes measurable objectives and timetables to 675596 Page 5 of 7 675596 01/19/2024 Barton Valley Rehabilitation and Healthcare Center 4501 Dudmar Dr Austin, TX 78735

F 0657 meet the residents physical, psychosocial and functional needs is developed and implemented for each resident. Level of Harm - Minimal harm or potential for actual harm Policy interpretation and implementation: Residents Affected - Some 1. The interdisciplinary team, in conjunction with the resident and his or her family or legal representative, develops and implements A comprehensive, person-centered plan for each resident. 2. The care plan interventions are derived from a thorough analysis of the information gathered as part of the comprehensive assessment. 3. The IDT includesA) the attending physician. B) a registered nurse who is responsible for the resident. C) a nurse said who is responsible for the resident. D) a member of the food and nutritional service staff E) the resident and the resident's legal representative other appropriate staff or professionals as determined by the residents needs or as requested by the resident. 4. Each resident's comprehensive person-centered care plan will be consistent with the residents' rights to participate in the development and implementation of his or her plan of care including the right toA) Participate in the planning process. 675596 Page 6 of 7 675596 01/19/2024 Barton Valley Rehabilitation and Healthcare Center 4501 Dudmar Dr Austin, TX 78735

F 0657 B) Level of Harm - Minimal harm or potential for actual harm Identify individuals or roles to be included. C) Residents Affected - Some Request meetings D) Request revisions of the plan of care. E) Participate in an establishing the expected goals and outcomes of care. F) Participate in determining the type, amount, frequency and duration of care. G) Receive the services and or items included in the plan of care see the care plan in sign it after significant changes are made. 12. Comprehensive person-centered care plan is developed within seven days of the completion of the required comprehensive assessment. 675596 Page 7 of 7