Health inspection·October 12, 2023

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care for 1 resident (Resident #12) out of 6 residents reviewed for care plans in that: Resident #12 did not have a baseline care plan created within 48 hours when she was first admitted to the facility. A past noncompliance was determined to have existed from 09/27/23 through 09/30/23.The facility implemented actions that corrected the non-compliance prior to the beginning of the survey. This deficient practice affects residents who are new admissions and could result in decreased quality of care. The findings included: Record review of Resident #12's electronic face sheet dated 10/11/2023, revealed she was initially admitted to the facility on [DATE]. Resident #12 was a [AGE] year-old female. Her diagnoses include Cervical Disc Disorder with Myelopathy, Hemiplegia and Hemiparesis following cerebral infarction affecting left non-dominant side, type 2 diabetes with diabetic neuropathy, and history of falling. Resident #12 is allergic to: Iodine I 131 Tositumomab, Naproxen, Darvon, Citrus products, and Latex. Record Review of Resident #12's MDS, of her BIMS Interview/Observation, dated 9/27/2023, indicated a score of 15 out of 15 showing she was cognitively intact. Further review showed she was a fall risk and needed help with assisted daily living. Observation and interview on 10/10/23, at 1:44 PM - revealed Resident #12 was sleeping in bed but responded to questions. Interview on 10/10/2023, at 1:45 PM with Resident #12, revealed she came here from a hospital because she had a fall and was injured. She needed help with ADLs. She usually was in pain and was on pain medication. Review of Resident #12's Care Plan, dated 9/30/2023, revealed the resident had an ADL deficit, was Page 1 of 6 675650 675650 10/12/2023 Garden Terrace Healthcare Center of Fort Worth 7500 Oakmont Blvd Fort Worth, TX 76132

F 0655 a poor candidate for bowel and bladder retraining, and was at mild risk for contracting pressure ulcers. Level of Harm - Minimal harm or potential for actual harm Interview on 10/11/2023, at 3:17 PM, with Regional Nurse B, stated Baseline Care Plans were initiated by the floor nurses. The MDS Coordinator or the DON would complete them after the floor nurses initiate them. Regional Nurse B confirmed that the Baseline Care Plan for Resident #12 was not completed until 9/30/2023. Residents Affected - Few Interview on 10/11/2023, at 3:30 PM with the DON, revealed the process for completing Baseline Care Plans was staff to look at the orders from the physician and start implementing the orders by creating the Baseline Care Plan. The floor nurses initiate the baseline care plans for the residents. Her expectation was the facility completed the plan within 48 hours. The DON stated she missed getting a baseline care plan done timely, for Resident #12, due to an internet outage for 5 days. Record review of the facility's policy and procedure titled Area of Focus: Care Planning - Baseline, Comprehensive, and Routine Updates, undated, indicated the Baseline Care Plan must be developed within 48 hours of a resident's admission. The policy further stated Completion and implementation of the Baseline Care Plan within 48 hours of a resident's admission is intended to promote continuity of care and communication among nursing home staff, increase resident safety, and safeguard against adverse events that are most likely to occur right after admission; and to ensure the resident and representative, if applicable, are informed of the initial plan for delivery of care and services by receiving a written summary of the Baseline Care Plan. 675650 Page 2 of 6 675650 10/12/2023 Garden Terrace Healthcare Center of Fort Worth 7500 Oakmont Blvd Fort Worth, TX 76132

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 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 kitchen sanitation in the facility's only kitchen observed for kitchen sanitation. 1. The facility failed to ensure kitchen staff wore appropriate hair and beard restraints. 2. The facility failed to ensure food items in the refrigerator were dated, labeled and sealed appropriately. These failures could affect residents by placing them at risk for food-borne illness. Findings included: 1. In an observation and interview on 10/10/2023, at 9:15 AM, revealed Activity Assistant A was not wearing a hairnet. Activity Assistant A stated that she thought she had one on and it must have come off her head. Activity Assistant A stated the importance of wearing a hairnet to prevent foodborne illness and put one on immediately. Review of the facility's Food Safety Policy titled Chapter 9 - Food and Nutrition Services that was not dated, stated: All associates should have their hair covered with hair restraints. No bangs should be hanging out . . 6. The staff is utilizing proper hair restraints, covering exposed hair . 17. Infection Control Several guidelines are important in preventing the spread of infection . Also, proper usage of hairnets is essential. These must be properly sanitized to prevent disease transmittal among residents and associates. Review of the U.S. Public Health Service Food Code, dated 2022, reflected: 2-402.11 Effectiveness. (Hair Restraints) 1. Code of Federal Regulations, Title 21, Sections 110.10 Personnel. indicated (1) Wearing outer garments suitable to the operation (6) Wearing, where appropriate, in an effective manner, hair nets, head bands, caps, beard covers, or other effective hair restraints. 2. In an observation and interview on 10/10/2023, at 9:20 AM, with [NAME] C reflected a food tray containing cooked sausage, hard shelled eggs, and butter were stored in the refrigerator without being labeled or dated. The tray was covered in cellophane plastic. [NAME] C stated it was important to label and date foods stored in the refrigerator to prevent serving foods past their expiration date to prevent foodborne illness. [NAME] C stated she just forgot to put the date on the tray as she was in a hurry and was the only one working at the time. Review of the U.S. Public Health Service Food Code, dated 2022, reflected: 675650 Page 3 of 6 675650 10/12/2023 Garden Terrace Healthcare Center of Fort Worth 7500 Oakmont Blvd Fort Worth, TX 76132

F 0812 3-501.17 Ready-to-Eat, Time/Temperature Control for Safety Food, Date Marking. Level of Harm - Minimal harm or potential for actual harm (A) Except when PACKAGING FOOD using a REDUCED OXYGEN PACKAGING method as specified under § 3-502.12, and except as specified in (E) and (F) of this section, refrigerated, READY-TO-EAT, TIME/TEMPERATURE CONTROL FOR SAFETY FOOD prepared and held in a FOOD ESTABLISHMENT for more than 24 hours shall be clearly marked to indicate the date or day by which the FOOD shall be consumed on the PREMISES, sold, or discarded when held at a temperature of 5ºC (41ºF) or less for a maximum of 7 days. The day of preparation shall be counted as Day1. Residents Affected - Many Review of the facility's Food Safety in Receiving and Storage policy, that was not dated, titled Chapter 9 Food and Nutrition Services, revealed, Any food not in its original container must be labeled with the date and contents and must be securely covered. Temperatures are to run 34° to 38°F. 3. In an interview on 10/11/2023, at 11:25 AM with the Dietician, revealed the Dietary Manager was out on sick leave and she was filling in as Dietary Manager until the Dietary Manager returns. The Dietician stated she normally only worked on Wednesdays and was contracted with the facility. The Dietician indicated the importance of wearing hair restraints and dating foods put in the refrigerator was to prevent food borne illnesses. 675650 Page 4 of 6 675650 10/12/2023 Garden Terrace Healthcare Center of Fort Worth 7500 Oakmont Blvd Fort Worth, TX 76132

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to ensure staff followed their infection prevention policy for 1 (Resident #11) of 3 residents and 2 (Treatment Carts A and B) of 6 sharps containers reviewed for infection control. Residents Affected - Few 1. Staff failed to don the appropriate PPE when providing care to Resident #11 who was on Enhanced Barrier Precautions 2. Staff failed to change out the sharps containers on Treatment carts A and B before they became over filled. Each container has a Do Not Fill Past line, at which time it should be changed out to ensure the safety flap continues to work properly. These failures could place the residents at risk of exposure to infectious agents. Findings included: Review of Resident #11's admission Record revealed he was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included stroke affecting his right side, speech and swallowing; diabetes, and muscle weakness. Review of Resident #11's admission MDS, dated [DATE], revealed a BIMS score not calculated, his Functional Status indicated he required minimal assistance with his ADLs. His Swallowing and Nutritional Status indicated her required the use of a gastric tube for nutrition. Review of Resident #11's care plan, dated 9/01/23, revealed he had a self-care deficit, and required the use of a feeding tube related to swallowing problems. Observation on 10/10/23 at 9:40 AM Resident #11's room had signage indicating he was on Enhanced Barrier Precautions, requiring staff to wear a gown and gloves when providing care. No PPE was posted outside the room. Observation on 10/10/23 at 9:45 AM LVN-A and CNA-B exited Resident #11's. Interview and observation on 10/10/23 at 9:50 AM, Resident #11 stated staff had just been in his room to change his brief and his linen. Resident #11 stated staff were not wearing gowns, and he couldn't recall if they were wearing masks. Observation of Resident #11's room revealed no PPE for use was in his room, no containers to doff PPE into were present, and the trash contained no doffed PPE. Interview on 10/10/23 at 10:00 AM LVN-A stated Resident #11 was on Enhanced Barrier Precautions (EBP) because he had a gastric tube. Residents with tubes or wounds were placed on EBP to prevent staff from transmitting an infection out of the resident's room. LVN-A stated she should have worn PPE while in Resident #11's room. LVN-A stated she did not know why PPE had not been placed outside the rooms with residents on EBP. Observation on 10/10/23 at 10:04 AM CNA-B carried isolation cabinets to the rooms of residents on EBP. 675650 Page 5 of 6 675650 10/12/2023 Garden Terrace Healthcare Center of Fort Worth 7500 Oakmont Blvd Fort Worth, TX 76132

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 110/10/23 at 10:10 AM the DON stated PPE was required for any close contact with residents on EBP. Staff could give medications, or carry on a conversation with the resident without PPE, but changing linen, changing briefs, etc, required the use of PPE. Observation on 10/10/23 at 10:15 AM the sharps container for Treatment cart for Hall A was filled past the Do Not Fill Past line. Observation on 10/10/23 at 10:20 AM the sharps container for Treatment cart for Hall B was filled past the Do Not Fill Past line. Observation on 10/11/23 at 8:10 AM the sharps containers for the Treatment carts on Hall A & B remain over filled. Interview on 10/12/23 at 9:45 AM LVN-A (also the Infection Preventionist) stated the nursing staff were responsible for changing out sharps containers when they were half full to prevent exposure to any contaminated sharps. LVN-A stated contaminated sharps had the potential to infect someone with unknown bacterial agents. Review of the facility policy Enhanced Barrier Precautions, revised on 6/12/23, revealed: The facility may use Enhanced Barrier Precautions as an additional mitigation strategy for residents that meet the following criteria, during high contact resident care activities: 2. Indwelling medical devices (central line, urinary catheter, feeding tube, trach, and ventilators), . Procedure: 1. post clean signage on the door of the resident's room indicating the resident is on Enhanced Barrier Precautions. 4. Make Personal Protective Equipment available outside the resident's room. 6. Position a trash can for discarding PPE after removal, prior to the exit of the room. Review of the facility policy Handling and Disposing of Sharps, revised on 0/08/23, revealed: The facility will handle and dispose of sharps in accordance with local, state and federal standards. Sharps are objects that can penetrate a worker's skin, such as needles, scalpels, and broken glass. Procedure: 4. When the sharps disposal container is 3/4 full, lock it and replace it. 675650 Page 6 of 6