Health inspection·March 20, 2024

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on, interviews, and record reviews, the facility failed to ensure hospitality aides with the supervision of a CNA can care for resident's needs, as identified through resident assessments, and described in the plan of care for 1 of 4 Residents (Resident #1) in that: 1. The facility failed to ensure CNA C supervised hospitality aide HA B in assisting Resident #1 to the toilet. These deficient practices affect residents who require assistance from trained staff which could contribute to possible adverse reactions. The findings included: Review of an admission Record for Resident #1 dated 3/20/24 reflected she was a [AGE] year-old female, admitted to the facility on [DATE] with diagnosis including Neurocognitive disorder, aphasia, type 2 diabetes, and Parkinson's disease. BIMs of 7 indicating sever cognitive impairment. Review of an annual MDS assessment for Resident #1 dated 1/17/24 reflected, Toilet use: I require limited assistance x1 staff support with toileting task and toilet hygiene. Progress notes of Resident #1 dated 3/6/24 at 1:32 AM entered by LVN A indicated: Note Text: Resident was being assisted to the bathroom by CNA B. CNA had resident ride in wheelchair to the bathroom due to resident's weakness noted. When CNA asked resident if she was ready to stand and get onto the toilet resident responded that she was ready. When resident stood up, she leaned back against CNA and her legs could not hold resident up. CNA lowered resident onto the floor Infront of the toilet and got this nurse. When this nurse entered room. Resident was assessed for injuries. Resident stated that her legs were sore but did not hurt from the fall. CNA B and X2 staff members (LVN A and HA B) lifted resident with gait belt and placed resident onto the toilet. Staff are now to use X2 staff for all transfers as of this time. Physician and resident's spouse has been notified. During an interview on 3/20/24 at 10:45 AM ADON stated the normal process was for a hospitality aide to go through training to be able to be a CNA. She stated a HA was to only assist and help around the facility but should always have a CNA with them. During a phone interview on 3/20/24 at 11:05 AM LVN A stated that she was working 3/6/24 that Resident #1 had her fall. She stated that it was her understanding that HA B was a CNA. She stated that night she did not witness what happened, but it was brought to her attention by HA B the moment the Page 1 of 2 675681 675681 03/20/2024 Bronte Health and Rehab Center 900 S State St Bronte, TX 76933

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few incident occurred, that she went in to help Resident #1 to the toilet. She stated that HA B told her Resident #1 went to get up to go to the toilet and fell backwards but was caught and assisted to the ground. She stated that the right after the assessment of Resident #1, she told HA B from that point on that she needed to have a CNA with her to help with any residents that needed assistance. During an interview on 3/20/24 at 11:45 AM Resident #1 stated she did have a fall, but it was more of an assist to the floor by the aide. She stated she was usually pretty good and doesn't have to many falls. She stated she only remembers trying to stand up but started to fall backwards and the aide caught her and helped her to the ground. She stated nothing hurt and she did not sustain any injuries. She stated she could not remember the aide's name that was assisting her the night of 3/6/24. During a phone interview on 3/20/24 at 11:55 AM HA B stated that when Resident #1 put on her call light she asked CNA C to help her. HA B stated that CNA C stated, that Resident #1 was easy, you can do that on your own. She stated she went to assist Resident #1 to the toilet. HA B stated she entered the room and Resident #1 was in her wheelchair near the restroom. She stated that she assisted Resident #1 to stand up, Resident #1 began to sway and started to fall backwards. She stated she caught Resident #1 and assisted her to the ground. She stated she called for the LVN A and explained what happened. Attempted to contact CNA C on 3/20/24 at 12:05 PM, no answer, left message. During an interview one 3/20/24 at 11:50 AM DON stated that all HA's should have a CNA with them all the time. She stated that no HA should go and help residents transfer, toilet, etc. by themselves they must have a CNA with them. She stated that if a CNA was not with the hospitality aid, residents may receive incorrect assistance needed by the resident resulting in injury. Record review of facilities Job description not dated indicated: As a Nursing Home Hospitality Aide, you will play a vital role in providing compassionate care and support to residents in a nursing home setting. Your primary responsibility will be to ensure the comfort, well-being, and satisfaction of resident by assisting them with various hospitality task and providing emotional support under the supervision of a certified nursing assistant. 675681 Page 2 of 2