Health inspection·July 10, 2024

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff and the public on three of five halls observed (hall 100, 400 & 500). Floors on Secured unit (hall 100) were dirty and stained. Resident bathrooms on halls 100 were unkept, unclean, had strong urine odor and unsanitary. Window blinds on halls 100, 500 were bent and torn and Hall 400 vertical blinds had missing slats. Windows on hall 100 has an accumulation of spider webs and green stuff on the outside. The toilet bowls on hall 100 had brown and black stains in them. The tiles in rooms on 100 hall was broken, based boards not affixed to the wall, broken sheet racks and peeling paint on the wall. These failures could place residents at risk of living in an unsafe, unsanitary, and uncomfortable environment. Findings included: Observation of Hall 100 on 07/10/2024 between 11:10-11:40 AM reveal the following: *room [ROOM NUMBER] had broken floor tiles at the entrance door, near the window tiles were lifting off the floor. Baseboard was not affixed to the wall and the sheet rack was torn. The bathroom had strong urine order. *room [ROOM NUMBER] baseboard was off the wall near the bathroom and broken window blinds. The toilet bowl had brown stains and strong urine odor. The shower stall (not in use) had what looked like a dirty towel on the floor and brown stains on the floor. *room [ROOM NUMBER] had broken window blinds and the baseboard was not affixed to the wall. *room [ROOM NUMBER] had broken sheet rack to the bathroom door, peeling paint on the bathroom door, broken window blinds and missing baseboard near the right of closet. Page 1 of 4 675700 675700 07/10/2024 Harmony Care at Brookshire 710 Hwy 359 S Brookshire, TX 77423

F 0921 Level of Harm - Minimal harm or potential for actual harm *room [ROOM NUMBER] had strong urine odor in the bathroom baseboard near to bed A was not affixed to the wall. *room [ROOM NUMBER] window had an accumulation of green stuff on the outside of the window, an accumulation of spider webs. The toilet had black stuff and strong offensive urine order. Residents Affected - Some *room [ROOM NUMBER] had broken window blinds, an accumulation of green stuff on the outside of the window and an accumulation of spider webs. *The dining room had broken window blinds with an accumulation of green stuff and spider webs on the outside of the windows. The paint was peeling off the wall and the floor dirt had stains on it. *room [ROOM NUMBER] wall had peeled paint and the A/C thermostat was broken. In an observation and interview on 7/10/2024 at 11:40am with CNA B she said the 100 hall really needed to be cleaned. She said housekeeping had not been to the unit that morning to clean. She said usually they would be on the hall already the green stuff on the wall was pointed out to her and she agreed that it had been there a long time. Observation of hall 400 on 7/10/2024 between 11:50am and 12:05pm revealed the following: *room [ROOM NUMBER] vertical window blinds had missing slats and there was no string to the over bed light. *room [ROOM NUMBER] vertical window blinds had missing slats and there was a hole in the sheet rack above the base board. *room [ROOM NUMBER] vertical window blinds had missing slats. *room [ROOM NUMBER] window vertical blinds had missing slats. *room [ROOM NUMBER] has broken sheet rack to the bathroom wall. *room [ROOM NUMBER] has broken window blinds and peeling paint. *room [ROOM NUMBER] has a hole in the sheet rack under the TV. In an interview on 7/10/2024 at 12:51 pm with Housekeeping Staff A she had just gone to the Secured unit to clean, but she was going to get supplies. She said her job was to mop, dust, throw out the trash and clean the floor. At that point she was asked who cleans the window. She said housekeeping cleans the inside and maintenance cleans the outside of the window. In an interview on 7/10/2024 at 1:00pm, Maintenance Man A said the previous housekeeping supervisor had a crew who usually cleans the outside of the windows but since she left the windows had not been cleaned. He said he was going to get with housekeeping to come up with a plan to ensure the windows were cleaned. He said they were short on staff and was not able to address issues as quickly as possible. In an interview on 7/10/2024 at 1:15pm the Housekeeping Supervisor said she was new to the building 675700 Page 2 of 4 675700 07/10/2024 Harmony Care at Brookshire 710 Hwy 359 S Brookshire, TX 77423

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some and was working on getting things in place. She said they were short on housekeeping staff and as soon as they are staffed, they will be more flexible with getting things done quickly. She said she was going to ensure that facility was deep cleaned, and daily cleaning done. She said the secured unit will be cleaned 2-3 times a day to get rid of the odor. She said when housekeeping identified issues they should report it to maintenance and maintenance should address them. She said she had been in the building only for one week and was just trying to put things in place to ensure the building was always clean. In an interview with the Administrator on 7/10/2023 at 5:15pm he said they had identified some of the environmental issues and was working on addressing them. He said the storm came and they had to take care of the issues that came with the storm. Record review of the facility's policy and procedure titled Homelike Environment- Quality of Life dated 11/28/2023 read in part . Policy Statement Residents are provided with a safe, clean, comfortable, and homelike environment and encouraged to use their personal belongings to the extent possible including but not limited to receiving treatment and supports for daily living safely. Policy Interpretation and Implementation 1. Staff shall provide person-centered care that emphasizes the residents' comfort, independence and personal needs and preferences while ensuring receipt of care and services safely which maximize independence and does not pose a safety risk. 2. The facility staff and management shall maximize, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting. These characteristics include: a. Cleanliness and order; e. Pleasant, neutral scents; f. Clean bed and bath linens that are in good condition; g. Comfortable temperatures; and 3. 675700 Page 3 of 4 675700 07/10/2024 Harmony Care at Brookshire 710 Hwy 359 S Brookshire, TX 77423

F 0921 The facility staff and management shall minimize, to the extent possible, the characteristics of the facility that reflect a depersonalized, institutional setting. These characteristics include: Level of Harm - Minimal harm or potential for actual harm b. Residents Affected - Some Institutional odors; h. The use of contrasting paint to aid visually impaired residents (for example, plates that contrast with the table linens and toilets that contrast with the bathroom wall color). 675700 Page 4 of 4