Health inspection·June 3, 2022

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and facility policy review, it was determined the facility failed to ensure one (Resident #33) of one resident who was fed by enteral means (a feeding tube) received the appropriate treatment and services to prevent complications of enteral feeding (tube feeding), including but not limited to, aspiration pneumonia. Specifically, the facility failed to ensure Resident #33's bed was not in a flat position when the resident's enteral feeding was actively running. Findings included: A review of the facility policy titled, Enteral Feedings - Safety Precautions, revised November 2018, revealed, Purpose: To ensure the safe administration of enteral nutrition .Preventing aspiration .3. Elevate the head of the bed (HOB) at least 30[degrees] during tube feeding and at least 1 hour after feeding. A review of the admission Record revealed the facility readmitted Resident #33 on 04/09/2022. Diagnoses included dysphagia, oropharyngeal phase; gastrostomy status; and adult failure to thrive. The quarterly Minimum Data Set (MDS), dated [DATE], revealed a Brief Interview for Mental Status (BIMS) assessment was not completed with the resident. The Staff Assessment for Mental Status indicated the resident was severely cognitively impaired. The resident required one person's physical assistance for bed mobility, eating, and personal hygiene. A review of the June 2022 physician's orders revealed the resident was NPO (nothing by mouth). A review of the June 2022 medication administration record (MAR) revealed the resident had a gastrostomy tube (G-tube) feeding order which indicated, Encourage and assist Resident to elevate head of bed as tolerated. A review of the undated care plan revealed the resident required a tube feeding related to swallowing disorder, dementia, and cancer. The interventions included to encourage and assist the resident to elevate the head of bed as tolerated. On 05/31/2022 at 12:10 PM, Resident #33 was observed in their room. The resident was connected to their enteral feeding system and the tube feeding was running. The observation revealed the resident's bed laid flat when their tube feeding was running. On 05/31/2022 at 12:20 PM, Registered Nurse (RN) E was observed to enter Resident #33's room. RN E acknowledged the resident's feeding tube was connected and running. Upon observing the resident in bed, RN E immediately got a hold of the bed's remote control and raised the head of the bed. RN E (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 675701 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675701 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lawrence Street Health Care Center 615 Lawrence Street Tomball, TX 77375 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)