Health inspection·September 8, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to consult with the resident's physician when there was a significant change in the resident's physical status for one (Resident #214) of eight residents reviewed for physician notification. The physician was not notified that Resident #214 had a fall on 08/25/23 and complained of pain to the left hip. This failure put residents at risk of delayed medical treatment. Findings include: Record review Resident #214's face sheet dated 08/08/2023 documented a [AGE] year-old female with an initial admission date of 12/29/2022, and a re-admission date of 08/30/2023 to the facility. Record review Quarterly MDS dated [DATE] for Resident #214 documented she had a BIMS of 7 (severe cognitive impairment). Required extensive assistance of two persons with bed mobility, transfers, and toilet use; requires extensive assistance of one person with locomotion on and off unit. Received scheduled and PRN pain medication. Pain presence - yes; Pain Frequency - occasional. Section I documented Resident #214 had diagnosis of Anxiety, non-Alzheimer's dementia, and unspecified fall. Review of Resident #214's Care Plan dated revised 05/05/23 for Resident #214 revealed family gives her Tic Tac as Placebo for pain. Rt. Reports effective. Goal: Rt will be comfortable and not experience pain. Interventions: Administer pain medications if RT has pain. Tic Tac are breath mints. Review of Resident #214's Care Plan revised on 07/13/23 revealed Resident #214 is at high risk for falls r/t Gait/balance problems, unaware of safety needs and history of falls. Interventions: Anticipate needs. Be sure call light is within reach. Follow Fall protocol. Review of Resident #214's Care Plan initiated on 07/13/23 and revised on 08/31/23 for Resident #214 revealed, Unwitnessed fall on 07/06/23. 8/20/23 no injuries sustained. Unwitnessed fall 8/25 with left hip fracture. Interventions: Bed at lowest position when in bed. Continue interventions on the at-risk-plan. For no apparent acute injury, determine and address causative factors of the fall. Monitor/document/report PRN x 72 hours to DM for signs & symptoms of pain, bruises, change in mental status, new onset: confusion, sleepiness, inability to maintain posture, agitation. Record review of Resident #214's History and Physical dated 9/03/23 documented readmission from Page 1 of 26 675723 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few hospital 91-year- old female with past medical history of hypertension, dementia, insomnia, anxiety who was transferred to the hospital after sustaining a recent fall at skilled nursing facility. X-ray at the nursing home was positive for acute intertrochanteric fracture of the left femoral head (hip fracture). Underwent and left hip hemiarthroplasty (a surgical procedure where half of the hip is replaced) on 8/27/23. Past Medical History: Displaced intertrochanteric fracture of right femur (a partial or complete break of the femur thigh bone). Abnormalities of gait and mobility. Cognitive communication deficit. Plan: Lt. Hemiarthroplasty-Acetaminophen tablet 325 mg give 2 tablets by mouth every six hours as needed for pain. Tramadol HCL (hydrochloride) oral tablet 50 mg one tablet by mouth every 12 hours as needed. Anxiety-hydroxyzine HCL oral tablet 25 mg give 1 tablet my mouth twice daily. Record Review of Residents #214's incident report dated 08/25/23 at 5:39 PM written by LVN U documented Unwitnessed Fall This nurse was alerted to the nurse's station. Resident was noted laying on her (L) left side. Head to toe assessment performed resident PROM (passive range of motion) to BLE (both lower extremities), no redness noted, no other skin concerns noted V/S (vital signs) obtained and noted. Resident was then transferred to bed. Resident medicated for pain. Resident Description: Resident unable to give description. Injuries Observed at Time of Incident: No injures observed at time of incident. Mobility: Wheelchair bound. Mental Status: Oriented to person. Injuries Report Post Incident: No injuries observed post incident. Level of Pain: (no information was documented). Predisposing Physiological Factors: Impaired Memory, Gait Imbalance, Incontinent, and Recent Illness. Predisposing Situation Factors: Ambulating without Assist. Other Info: Poor safety awareness, resident self-transfers, does not ask for assistance, poor cognition. Overestimates safety awareness. Witnesses: No witnesses found. Physician notified 08/26/23 at 10:54 AM. DON notified 08/25/23 at 10:53 AM. Responsible Party were notified 08/26/23 at 10:54 AM. Incident report completed by LVN U. Review of SBAR (Change of Condition) dated 08/26/23 at 06:20 AM written by LVN V documented, Pain to left hip. Increased confusion, and new or worsening behaviors. Functional Capacity Review: Fall, decreased mobility, increase in ADL assistance. Weakness. Stat (order should be prioritized first as it's needed urgently) hip x-ray ordered. Assessment: Injured in fall. Recommendations: X-Ray, Transfer to hospital. Physician notified 08/26/23 at 6:22 AM. Responsible Party notified 08/26/23 at 10:00 AM. Review of x-ray report dated 08/26/23 9:53 AM, Resident #214 revealed Findings: There is osteoporosis. Acute fracture of the left femoral neck. No metal fracture or hip dislocation noted at this time. Impression: Acute left femoral fracture. Fixated right intertrochanteric hip fracture with intact hardware. Record review of #214's nurse's progress note documented on 08/26/23 at 12:46 PM written by LVN V Data: rounded on Patient at 06:20 upon arrival to shift. Pt. observed to be crying out in pain and holding Left hip. CNAs reported resident unable to walk. Asked nurse giving report and she stated patient had a fall yesterday night at approximately 2000 (8 PM). Action: Contacted DON and Dr. 6:27 AM. Received order for x-ray bilat. hips and pelvis. Called x-ray company and placed stat x-ray order. Response: Received order for x-ray bilat hips and pelvis. X-ray staff arrived at 9:55 AM to complete. Received call from DON that x-ray was positive for fx (fracture) of left hip. 11:50 AM contacted Dr. on call. 11:58 AM received orders to send patient to ER via 911. 12:32 PM, patient left in ambulance. Record review of Medication Administration Record (MAR) dated August 2023 for Resident #214 revealed Acetaminophen 325 mg two tablets were administered on 08/26/23 at 2:24 AM by LVN W for pain level 675723 Page 2 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few of 8 and 08/26/23 at 7:03 AM by LVN V for pain level of 10. Pain level of 1 to 10, 10 being the worst pain. The MAR did not document LVN U had administered acetaminophen to Resident #214 on 8/25/23 on the 2-10 shift. Telephone interview on 09/06/2023 at 12:38 PM with LVN U revealed reported that she was assigned to Resident #214 on 08/25/23 on the evening when resident sustained an unwitnessed in front of the nurse's station after dinner. LVN U stated she had assessed Resident #214 and did not have any apparent injures at the time of the assessment and placed resident in bed. LVN U reported that resident had complained of generalized pain and medicated the resident with acetaminophen. LVN U stated, Resident #214 always complained of pain and did not note any change on that day after the fall. LVN U stated she made a decision based on her nursing judgment Resident #214 did not require any medical intervention or further monitoring and pain management. LVN U stated she had not notified the resident's responsible party that resident had sustained a fall on that day. LVN U, verbalized notifying doctor and DON. LVN U stated she had documented providing acetaminophen for pain management, LVN U verbalized including pain management in her incident report. LVN U denied noticing any difference in Resident #214. Telephone interview on 09/06/23 at 01:08 PM with Resident #214 family member revealed LVN U had notified her Resident #214 had sustained a fall on 8/25/23 in the evening and nurse had administered acetaminophen for general pain. Family member stated she felt no concern since she knew Resident #214 had fallen before and they had taken all the precautions to ensure Resident #214 had no injury and report to physician. Telephone interview on 09/08/23 at 02:21 PM, LVN V revealed she worked the morning shift on 08/26/23. LVN V stated, Resident #214 is usually up and in the halls when I arrive. The night nurse reported resident had sustained a fall on the evening shift and had complained of pain during the night and was medicated with acetaminophen and slept most of the night. LVN V reported that after report at approximately 6:20 AM, she went to Resident #214's room and noted resident was lying in bed, crying out in pain, and touching her left hip. CNAs reported resident unable to walk. LVN V reported that she immediately notified the physician and gave orders for x-rays of the hips and pelvis. LVN V stated that she had medicated Resident #214 with acetaminophen as ordered for pain. Interview on 09/08/23 at 03:19 PM with DON revealed LVN V had called her on 08/26/23 to report Resident #214 had sustained fall on 08/25/23 during the evening shift and was complaining of pain to the left hip. LVN V immediately reported to physician and gave orders for x-rays that revealed resident had a left hip fracture and was sent by EMS (emergency medical services) to emergency room per doctor's orders. DON stated LVN U failed to notify her and the physician on 8/25/23 that Resident #214 had sustained a fall and was complaining of pain. After investigation was completed the DON stated it was concluded Resident #214 pain was controlled after the fall no further harm resulted from the delay in notification to the physician and the resident staying in the facility until the following morning. The DON stated LVN U was given a disciplinary action for failure to report Resident #214's fall to the physician and to administrative staff, since failure to notify physician of change in condition can lead to residents not receiving the proper and/or delay in care, and can affect resident quality of life. Record review of the facility policy Change in Condition Communication revised date 06/2019 documented Policy: To improve communication between physician and nursing staff to promote optimal patient/resident care, provided nursing staff with guidelines making decisions regarding appropriate and timely notifications of medical staff regarding changes in patient/residence condition, and provide 675723 Page 3 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few guidance for the notification of residents and their responsible party regarding changes in condition. Procedures: Notify the physician of the change. (The physician notification grid may be used as a reference tool regarding acceptable notification timeframe's.) in medical condition. The nurse will document all assessments and changes in the resident's condition. The resident's legal representative will be notified of any change in medical condition or treatment plan. Physician Communication Grid documented in part: Falls; Treatment required within 1 hour, falls with hip or leg pain. These guidelines are not intended to substitute for good nursing judgment. If the nurse feels uncomfortable with a situation, he/she should not delay contacting the physician or call 911 if it appears to be life-threating event. The above applies 24 hours a day 7 days a week! 675723 Page 4 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

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 ensure that residents had clean bath linens for 2 (Resident #41 and Resident #24) of 16 residents reviewed for bath linens. The facility failed to ensure that Residents #41 and #24 had bath towels available to dry off with when bathed. This failure could put residents at increased risk of discomfort and embarrassment due to not having bath towels to dry off with after bathing. Findings included: Resident #41 Record review of Resident #41's face sheet date 09/08/23 revealed resident was a [AGE] year-old female admitted to the facility on [DATE]. Record review of Resident #41's History and Physical dated 06/21/22 documented a diagnosis of anxiety and depression. Record review of Resident #41's quarterly MDS dated [DATE] documented resident had a BIMS score of 15 indicating her cognitive status was intact. The MDS assessment documented Resident #41 was able to make her needs understood and could understand others. In section G was documented Resident #41 needed extensive assistance with one-person assistance for showers. In an interview on 09/07/23 at 08:46 AM, Resident #41 stated she was scheduled to receive 3 showers a week on Monday, Wednesday, and Friday in the morning and the shower scheduled was not followed by staff due to shortage of towels. Resident #41 stated having to continuously be asking staff on her scheduled shower day for her to receive a shower?and would at times be provided with a wash clothes to dry herself since the facility had no towels. Resident #41 stated staff at times are not able to provide showers to all the residents due to not having enough towels. In an interview on 09/08/23 at 6:30 PM with Resident #41 revealed she had been at the facility for one year. She stated there was always an issue with towels. She stated when she would take showers, the staff would give her a small towel to dry herself with. She said she was unable to dry herself. She stated at times, the staff would give her towels that belonged to other residents for her to be able to dry herself. She stated she told the staff Well how am I supposed to dry myself with no towel. She revealed it happened once a week. She stated the staff would say there were not enough towels for all residents. She stated she did not like it but put up with it since there was nothing she could do. Resident #24 Record review of Resident #24's face sheet dated 09/08/23 revealed resident was an [AGE] year-old female with an initial admission date of 09/22/2014 and re-admitted of 03/01/23 to the facility. 675723 Page 5 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #24's History and Physical dated 06/13/23 documented a diagnosis of CVA with left sided hemiparesis, and Parkinson. Record review of Resident #24's quarterly MDS dated [DATE] documented resident could make her needs understood and understand others. Resident #24 had a BIMS score of 14 indicating she was cognitively intact. Interview on 09/06/23 at 09:32 AM, Resident #24 revealed she was scheduled to receive baths 3 times a week and would not be provided the 3 scheduled baths due to shortage of towels. Resident # 24 stated the staff would offer to provide the bath and dry her with bed linen, but she did not like that because it irritated her skin. In an interview on 09/08/23 at 06:36 PM, Resident #24 revealed staff would tell her that there were no towels when it was time to take a shower. Resident #24 stated it happened often, but not all the time. Resident #24 stated staff would give her a bed sheet or whatever they had for her to dry herself. She said at times she did not shower because towels were unavailable. She stated she felt there was nothing she could do, but that showering with no towel was better than nothing. Observations on 09/08/23 at 07:50 AM of the laundry department with Laundry Worker S revealed washing machine #2 was not washing clothes and not in working condition. Dryer #1 and Dryer #2 were not drying clothes and not in working condition. In a group interview on 09/07/2023 at 10:00 AM, Resident #41 said the facility sometimes ran out of bath towels. She said that on one occasion (could not give a date) she was given a hand towel or wash cloth with which to dry off after a bath.She said this was not enough to dry her big body and was embarrassed because it was not big enough for her to cover herself, indicating her chest and pelvic areas. In a group interview on 09/07/2023 at 10:00 AM Resident #24 said there had been times when the CNAs did not have bath towels when it was time for her shower. In interview and observation on 09/07/2023 at 8:11 AM, with ADON B, three of three linen closets on the second floor were observed to have no towels in them. ADON B stated that bathing was finished for the morning so the towels were used up, but that Housekeeping would bring more towels onto the floor later in the morning. He said that on some occasions when there were no towels, staff had used a heavy sheet/light blanket to dry residents and pointed these out in one of the linen closets. He said sometimes if towels were not available CNAs would delay showers until towels were available. In an interview on 09/07/2023 at 8:15 AM, CNA R said they ran out of towels about once a week. She said that she was usually able to bathe residents when desired, but she might have to delay showers due to running out of towels.When told that there were no towels in the linen closet that morning, she said towels would probably be delivered to the floor by around 9:30 AM. She said that if there were no towels available when needed, she would go to the laundry to get some, although sometimes the laundry worker was still folding towels when she got there, so showers might be delayed. In an interview on 09/07/23 at 3:21 PM, with the DON revealed the laundry workers would be at the facility from 4 AM-4 PM. The DON stated she was not aware if there was a washing or drying machine that was not working. She stated the laundry staff would wash all linen and towels, and then they would wash the resident's clothes. She stated there was no decrease in towels because of the washing 675723 Page 6 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0584 machines being down. She stated if CNAs needed towels, they could go to the other floor and get them. Level of Harm - Minimal harm or potential for actual harm In an interview on 09/07/2023 at 5:02 PM, the Maintenance Supervisor said the one washer and one dryer that were currently broken had been broken since he had started working at the facility [5/30/23]. He said the other dryer that was currently broken had broken shortly after he started working at the facility. He said he had recently been in touch with the vendor who supplied the machines to ask that they be repaired, and that repairs were pending receipt of parts. Documentation of his contact with the vendor was requested. Residents Affected - Some In an interview on 09/08/23 at 07:55 AM, with Laundry Worker S revealed she had been working at the facility for one month. She stated her shift started when she arrived at the facility at 5 AM and ended at 2 PM. Laundry Worker S revealed since she started working, the machines had been down (1 washing and 2 dryers). She stated at times, the facility would be short on towels because of the machines not functioning, or because the CNAs would throw them away if soiled. She stated the laundry staff had been sending 10 towels in the linen cart, when it should have been 15-20 towels. She stated if the CNAs needed more towels, they would go to laundry and grab some for the morning showers. She stated there had been a laundry machine technician that had checked on the machines when she first started working. She said the parts had been ordered and were pending delivery. In an interview on 09/08/2023 at 10:37 AM, the Maintenance Supervisor said the laundry equipment vendor who was to repair the washer and dryers was in Mexico and would not be able to get back to repair the machines until 09/09/2023. He said he had not been aware that the machines being broken had caused a problem with the availability of towels, and only decided to repair them because of problems with other equipment in the laundry. In an interview on 09/08/23 at 02:25 PM, Laundry Worker S said clean towels were delivered to the floor six times between 6:00 AM and 5:15 PM. She said CNAs came to the laundry to pick up towels about twice a week. The Housekeeping Supervisor would also sometimes call the laundry to ask for towels. She said that during a normal week CNAs had to wait for towels about three times. She said she heard that all the machines were working there would not be a problem with running out of towels. In an interview on 09/08/23 at 02:42 PM, the House Keeping Supervisor said CNAs asked for towels most often in the mornings. She said this happened once or twice since she started working (June 30, 2023). She said she heard they were getting ready to run out of towels about 5 times, and that at times she had to tell the CNAs the towels were about ready to come out of the dryer. She said when she started working two out of 4 of the dryers were broken and that shortly after her hire, one of three washing machines had broken down. She said there would be fewer issues with running low on towels if the washer and dryers were not broken. In an interview on 09/08/23 at 06:20 PM, the DON said the facility had no policy regarding availability of linens. In an interview on 09/08/23 at 09:04 PM, the Administrator said he was not aware that there were concerns about the availability of the towels. He said he became aware that there were two dryers and washers down a few days ago. He said this could affect the timing of showers for residents but had never been told it was an issue. He said he ensured that equipment was functioning properly by hearing about problems from the Maintenance Supervisor. He said the Maintenance Supervisor said the vendor servicing the machines in the laundry had been called and that they would be at the facility the 675723 Page 7 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0584 next day to service the washer and dryers. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 675723 Page 8 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the faciality failed to develop and implement a comprehensive, person-centered care plan for each resident that included measurable objectives and time frames to meet, attain and/or maintain the resident's highest practicable physical, mental and psychosocial well-being for 1 (Resident #19) of out 8 residents reviewed for care plans. The facility failed to develop and implement a comprehensive person-centered care plan for Resident #19 preferences of showers. This failure could place residents at risk of decreased quality of life due to not having their treatment and preferences met. Findings include: Record review of Resident #19's face sheet dated 09/08/23revealed resident was an [AGE] year-old female with an initial admission date of 03/17/2023 and re-admitted on [DATE] to the facility. Record review of Resident #19's History and Physical dated 06/13/23 documented a diagnosis of right femoral vein DVT s/p ivc filter, (filter placed in vein in leg to treat blood clots) seizure disorder and severe physical deconditioning. Record review of Resident #19's Quarterly MDS dated [DATE] revealed Resident #19 had a BIMS score of 10 indicating residents moderately cognitively impaired. Resident #19 was able to understand others and make her needs understood. In section G of the MDS documented Resident #19 utilized a wheelchair, required extensive assistance with one person assist for personal hygiene and two-person assistance with transfers. Record review of Resident #19's Care plan dated last reviewed date on 07/10/23 documented ADL self-care performance deficit related to limited mobility. Interventions: Personal Hygiene Resident #19 requires x1 staff participation with personal hygiene. In an interview on 09/07/23 at 08:28 AM, with Resident #19 revealed resident would receive bed baths 3 times a week. Resident #19 stated she preferred receiving showers and does not like bed baths. The resident said she had told CNAs that she wanted showers but they said they said they could not because they were short on staff. In an interview and record review on 09/08/2023 at 11:44 AM, LVN T revealed Resident #19 would at times get both bed baths and other times would be placed in a shower chair with a Hoyer and received assistance with a shower by the CNAs. LVN T stated it was based on request and it would be documented in the resident's care plan that would transfer into the Kiosk for the CNAs. LVN T stated there was no specific order that indicated how Resident #19 should be showered or bathed after reviewing Residents #19's chart. LVN T stated Resident #19 does have 2 CNA's always assist her however does not know the resident's preference. LVN T stated if the resident's preferences are not followed it could negatively affect Resident #19's self-esteem. Interview on 09/08/23 at 04:20 PM, with the DON revealed that there is no specific order or 675723 Page 9 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some indication how a resident can receive their bath it would be more on the resident's preference, if there is no physical limitation resident can receive a shower. The DON verbalized that she was not aware of Resident #19's preference of a shower instead of a bed bath and stated that she was under the impression she was receiving a shower. The shower/bath task does not indicate how the resident receives their bath for the day. In an interview on 09/08/2023 at 8:37 PM the MDS Nurse revealed she used physician's orders, MDS diagnoses and incident reports to customize the care plan. The MDS Nurse said resident bathing preferences should be care planned. The MDS nurse said she had not done an audit of resident bathing preferences so bathing preferences were not in care plans. Record review of the facility policy Care Plans, Comprehensive Person-Centered dated 12/2016 documented that a comprehensive person-centered care plan will: included measurable objectives and timeframes. The care plan would describe services to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial wellbeing, would incorporate identified problem areas, and risk factors associated with identified problems to build on the residents' strengths. Describe the services that would otherwise be provided for the above but are not provided due to the resident exercising his or her rights including the right to refuse treatment. 675723 Page 10 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

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 and record review the facility failed to ensure that a resident who is fed by enteral means receives the appropriate treatment and services for 1 of 8 residents (Resident # 165) reviewed for enteral feeding. -Resident #165's enteral feeding formula was not labeled with time of administration, date it was hung, and rate that formula was given. This failure could place residents receiving enteral feedings at risk of malnutrition if feedings were to be given incorrectly. Findings include: Record review of Resident #165's face sheet dated [DATE] documented a [AGE] year-old female with an admission date to the facility of [DATE]. Record review of Resident #165's History and Physical dated [DATE] documented she had a diagnosis of protein caloric malnutrition and had a PEG tube in place. It also documented that tube feedings were to be given. Record review of comprehensive care plan dated [DATE] documented Resident #165 had tube feedings at night with a goal of remaining free of side effects or complications related to tube feeding. Interventions included providing local care to G-tube site and checking for tube placement and gastric contents/residual volume per facility protocol . Record review of physician order dated [DATE] documented Enteral feeding-Jevity 1.2 @ 45 mL/hr from 7pm-6am. Observations on [DATE] at 10:01 AM, of Resident #165's tube feeding formula revealed a Jevity 1.2 bottle that was unlabeled with date, time of administration, and rate at which it had run at. The formula was currently not running or connected to Resident #165. In an observation and interview on [DATE] at 10:02 AM, with LVN O revealed Resident #165 received nocturnal feedings. He observed the tube feeding for Resident #165 and revealed it was not labeled and was missing information. He stated the feeding should be labeled with the name of the resident, date and time it was hung, and the amount the formula was running at. In an interview on [DATE] at 9:20 AM, with LVN P revealed she worked 6AM to 2PM shift. She stated the tube feeding should have been labeled with name of resident, date it was hung, time it was hung, and the rate of how fast formula was running. She stated it was important to do so to ensure the correct rate was being given and to know when the formula expired since it was no longer good after 24 hours. In an interview on [DATE] at 11:20 AM, with LVN Q revealed she worked 6AM to 2 PM shift. She stated the tube feeding formula should be labeled with time it was hung, date it was hung, name of resident and rate it was being given. She stated the formula was only good for 24 hours, and it was 675723 Page 11 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0693 important to ensure it was labeled to know if the formula was being given correctly. Level of Harm - Minimal harm or potential for actual harm In an interview on [DATE] at 3:13 PM, with the DON revealed the tube feeding had to be labeled with residents' name, formula type, rate of formula being given, time it was hung and the date it was given. She stated it was important to do that to make sure that the correct formula was given. She stated there could be a risk to the residents if the tube feeding was not labeled correctly. Residents Affected - Few In a follow-up interview on [DATE] at 6:01 PM, with the DON [DATE] she stated there was no policy on tube feeding labeling. 675723 Page 12 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record review the facility failed to ensure residents received parenteral fluids must be administered consistent with professional standards of practice and in accordance with physician orders for 1 (Resident #28) of 2 residents reviewed for peripheral intravenous care. Residents Affected - Few - The facility failed to date the intravenous dressing site of Resident #28's central line when it was changed. This failure placed residents at risk of developing an infection. Findings included: Record review of Resident #28's face sheet dated 09/08/2023 documented a [AGE] year-old male with an admission date to the facility of 08/10/2023. Record review of Resident #28's History and Physical dated 08/11/2023 documented a diagnosis of chronic back pain and was status-post back surgery. He was receiving IV antibiotics for his wound and was to continue to do so while at the facility. Record review of Resident #28's MDS comprehensive assessment dated [DATE] documented a BIMS score of 8, indicating a moderate cognitive impairment. It also documented that Resident #28 was receiving IV medications while at the facility. Record review of Resident #28's comprehensive care plan dated 08/21/2023 documented Resident #28 was on IV Medications and the goal was to not have any complications related to IV therapy. Interventions included to check dressing site daily and monitor for signs and symptoms of infection. Record review of Resident #28's physician order dated 09/03/2023 documented Change Central Line dressing every 5 days and as needed. Record review of Resident #28's physician order dated 08/30/2023 documented Central Line Site Observation: Monitor Central Line to Right Chest Wall site each shift. Observation on 09/06/23 at 09:27 AM, of Resident #28 revealed a central line dressing that was not dated. The dressing appeared clean and intact but was missing the date it was changed and the initials of who had changed it. Observation on 09/08/23 at 10:35 AM, of Resident #28 revealed the central line dressing was dated for 09/06/2023. The dressing appeared clean and intact. In an interview on 09/07/23 at 11:20 AM, with LVN Q revealed the dressing changes for central lines were to be done per physicians' orders but should be labeled with date and time it was changed. She said it had to be labeled due to it being an infection control issue for the residents. In an interview on 09/07/23 at 3:13 PM, with the DON revealed nurses knew to change and label the dressings on all intravenous lines. She stated the dressing had to be labeled with the date it was changed, and the initials of the individual who changed it. She revealed it was important to do so to 675723 Page 13 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0694 prevent infections and to know when the dressing would have to be changed. Level of Harm - Minimal harm or potential for actual harm In an interview on 09/08/23 at 10:36 AM with LVN O, revealed the central line dressing had been changed on 09/06/2023. He stated the dressing needed to have the date and time it was changed, as well as the initials of the person who had changed it. He revealed he had not noticed that the dressing before the current one had not had the date, time or initials. He stated the importance of labeling a dressing correctly would be to know when it was last changed and ensure it was not over-due. Residents Affected - Few In an interview on 09/08/23 at 10:37 AM, with WC LVN revealed she had changed the central line dressing for Resident #28 on 09/06/2023, and the previous line dressing as well. She stated she had not noticed that the previous dressing was not labeled. She stated the dressings had to be labeled with the time and date it was changed, and with initials of who had changed it. She stated the importance of doing so was to keep track of when the dressing was changed and to ensure if it was changed as ordered. She stated if it was not done, the nurses could lose track of when it had to be changed and could be a risk for infection. Record review of facility policy titled Central Venous Access dated 02-2009 read in part .Label dressing with nurse date and your initials . 675723 Page 14 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interviews, and record review, the facility failed to provide pharmaceutical services, including procedures that assure the accurate administering of all drugs to meet the needs of the residents for 1(2nd floor) of 2 medication storage rooms and 1(1st floor) of 3 medication carts. -1st floor medication cart had expired medications. -2nd floor medication room had expired medications. This failure could cause a decline in health in residents if expired medications were to be given. Findings included: Observations on 09/07/23 at 9:19 AM with LVN P in the medication room on the second floor revealed one unopened bottle of multivitamins with iron with an expiration date of 4/23 located on one of the shelves. Inside the refrigerator was a package of Acetaminophen suppositories 650 mg dated 06/2023. Observations on 09/07/23 at 11:20 AM with LVN Q of 1st floor medication cart revealed one bottle of multivitamins with minerals with an expiration date of 08/23. One bottle of multivitamins with iron with an expiration date of 04/23 and one bottle of multivitamins dietary supplement with an expiration date of 08/23. In an interview on 09/07/23 at 9:21 AM with LVN P revealed the supply personnel was responsible for checking the medications and ensuring they were within date of expiration. She stated the medication should not have been in the medication room because it was expired, and it could affect the residents if it were to be given to them. In an interview on 09/07/23 at 11:20 AM with LVN Q revealed she tried to go through the medications and check expiration dates once a month in her medication cart (1st floor).? She stated the medications should not have been in the medication cart because they were expired. She stated the risk to the residents could be that they would get expired medications because of them being in the cart. In an interview on 09/07/23 at 3:16 PM with DON revealed nurses would frequently try to check their supply in the medication room and ensure that they were not expired. She stated central supply would check the medications in the medication room as well as nurses. She revealed nurses had to ensure no expired medications were in the medication room because it could be a risk to the residents. No specific risk was stated. In an interview on 09/08/23 at 5:36 PM with Central Supply Coordinator revealed she would restock the medication in the medication rooms. She said the first thing she did was see what medication had to be stocked. She stated she would focus on how much medication was needed, but not the expiration date. She revealed she was not in charge of that. She stated there could be side effects if residents were to take expired medications. Record review of facility policy titled Storage of Medications undated read in part .Outdated, contaminated or deteriorated medications .are immediately removed from inventory, disposed of according 675723 Page 15 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0755 to procedures for medication disposal and reordered from the pharmacy .All expired medications will be removed from the active supply and destroyed in the facility, regardless of amount remaining . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 675723 Page 16 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review the facility failed to ensure that residents who use psychotropic drugs receive gradual dose reductions for 1 (Residents #52) of 6 residents whose drug regimens were reviewed. Resident #52 was receiving an antipsychotic for which no gradual drug reduction had been attempted. This failure puts residents at increased risk of experiencing side effects as a result of taking unnecessary medications. Findings include: Record review of Resident 52's Face Sheet dated 09/07/2023 documented that she was [AGE] years old and was admitted to the facility on [DATE]. Record review of Resident #52's Psychiatric Subsequent Assessment note dated 08/31/2023 documented she had a past psychiatric diagnoses including Anxiety, Bipolar disorder, Dementia and Schizophrenia. Record review of Resident 52's electronic diagnosis listing dated 09/07/2023 documented she had diagnoses including dementia, anxiety disorder, bipolar disorder and schizophrenia. Record review of Resident 52's quarterly Minimum Data Set, dated [DATE] documented she had a BIMS of 8 (Moderate cognitive impairment). She had no potential indicators of psychosis and no behavioral symptoms during the look-back period. She had diagnoses of Non-Alzheimer's Dementia, Anxiety, bipolar disorder and Schizophrenia. She received antipsychotics on a regular basis and had received antipsychotic medication on 7 of the past 7 days. Gradual dose reduction was documented to not have been attempted. Record review of Resident #52's physician's order dated 12/13/2022 documented she was to receive 0.5 mg of Risperidone twice a day to treat schizophrenia (an antipsychotic medicine used to treat schizophrenia). Record review of Resident #52's Pharmacy Recommendation dated 02/27/2023 documented that the resident was receiving 0.5 mg of Risperdal (an antipsychotic medication) twice a day, and that the pharmacist recommended a gradual dose reduction to 0.25 mg twice a day. A follow-through note on the Pharmacy Recommendation stated, note written to secondary provider. Record review of Resident #52's March 2023 MAR showed that the resident was administered 0.5 mg of Risperdal twice daily on 31 of 31 days of the month. Record review of Resident #52's April 2023 MAR showed that the resident was administered 0.5 mg of Risperdal twice daily on 30 of 30 days of the month. Record review of Resident #52's May 2023 MAR showed that the resident was administered 0.5 mg of 675723 Page 17 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0758 Risperdal twice daily on 31 of 31 days of the month. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #52's June 2023 MAR showed that the resident was administered 0.5 mg of Risperdal twice daily on 30 of 30 days of the month. Residents Affected - Few Record review of Resident #52's July 2023 MAR showed that the resident was administered 0.5 mg of Risperdal twice daily on 31 of 31 days of the month. Record review of Resident #52's August 2023 MAR showed that the resident was administered 0.5 mg of Risperdal twice daily on 31 of 31 days of the month. In an interview on 09/08/23 at 12:13 PM, ?ADON A said regarding Resident #52 that the facility medical director did not feel comfortable ordering a GDR for Resident #52 so referred the pharmacy recommendation to a psychiatrist. The ADON said at the time of the Medical Director's referral, the facility did not have a psychiatrist. She said that the facility now had a Psychiatric Nurse [Practitioner] who started working in July 2023 and was handling the facility's psychiatric cases. She did not know if the pharmacy recommendation from 02/27/2023 had been passed along to the Psychiatric Nurse [Practitioner]. Documentation of the Medical Director's communication of the pharmacy recommendation to a psychiatrist?was requested. Record review of Resident #52's Physician Progress Note dated 02/21/2023, written by the Medical Director's FNP and signed by the Medical Director on 02/28/2023 documented in part Bipolar Risperidone referral to psychiatrist . In a telephone interview on 09/08/23 at 12:23 PM regarding Resident #52, the Psychiatric Nurse Practitioner said he had seen Resident #52 as a client but had no record of having received a pharmacy recommendation regarding gradual dose reduction for Risperidone. He said that he was not sure she had a diagnosis of schizophrenia but that her actual diagnosis might be bipolar disorder, and that he needed more contact with the resident to determine this. In a telephone interview on 09/08/23 at 12:55 PM regarding Resident #52, the Psychiatric Nurse Practitioner said he confirmed in his records that he had not received or signed a GDR for Risperidone for Resident #52. He said GDRs for antipsychotics were important for geriatric patients because antipsychotics come with a black box warning indicating they could result in sudden death in geriatric residents with dementia-related psychosis and posed other health risks for elderly patients. He said having Resident #52 on this medication might put her at risk of these side effects. In an interview on 09/08/23 at 08:08 PM the DON said Resident #52 did not have a GDR for Risperidone because the facility did not have a psychiatrist and the resident's insurance would not cover having her go out to a provider. The DON said the FNP for the facility Medical Director told the DON not to mess with the resident's psychiatric medications. The DON said Risperidone had a Black Box warning because it could increase suicidal ideation and put residents at risk of extrapyramidal effects, so Resident #52 might be at risk of these side effects. Record review of the facility's policy Psychotropic Drug Use dated 6/2019 documented residents were to receive gradual dose reductions in an effort to discontinue these drugs. Dose reductions for antipsychotics were to be attempted twice a year. Record review of the website https://www.drugs.com/risperidone.html accessed on 09/11/2023 at 3:35 675723 Page 18 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0758 PM documented in part Risperidone is not approved for use in older adults with dementia-related psychosis. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 675723 Page 19 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 food service safety for 1 of 1 kitchen reviewed for dietary services. The facility failed to properly seal and date food in the freezer, refrigerator and dry food storage. The facility failed to dispose of expired items in the food prep areas. This failure places residents who eat food prepared by the facility at risk of foodborne illnesses. Findings include: During the initial observation on 09/06/23 at 08:59 AM during initial round with [NAME] and the Dietary manager reveal: Observed in the freezer individual cut rolls dough, frozen sliced carrots, frozen cut green beans, frozen green sweet peas, frozen broccoli cuts, and frozen golden corn?in a box container improperly sealed or labeled with open date. Observed in the refrigerator an improperly label with open date gallon of Worcestershire sauce. Observed in the refrigerator an improperly sealed container with cheese. Observed in the refrigerator a side garden salad without a label. Observed in the refrigerator found an opened quart size container of thickened lemon-flavored water unlabeled. Observed in the refrigerator found a container containing multiple individualized expired salsas labeled preparation dated 08/19/23, use by 08/16/23. Observed in the refrigerator an unlabeled tray containing resident's drinks sealed. Observed in the refrigerator two unlabeled sealed 8 oz. foam cups containing resident's drinks. Observed in the refrigerator an unlabeled with open date gallon jar of dill pickle chips. Observed in the refrigerator a tray with sealed container labeled Italian mix dated prep date 08/28/23 and use by date 08/30/23. Observed in the storage area an unlabeled with open date gallon of apple cider vinegar. Observed in the storage area an unlabeled with open date gallon of red wine vinegar. 675723 Page 20 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0812 The top of the food preparation table revealed the following: Level of Harm - Minimal harm or potential for actual harm A 22oz. bottle of Cajun with expiration date of 12/15/22, 16 oz bottle of ground nutmeg with expiration date of 3/27/23, an opened 16oz bottle of crush chili pepper flakes with residual in the cap, grease build up on top and side of the bottle and a unlabeled opened 36 oz thicker container. Residents Affected - Some Interview on 09/08/23 at 07:20 PM, with the Dietary manager revealed food is required to be labeled upon when delivered to the facility and when opened. The Dietary manager stated food was expected to be used before the expiration date if not food needed to be disposed of. The Dietary manager stated findings were being addressed got fixed as we identified them during the kitchen observation. The Dietary manager stated it was important to follow guidelines to prevent cross-contamination, food born illnesses and objects falling into the food. Record review of the facility provided policy titled Food Safety in receiving and storage revised dated 08/12/2019 Documented in part food will be received and stored by method to minimize contamination and bacterial growth. Refrigerate ready to eat time/temperature control safety foods are properly covered, labeled, dated with a use-by date and refrigerated immediately. [NAME] them clearly to indicate the use by which the food shall be consumed or discarded. The day of preparation or day original container is open shall be considered day one discard after three days unless otherwise indicated. Refer to cold storage chart. In case of commercially processed food the date marked by the facility may not exceed the manufacturer used by date. Refrigerated condiments and salad dressings are properly covered labeled and clearly marked to indicate use by date two months from the date opened. 675723 Page 21 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to dispose of garbage and refuse properly for 1 out of 1 trash containers reviewed for food safety requirements. Residents Affected - Some The facility failed to have garbage cans without a lid in the kitchen. This failure could affect residents by placing them at risk of food born illness, illnesses, or be provided with an unsafe, unsanitary and uncomfortable environment. Findings included: Observation on 09/06/23 at 08:59 AM during initial kitchen observation revealed the facility used garbage can containers without lids in the kitchen area and in the area where the dishwasher is located. During an interview on 09/08/23 at 07:20 PM, the Dietary Manager confirmed they were using garbage receptacles without lids in the kitchen and area with the dishwasher. The Dietary Manager stated he wasn't aware the staff were utilizing trash containers that did not have a trash lid, this was not allowed practice and will be correcting it. The Dietary Manager stated this practice can lead to cross-contamination. The facility provided a policy & procedure titled Waste Disposal dated 8/1/20. The policy states, waste will be disposed of in a manner to prevent transmission of disease, nuisance or breeding place for insects, and feeding places for rodents and other mammals. (1) Waste is not disposed of by garbage disposals. It is kept in leakproof non-absorbent containers with close fitting lids. (5) Always cover waste containers and close dumpsters. 675723 Page 22 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview the facility failed to maintain all mechanical equipment in safe operating condition for one of three washing machines and two of four dryers reviewed for being in operating condition. Residents Affected - Some The facility failed to repair one washing machine and two dryers for a period of one month. This failure placed residents at risk of not having enough towels to dry?with after showers. Findings included. Observations on 09/08/23 at 07:50 AM of the laundry department revealed washing machine #2 was not in working condition. Dryer #1 and Dryer #2 were not in working condition. In an interview on 09/07/2023 at 5:02 PM, the Maintenance Supervisor said the one washer and one dryer that were currently broken had been broken since he had started working at the facility [5/30/23]. He said the other dryer that was currently broken had broken shortly after he started working at the facility. He said he had recently been in touch with the vendor who supplied the machines to ask that they repaired, and that repairs were pending receipt of parts. Documentation of his contact with the vendor was requested. In an interview on 09/08/23 at 07:55 AM, with Laundry Worker S, she revealed she had been working at the facility for one month. She revealed since she started working, in July, the machines had been down (1 washing and 2 dryers). She stated there had been a laundry machine technician that had checked on the machines when she first started working. She said the parts had been ordered and were pending delivery. In an interview on 09/08/2023 at 10:37 AM, the Maintenance Supervisor said the laundry equipment vendor was in Mexico and would not be able to get back to repair the machines until 09/09/2023. He said he had not been aware that the machines being broken had caused a problem with the availability of towels, and only decided to repair them because of problems with other equipment in the laundry. In an interview on 09/08/23 at 02:42 PM, the Housekeeping Supervisor said when she started working [06/30/2023] two out of 4 of the dryers were broken and shortly after her hire, one of three washing machines broke down. In an interview on 09/08/23 at 09:04 PM, the Administrator said he became aware that there were two dryers and washers down a few days ago. He said he ensured that equipment was functioning properly by hearing about problems from the Maintenance Supervisor.? He said the Maintenance Supervisor had said the vendor servicing the machines in the laundry had been called and that they would be at the facility the next day to service the washer and dryers. In an interview on 09/08/23 at 06:20 PM, the DON said there was no policy regarding maintenance of equipment. 675723 Page 23 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0941 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members. Based on interview and record review the facility failed to include effective communications as mandatory training for direct care staff for 11 (DON, ADON A, LVN C, LVN D, CNA H, CNA I, CNA J, Social Worker, SLP L, O.T. M, and P.T. N) of 17 direct care staff reviewed for training on effective communication The facility failed to ensure direct care staff received training on effective communication?for the DON, ADON A, LVN C, LVN D, CNA H, CNA I, CNA J, the Social Worker, SLP L, OT M, and PT N. This failure could put residents at increased risk of not having a way to effectively communicate their wants or needs. Findings include: In an interview and record review on 09/08/2023 at 8:42 AM, the HR Director revealed the following employees had not completed training on effective communication: the DON hired 12/19/2022, ADON A hired 12/19/2022, LVN C hired 08/26/2023, LVN D hired 05/16/2022, CNA H hired 05/16/2022, CNA I hired 10/01/2022, CNA J hired 05/16/2022, the Social Worker hired on 11/14/2022,? SLP L hired on 08/15/2022, OT M hired on 06/27/2022, and PT N hired on 06/01/2022. He said it was important employees were trained to ensure the safety of the residents. He said the risk to residents was that they would be getting treatment from untrained personnel. Record review of the facility All Staff Education Calendar dated 2023 documented training on effective communications was offered in May of 2023. In an interview on 09/08/2023 at 09:10 PM, the Administrator said he was not aware that training in effective communications was required. He said the risk to residents was that they might not be able to get their needs met. In an interview on 09/08/2023 at 6:00 PM, with the DON, policies regarding required staff training were requested, but were not received before exit. 675723 Page 24 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0942 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents. Based on interview and record review the facility failed to ensure that all staff members are educated on the rights of the resident and the responsibilities of a facility to properly care for its residents for 10 (DON, ADON A, ADON B, LVN D, CNA F, CNA J, the Activity Director, the Maintenance Supervisor, O.T. M, and P.T. N) of 21 employees reviewed for training on the rights of the resident and the responsibilities of a facility to properly care for its residents The facility failed to ensure theDON, ADON A, ADON B, LVN? D, CNA F, CNA J, the Activity Director, the Maintenance Supervisor, O.T. M, and P.T. N received training on the rights of the resident and the responsibilities of a facility to properly care for its residents This failure could put residents at increased risk of not having their rights respected or not receiving proper care. Findings include: In an interview and record on 09/08/2023 at 8:42 AM, the HR Director said that following employees did not receive training on the rights of the resident and the responsibilities of a facility to properly care for its residents: the DON hired on 12/19/2022, ADON? A hired on 12/19/2022, ADON B hired on 12/09/2022, LVN? D hired on 05/16/2022, CNA F hired on 05/16/2022, CNA J hired on 05/16/2022, the Activity Director hired on 05/16/2022, the Maintenance Supervisor hired on 05/30/2023, O.T. M hired on 06/27/2022, and P.T. N hired on 06/01/2022. He said it was important employees were trained to ensure the safety of the residents. He said the risk to residents was that they would be getting treatment from untrained personnel. Record review of facility All Staff Education Calendar dated 2023 documented in part training on resident rights was offered in April 2023. In an interview on 09/08/2023 at 09:10 PM, the Administrator said he was not aware that training on the rights of the resident and the responsibilities of a facility to properly care for its residents was required.? He said the risk to residents was of receiving services from staff who were not aware of resident rights. In an interview on 09/08/2023 at 6:00 PM with the DON, policies regarding required staff training were requested, but were not received before exit. 675723 Page 25 of 26 675723 09/08/2023 Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903

F 0943 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation. Based on interview and record review the facility failed to ensure that training was provided regarding dementia management for 9 (Administrator, DON, ADON A, ADON B, LVN C, LVN D, CNA G, CNA H, and CNA J) of 12 employees reviewed for training on dementia management. The facility failed to ensure the Administrator, DON, ADON A, ADON B, LVN C, LVN D, CNA G, CNA H, and CNA J received training on dementia management. This failure could put residents at increased risk of improper management of dementia-related issues. Findings include: In an interview and record review on 09/08/2023 at 8:42 AM, the HR Director said that following employees did not receive training on dementia management: the Administrator hired on 05/23/2023, the DON hired on 12/19/2022, ADON A hired on 12/19/2022, ADON B hired on 12/09/2022, LVN C hired on 08/6/2023, LVN D hired on 05/16/2022, CNA G hired on 04/24/2023, CNA H hired on 05/16/2022, and CNA J hired on 05/16/2022. He said it was important employees were trained to ensure the safety of the residents. He said the risk to residents was that they would be getting treatment from untrained personnel. Record review of facility All Staff Education Calendar dated 2023 documented in part training on dementia management was provided in August 2023. In an interview on 09/08/2023 at 09:10 PM, the Administrator said he was not aware that training on dementia management was not completed for some employees. He said the risk to residents was that residents with dementia might not get appropriate treatment. In an interview on 09/08/2023 at 6:00 PM with the DON, policies regarding required staff training were requested, but were not received before exit. 675723 Page 26 of 26