Health inspection·September 15, 2024

F 0728 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse aides who have worked less than 4 months are enrolled in appropriate training. Based on interview and record review, the facility failed to not use any individual working in the facility as a nurse aide for more than four months, on a full-time basis, unless that individual is competent to provide nursing and nursing related services; and that individual has completed a training and competency evaluation program, or a competency evaluation program approved by the State for 4 of 4 Student Nurse Aide (NA) reviewed for training and competency ( NA B, NA C, NA D and NA E). The facility failed to ensure NA B, NA C, NA D and NA E were certified nurse aides and had the appropriate training/competency to provide care to residents within four months of hire. This failure could place residents at risk for injury or receiving improper care by unlicensed personnel. Findings included: Record review of employee roster dated 9/13/24 revealed NA B had a hired date of 3/21/24 and position: nurse aide; NA C had a hired date of 3/21/24 and position: nurse aide; NA D had a hired date of 12/15/23 and position: nurse aide; NA E had a hired date of 12/13/23 and position: nurse aide. Record review of NA B's Texas Nurse Aide Performance Record revealed a training begin date of 3/27/24 and an end date of 4/19/24. Record review of NA C's Texas Nurse Aide Performance Record revealed training a begin date of 3/27/24 and an end date of 4/19/24. Record review of NA D's Texas Nurse Aide Performance Record revealed a training begin date of 12/18/23 and an end date of 1/12/24. Record review of NA E's Texas Nurse Aide Performance Record revealed training a begin date of 3/27/24 and an end date of 4/19/24. During an interview on 9/15/24 at 10:21 a.m., NA E said she had worked at the facility full time since April or May 2024 and was not a certified NA. She said she worked the 100 Hall from 6am-2pm shift and sometimes double shifts if needed independently. NA E said she had not scheduled to retake the state certification at this time and planned on scheduling to take the test soon. She said she previously took the test but did not pass. NA E said when she first started, she did some training and she worked with another CNA for a few days to know how to care for the residents. She said she did a peri care check off with the DON. She said she now worked independently when providing care to a Page 1 of 2 675774 675774 09/15/2024 Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402

F 0728 resident unless she needed another aide to assist her with a resident that required two people. Level of Harm - Minimal harm or potential for actual harm During an interview on 9/15/24 at 10:47 a.m., NA D said she had worked at the facility full time since around December 2023 and was not a certified NA. She said she worked the 200 Hall from 6am-2pm shift independently. NA D said she had not scheduled to take the state certification at this time and planned on scheduling to take the test soon. Residents Affected - Some During an interview on 9/15/24 at 2:09 p.m., NA B said she had worked at the facility full time since April 2024 and was not a certified NA. She said she worked the 400 Hall from2p -10p shift independently. During an interview on 9/15/24 at 2:43p.m., NA C said she had worked at the facility full time since April 2024 and was not a certified NA. She said she worked the 300 Hall from2p -10p shift independently. NA C said when she first started, she did some training and she worked with another CNA for a few days to know how to care for residents. She said she did a peri care check off with the DON. She said she now worked independently when providing care to a resident unless she needed another aide to assist her with a resident that required two people. During an interview on 9/15/24 at 4:39 p.m., the Operations Manager said NA B, NA C, NA D and NA E were considered full-time staff. During an interview on 9/15/24 at 4:57 p.m., the DON said she was aware NA B, NA C, NA D and NA E were not certified NAs and NA B, NA C, NA D and NA E were allowed to provided patient peri care independently because they had completed training prior to working independently. The DON said she was aware NAs had 120 days to become certified, but NA B, NA C, NA D and NA E all went through a refresher class in August 2024 and had 3 more months to schedule to test. The DON said she was not aware NAs were not allowed to keep doing refreshers to restart the four months time period of working as NAs . Record review of the facility's nursing assistant job description dated 12/17/21 revealed the following: Position Summary - The primary purpose of your job position as a full-time staff member is to acquire the knowledge, skills, and certification as a Certified Nursing Assistant by participation in the facility's planned educational program consisting of classroom instructions, clinical practice and on- the - job supervised training, and to perform certain services for which you have been trained and found to be competent during the training period Acknowledgement: This position consistently supports and promotes compliance with the Code of Conduct by maintaining the privacy and confidentiality of information, protecting the assets of the facility, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal, State, and local laws and regulations, accreditation and licensure requirements (if applicable), and all policies and procedures . 675774 Page 2 of 2