Health inspection·October 12, 2023

F 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure a resident is given the appropriate treatment and services to maintain or improve his or her ability to carry out the activities of daily living for 1 of 27 residents (Resident #86) reviewed for positioning and meal assistance. Residents Affected - Few The facility failed to ensure Resident #86 was monitored for assistance needs and failed to ensure she was positioned in a manner that would allow her to feed herself while in bed. This failure placed residents at risk for weight loss, ADL decline and poor self-esteem. Findings included: Review of Resident #86's Face Sheet dated 10/12/2023 reflected an [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE] with the following diagnoses Alzheimer's Disease (A type of brain disorder that causes problems with memory, thinking and behavior. This is a gradually progressive condition.), Diabetes Mellitus Type 2 (A condition results from insufficient production of insulin, causing high blood sugar.) and Dementia (A group of symptoms that affects memory, thinking and interferes with daily life.) Review of Resident#86's Annual MDS assessment dated [DATE] reflected Resident #86 was assessed to have a BIMS score of 9 indicating moderate cognitive impairment. Resident #86 was assessed to require supervision assist with eating. Resident #86 was assessed to be dependent on staff for bed mobility. Resident #86 was further assessed to not reject care. Review of Resident #86's Comprehensive Care Plan reflected a problem dated 08/16/2022 and revised on 10/24/2022 ADL self-care performance deficit related to displaced Trimalleolar fracture (break in your lower leg that forms the ankle joint) of left lower leg, morbid obesity, and osteoarthritis. Interventions included .Bed Mobility: The resident requires total assist by (2) staff to turn and reposition in bed : low air loss mattress .Eating: The resident requires Supervision with set up help only to eat . Observation and interview on 10/11/2023 at 09:42 AM revealed Resident #86 in her room in bed with her breakfast meal in front of her. Resident #86 was leaning far over to the left with her head in the window sill. Resident #86's had her orange juice in her hand which had spilled into the window sill. Resident #86's had not eaten any of her breakfast. When asked if she was ok Resident #86 stated no they have put me in this room and won't let me leave Resident #86 was asked if she was hungry and she stated yes. When asked if she could reach her food, she stated no. Surveyor put on Resident Page 1 of 3 675799 675799 10/12/2023 Brenham Nursing and Rehabilitation Center 400 E Sayles St Brenham, TX 77833

F 0676 #86's call light to summon staff to the room to provide resident with assistance. Level of Harm - Minimal harm or potential for actual harm Observation and interview on 10/11/2023 at 2:00 PM revealed Resident #86 in bed with her lunch tray in front of her. Resident #86 food had not been eaten. Resident #86 was slouched down in the bed and her positioning was not conducive for being able to reach her food. Resident #86 had her ice cream between the over bed table and her stomach trying to eat it. Resident #86 was having difficulty bring the spoon to her mouth. Further observation revealed her ice cream was melted indicating she had been trying to eat the ice cream for some time. Resident #86 was asked if she was hungry, she stated yes and continued to try to bring the ice cream to her mouth. Resident #86 was able to get the spoon to her mouth, but no ice cream was on the spoon. Resident #86 was asked if she needed help to eat, she did not answer and stated, it takes me a while. RN A entered the room and asked resident if she needed assist and she told him No. When RN A was asked by surveyor if the resident needed repositioning, he stated yes he would get someone. Residents Affected - Few Observation and interview on 10/11/2023 at 2:06 PM revealed CNA D entered the room and asked Resident #86 if she needed help with her lunch. Resident #86 stated yes and told the CNA she was a slow eater. CNA D stated Resident #86 was usually able to feed herself but has been having problems recently. CNA D washed her hands and sat beside Resident #86 and started feeding her. Resident #86 was receptive and started to eat. CNA D asked her how the food was, and Resident #86 stated it's good. Observation on 10/11/2023 at 2:20 PM revealed Resident #86 continued to eat her meal with assist. In an interview on 10/11/2023 2:23 PM The DON stated when asked about Resident #86 needing assist with positioning and feeding she stated Resident #86 was having a decline. The DON stated she would get Resident #86 therapy and stated the resident would refuse assist at times. In an interview on 10/11/2023 at 3:20 PM The RNC approached surveyor stating Resident #86 was independent with feeding and wanted to feed herself. She stated staff should monitor Resident #86 for correct positioning and monitor if resident was having difficulty eating. The RNC further stated residents should be positioned properly for meals to ensure they can reach their food. In an interview on 10/11/2023 at 3:32 PM DOR OT stated she had just done an evaluation for Resident #86. The DOR OT stated Resident #86 was able to eat when she was positioned properly. She stated it looked like she was able to feed herself, but she would need to be monitored. Review of Resident #86's Therapy evaluation dated 10/11/2023 reflected Patient observed following lunch meal and observed to have adequate ROM, strength, coordination, and initiation to perform self-feeding tasks with setup. OT to continue to monitor throughout OT POC to ensure that no functional decline is observed .Patient Goals: The patient states I want to keep feeding myself. Potential for Achieving Goals: Patient demonstrates good rehab potential as evidenced by ability to follow 2-step directions, able to make needs known, initiates to perform tasks, strong family support and supportive caregivers/staff . Observation and interview on 10/12/2023 09:12 AM revealed Resident #86 in bed alert pleasant with proper positioning. When asked if she ate her breakfast, she stated yes all of it. Review of Resident #86's meal intake for the 14 days (09/29/2023 through 10/12/2023) reflected Resident #86's meal intake was 75-100% except for 10/10/2023 with her intake being 25 to 50%. 675799 Page 2 of 3 675799 10/12/2023 Brenham Nursing and Rehabilitation Center 400 E Sayles St Brenham, TX 77833

F 0676 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview on 10/12/2023 10:47 AM the DON stated she expected the nurses to make rounds during meals to ensure residents eating in their rooms did not need assistance with eating or repositioning to ensure all residents were able to complete their meals. The DON stated she did not have a policy on positioning. Review of the facility's policy ADLs dated 05/26/2023 reflected The facility will, based on the resident's comprehensive assessment and consistent with the resident's needs and choices, ensure a resident's abilities in ADLs do not deteriorate unless deterioration is unavoidable. Care and services will be provided for the following activities of daily living . Eating to include meals and snacks .3. A resident who is unable to carry out activities of daily living will receive the necessary services to maintain good nutrition, grooming, and personal and oral hygiene. 675799 Page 3 of 3