Health inspection·August 3, 2022

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality for one (Resident #6) of four residents reviewed for resident rights. The window blinds in Resident #6's room prevented him from having privacy. This failure could place residents at risk for decreased dignity and privacy. Findings included: Review of Resident #6's MDS assessment dated [DATE] revealed he was an [AGE] year-old male who was admitted to the facility 01/14/18. His diagnosis included: anemia, coronary artery disease, hyponatremia, hyperkalemia, Alzheimer's disease, non-Alzheimer's dementia, and vitamin D deficiency. Review of Resident #6's MDS assessment dated [DATE] revealed he was usually understood, usually understood others, and had clear speech. His BIMS score (0) revealed he was cognitively impaired. There was no evidence of delirium or psychotic behaviors. Review of the facility maintenance log dated 03/2022 - 08/02/22 revealed there were no repair requests or resident refusals for the window blinds in Resident #6's room. In an observation and interview with Resident #6 on 08/01/22 at 12:09 PM revealed his blinds were stuck in the middle of his window and missing several slats. Resident #6's window was facing the parking lot. From the parking lot his television, bathroom, closet, and room door were visible. A staff member was observed in the parking lot looking inside his room. Resident #6 stated the blinds in his room were broken when he moved into the room. He stated he did not break the blinds. Resident #6 stated people were constantly walking in the parking lot and looking inside his room. He stated the only privacy in his room was by his bed with the privacy curtain or inside the bathroom with the door closed. He stated he has asked the Maintenance supervisor to fix his blinds. Resident #6 stated he has never had his blinds fixed or replaced. Interview with CNA B and LVN C on 08/03/21 at 03:21 PM revealed they did not know Resident #6's blinds were broken and did not completely cover his window. They stated he used his privacy curtain by his bed while changing clothes or sleeping. They stated he could be seen in his room from the parking lot if he was sitting in his wheelchair watching television, letting himself inside the bathroom, Page 1 of 9 675822 675822 08/03/2022 Beltline Healthcare Center 106 N Beltline Rd Garland, TX 75040

F 0550 or closet. They stated Resident #6 had a right to privacy and should have his blinds fixed to provide privacy. Level of Harm - Minimal harm or potential for actual harm Interview with Maintenance Supervisor on 08/03/22 at 03:43 PM revealed he was responsible for repairing Resident #6's window blinds. He stated the window blinds did not provide privacy to Resident #6. He stated Resident #6 had the right to privacy. He stated he first noticed Resident #6's broken blinds one week ago. He stated Resident #6 took the window blinds down and refused to allow him to make repairs. He stated he tried entering Resident #6's room the week of 7/25/22. He stated Resident #6 refused to allow him to enter at that time. He stated he documents needed repairs and resident refusals in the maintenance log. He stated he made daily rounds to ensure facility upkeep. He stated he was responsible for overseeing all maintenance repairs. Residents Affected - Few Review of facility policy, Resident Rights, dated December 2016, reflected, employees shall treat all residents with kindness, respect, and dignity. 675822 Page 2 of 9 675822 08/03/2022 Beltline Healthcare Center 106 N Beltline Rd Garland, TX 75040

F 0638 Assure that each resident’s assessment is updated at least once every 3 months. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to assess a resident using the quarterly review instrument specified by the State and approved by CMS not less frequently than once every 3 months for four (Residents #1, 2, 3, 4) of four residents reviewed for resident assessments. Residents Affected - Some The facility failed to ensure Residents #1, 2, 3, and 4's MDS assessment was updated quarterly. This failure could place residents at risk for not receiving the appropriate level of care and services. Findings included: Review of Resident #1's quarterly MDS assessment, dated 03/28/22, reflected she was an [AGE] year-old female who was admitted to the facility on [DATE]. Her diagnosis included: hypertension, renal failure, diabetes mellitus, hyponatremia, hyperlipidemia, Non-Alzheimer's Dementia, hemiplegia, depression, psychotic disorder, edema, insomnia, and dysphagia. Review of Resident #1's quarterly MDS assessment, dated 06/28/22, reflected the assessment was in-progress. The assessment had an ARD of 06/28/22. Review of Resident #2's quarterly MDS assessment, dated 03/28/22, reflected she was an [AGE] year-old female who was admitted to the facility on [DATE]. Her diagnosis included: heart failure, hypertension, renal failure, peripheral vascular disease, gastroesophageal reflux disease, diabetes mellitus, hyponatremia, hyperkalemia, hyperlipidemia, thyroid disorder, arthritis, Non-Alzheimer's Dementia, Alzheimer's disease, hemiplegia, depression, and dysphagia. Review of Resident #2's quarterly MDS assessment, dated 06/28/22, reflected the assessment was in-progress. The assessment had an ARD of 06/28/22. Review of Resident #3's quarterly MDS assessment, dated 03/23/22, reflected he was a [AGE] year-old male who was admitted to the facility on [DATE]. His diagnosis included: anemia, hypertension, aphasia, cerebrovascular accident, Non-Alzheimer's Dementia, constipation, malnutrition, vitamin D deficiency, and dysphagia. Review of Resident #3's annual MDS assessment, dated 06/23/22, reflected the assessment was in-progress. The assessment had an ARD of 06/23/22. Review of Resident #4's quarterly MDS assessment, dated 03/28/22, reflected he was a [AGE] year-old male who was admitted to the facility on [DATE]. His diagnosis included: pneumonia, hypertension, septicemia, diabetes mellitus, hyperlipidemia, manic disorder, psychotic disorder, schizophrenia, respiratory failure, and Alzheimer's disease. Review of Resident #4's quarterly MDS assessment, dated 06/28/22, reflected the assessment was in-progress. The assessment had an ARD of 06/28/22. Interview on 08/03/22 at 8:14 AM with the MDS Coordinator revealed the purpose of the MDS assessment was to paint a picture of the resident for everyone to know the resident's needs. She stated the 675822 Page 3 of 9 675822 08/03/2022 Beltline Healthcare Center 106 N Beltline Rd Garland, TX 75040

F 0638 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some MDS assessments were due quarterly which was every 90 days. She stated the risk of the quarterly MDS assessments not being completed was reimbursement for the facility. She stated the MDS quarterly assessments not being completed could affect the resident's revision of their care plan. She stated she did not know Resident #1, #2, #3, and #4's MDS assessments were not completed. She stated corporate conducted a mock survey in June 2022 to ensure MDS assessments were being completed. She stated the facility would start weekly audits this week to ensure the timeliness of MDS assessments. She stated the MDS assessment timeliness has been added to QAPI. She stated corporate ensured she completed MDS assessments in a timely manner by periodically reviewing residents' EMR. She stated she previously had issues completing MDS assessments because she had worked at two facilities at the same time. She stated she was currently only working at one facility. She stated she was the only MDS Coordinator for the facility and was trying to catch up on all past due MDS assessments. Review of facility policy, Resident Assessment Instrument, dated September 2010, reflected, the Assessment Coordinator is responsible for ensuring that the Interdisciplinary Assessment Team conduct timely resident assessments and review according to the following schedule: within fourteen (14) days of the resident's admission to the facility; when there has been a significant change in the resident's condition; at least quarterly; and once every twelve (12) months. 675822 Page 4 of 9 675822 08/03/2022 Beltline Healthcare Center 106 N Beltline Rd Garland, TX 75040

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident that included measurable objectives and time frames to meet residents' medical needs for one (Resident #16) of five residents reviewed for care plans. The facility failed to develop a care plan with measurable objectives and timeframes to address Resident #16's care. This failure could place residents at risk of receiving inadequate individualized care and services. Findings included: Review of Resident #16's MDS Assessment, dated 05/27/22, reflected he was a [AGE] year-old male who was admitted to the facility on [DATE]. His diagnosis included: anemia, hypertension, gastroesophageal reflux disease, neurogenic bladder, paraplegia, depression, bipolar disorder, and colostomy. Review of Resident #16's EMR section title Care Plan, reflected his care plan had not been completed. Interview on 08/03/22 at 8:39 AM with the MDS Coordinator revealed she was responsible for completing Resident #16's care plan. She stated the purpose of the care plan was to paint a picture of the resident. She stated the care plan addressed any problems the resident had, how to address them, and interventions to resolve problems. She stated it was important for care plans to be completed timely so staff can know whatever the problem was and to know whether it needed to be addressed or had been addressed. She stated the care plan also helped other staff like agency for staff to know how to help/address the resident. She stated she did not know why Resident #16's care plan was not completed. She stated his care plan was supposed to be completed by day 14 from admission. She stated corporate ensured her care plans were completed on each resident. She stated corporate conducted a mock survey in June 2022 to ensure care plans were being completed. She stated the facility would start weekly audits this week to ensure the timeliness of care plans. She stated care plan timeliness has been added to QAPI. She stated corporate ensured she completed care plan in a timely manner by periodically reviewing residents' EMR. She stated she previously had issues completing care plans because she had worked at two facilities at the same time. She stated she was currently only working at one facility. She stated she was the only MDS Coordinator for the facility and was trying to catch up on all past due care plans. Review of facility policy, Care Plan, dated 02/17/20, reflected, It is the policy of this center that staff must develop a comprehensive person center care plan to meet the needs of the resident. 675822 Page 5 of 9 675822 08/03/2022 Beltline Healthcare Center 106 N Beltline Rd Garland, TX 75040

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, interviews, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for kitchen sanitation. The facility failed to ensure food was properly stored in the facility's kitchen. This failure could place residents at risk for food-borne illness. Findings Included: Observation of the facility's walk-in refrigerator on 08/01/22 at 9:35 AM revealed: - 3 containers of strawberries with white fuzzy spots; - 8 bags of grapes with white fuzzy spots; - 3 oranges with white spots; - 2 red onions with white and black spots; and - 1 box of bacon open and exposed to the air. Observation of the facility's small refrigerator on 08/01/22 at 9:42 AM revealed: -1 bag of bread open and exposed to air. Observation of the facility's small freezer on 08/01/22 at 9:44 AM revealed: -1 box of skinless pork sausage links open and exposed to air; -1 box of simply homestyle roll dough open and exposed to air; -1 bag of chicken nuggets open and exposed to air; -2 bags of French fries open and exposed to air; -1 box of chocolate chip frozen cookie dough open and exposed to air; -1 box of southern style biscuit dough open and exposed to air. Observation of the facility's walk-in freezer on 08/01/22 at 9:52 AM revealed: -1 box of chicken tenderloins open and exposed to air; -1 box of chicken breast tender fritters open and exposed to air; 675822 Page 6 of 9 675822 08/03/2022 Beltline Healthcare Center 106 N Beltline Rd Garland, TX 75040

F 0812 -1 box of breaded chicken breast nuggets open and exposed to air; Level of Harm - Minimal harm or potential for actual harm -1 box of classic beef patties open and exposed to air; -1 box of medium brussels sprouts open and exposed to air; and Residents Affected - Some -1 box of mixed vegetables open and exposed to air. Observation of the facility's spice rack on 08/01/22 at 9:58 AM revealed: -1 bottle of garlic powder open and exposed to air; and -1 bottle of seasoned salt open and exposed to air. In an interview with the Dietary Manager on 08/03/22 at 2:50 PM revealed the cooks checked the refrigerators, freezers, spice racks, and dry storage for expired and unsealed items every day. He stated he did not know how the expired and unsealed items were missed in the refrigerators, freezers, spice racks, and dry storage. He stated on Tuesdays and Fridays he ensured the cooks were checking the refrigerators, freezers, spice racks, and dry storage for expired and unsealed items by doing walk throughs. He stated the cooks will be in-served on 08/05/22 regarding food storage. He stated improper food storage can affect the taste of the food and cause residents to become sick Review of the facility policy titled Food Receiving and Storage, dated July 2014, revealed, Foods shall be received and stored in a manner that complies with safe food handling practices. Package Integrity reflected: Food packages shall be in good condition and protect the integrity of the contents so that the food is not exposed to adulteration or potential contaminants. Review of the Food and Drug Administration Food Code, dated 2017, reflected, .3-302.12 Food Storage Containers, Identified with Common Name of Food. Except for containers holding food that can be readily and unmistakably recognized such as dry pasta, working containers holding food or food ingredients that are removed from their original packages for use in the food establishment, such as cooking oils, flour, herbs, potato flakes, salt, spices, and sugar shall be identified with the common name of the food 3-305.11 Food Storage. (A) .food shall be protected from contamination by storing the food: (1) In a clean, dry location; (2) Where it is not exposed to splash, dust, or other contamination .(B) .refrigerated, ready-to eat time/temperature control for safety food prepared and packaged by a food processing plant shall be clearly marked, at the time the original container is opened in a food establishment and if the food is held for more than 24 hours, to indicate the date or day by which the food shall be consumed on the premises, sold, or discarded, based on the temperature and time combinations specified in (A) of this section and: (1) The day the original container is opened in the food establishment shall be counted as Day 1; and (2) The day or date marked by the food establishment may not exceed a manufacturer's use-by date if the manufacturer determined the use-by date based on food safety 675822 Page 7 of 9 675822 08/03/2022 Beltline Healthcare Center 106 N Beltline Rd Garland, TX 75040

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 observation, interview, and record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents for one (Hall 200) of 4 of halls observed for environment. The facility failed to ensure bathrooms and rooms on Hall 200, and baseboards were clean, safe, and in good repair for occupied rooms 203, 205, 207, 209, 210, and 212, and baseboards in room [ROOM NUMBER] and 205. These failures could place residents at risk for diminished quality of life due to the lack of a well-kept environment and equipment. Findings included: An observation on 08/01/22 at 10:25 a.m. revealed in occupied room [ROOM NUMBER] the baseboards had completely separated from the wall behind the bed exposing a gap between the sheet rock and the floor. There were two tiles by the air conditioner that were loose and cracked with parts of the tile's corners missing. In the bathroom next to the toilet, 4 tiles were loose and cracked. An observation on 08/01/22 at 10:49 a.m. revealed in occupied room [ROOM NUMBER] the baseboard behind the head of the residents' bed had separated completely from the wall, exposing a gap between the sheetrock and the floor. Two tiles under the air conditioner were loose. In the bathroom [ROOM NUMBER], tiles next to the toilet were loose and two tiles underneath the sink were loose. An observation on 08/01/22 at 11:25 a.m. revealed in room [ROOM NUMBER] there were 3 tiles next to the air conditioner that were loose and small parts of the tiles were missing from the corners. In the bathroom the linoleum on the floor appeared to have warped and bubbled and a section of the linoleum was missing. An observation on 08/01/22 at 11:32 a.m. revealed in room [ROOM NUMBER] there was a 2x2 inch hole in the far wall and visible marring to the wall. There were 3 loose and cracked tiles in front of the air conditioner. In the bathroom there were 4 loose tiles around the toilet, that were cracked and had built up dirt residue on the outer edges of the tiles. An observation on 08/01/22 at 11:41 a.m. revealed in room [ROOM NUMBER] the linoleum in the bathroom had been cut too small to cover the entire floor, the edges of the linoleum appeared to be curled up from the floor and torn. An observation on 08/01/22 at 12:17 p.m. revealed in occupied room [ROOM NUMBER], the linoleum near the corner behind the toilet appeared to be warped and bubbled. A large 5 X 3-inch section near the bathroom door was missing and the edges of the linoleum around the missing part were curled up and jagged. In an interview on 08/03/22 at 11:23 a.m. the Administrator agreed that that the tiles in the residents' bathrooms were very old and needed to be replaced and that he had seen a few of the loose and broken tiles in the residents' rooms. He stated that he was not aware of the baseboards being separated from the walls. He stated that the loose tiles, holes in the walls and baseboards could 675822 Page 8 of 9 675822 08/03/2022 Beltline Healthcare Center 106 N Beltline Rd Garland, TX 75040

F 0921 Level of Harm - Minimal harm or potential for actual harm adversely affect residents' lives. The Administrator further said that the staff were to use the maintenance books located at each of the nursing stations to report building maintenance issues. Review of the Maintenance Book at the nurse's station for the dates of 05/01/22 through 08/03/22 revealed no communication for floor or baseboards in the residents' bathrooms and rooms Residents Affected - Some Interview and observation on 08/03/22 at 12:01 p.m. with Maintenance Director revealed if the bathrooms and rooms needed repairs it was his responsibility. When observing the floors in the residents' bathrooms and rooms, the Maintenance director stated that the loose floor tiles, missing parts of tiles and the baseboards coming off the walls were his responsibility. He stated he was aware that the bathrooms needed repair, but it just seemed he never had the time to get all the repairs completed. He stated if the staff (to include all departments) put maintenance needs in the book then he would be aware of maintenance required in the bathrooms and rooms. Interview on 08/03/22 at 12:37 p.m. with CNA A revealed she knew where the maintenance logs were located and that the logs were to be used to report maintenance issues, and that they (the staff) generally reported air conditioners not working, outlets not working or toilets not working, she had never reported in the maintenance logbook about floor tiles or baseboards and assumed that the maintenance director just knew that those things needed to be fixed. Review of the Policy and Procedure Maintenance Services dated revised December 2009 reflected Maintenance service shall be provided to all areas of the building . and equipment .1. The maintenance Department is responsible for maintaining the buildings in a safe and operating manner at all times .2. Maintaining the building in compliance with current federal, state, and local laws, regulations, and guidelines .maintaining the building in good repair and free from hazards .establishing priorities in providing repair services .providing routinely scheduled maintenance service to all areas .3 the Maintenance Director is responsible for developing and maintaining a schedule of maintenance service to assure that the building . are maintained in a safe and operable manner .maintenance .shall follow established safety regulations to ensure the safety and well-being of all concerned . 675822 Page 9 of 9