Health inspection·February 16, 2023

F 0695 Provide safe and appropriate respiratory care 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 observations, interviews, and record reviews, the facility failed to ensure that residents who needed respiratory care were provided with such care, consistent with professional standards of practice for 1 of one resident (Resident #15) reviewed for respiratory care, in that: Residents Affected - Few The facility failed to: A.) Resident #15's tubing has not been changed since 1/27/23. B.) Resident #15's oxygen tubing was laying on the floor next to the Resident on 2/14/23 and 2/15/23. These deficient practices could place residents that receive oxygen therapy at risk for inadequate care and respiratory infection. Findings Included: Resident #15 Review of the facility's policy Safety Items, dated 12/9/2022 revealed, .Oxygen tubing must be changed out weekly on Oxygen concentrators and nebulizers Oxygen tubing must be bagged when not in use .Oxygen tubing must be dated with the date that it was changed. Use a piece of tape and write the date on it; place the tape on the bag . Record Review of Resident #15's face sheet dated 01/11/23 revealed the resident was an [AGE] year-old female admitted on [DATE]. Her diagnoses were congestive heart failure, anxiety, urinary tract infection and dementia. Resident was also on hospice care Observation on 2/14/23 at 11:20 a.m. revealed Resident #15 resting in chair in no apparent distress with an oxygen concentrator oxygen tubing laying on floor next to Resident. The oxygen concentrator was turned off. The change date on the tubing was labeled 1/27/23. Observation on 2/15/23 at 10:00 a.m. revealed Resident #15 resting in chair in no apparent distress with an oxygen concentrator oxygen tubing laying on floor next to Resident. The oxygen concentrator was turned off. The change date on the tubing was labeled 1/27/23. Page 1 of 6 675826 675826 02/16/2023 Sunset Home 1800 West 9th St Clifton, TX 76634

F 0695 Level of Harm - Minimal harm or potential for actual harm During the interview with Resident #15 on 2/14/23 at 11:20a.m. revealed that Resident #15 is non interview able. Record review of Resident #15's clinical physician orders dated as of 04/26/22 revealed for oxygen to be administered through the nostrils at 2-4 liters per minute as needed. Residents Affected - Few During an interview on 2/14/23 at 11:36 AM, LVN A stated oxygen tubing was changed every Sunday night and the tubing should be dated when it was changed. LNVA A also stated oxygen tubing should be placed in a plastic bag when not in use. During an interview on 2/16/23 at 2:00 p.m., the DON stated oxygen tubing was changed weekly and as needed. She stated when oxygen tubing was changed, staff were supposed to replace and date the oxygen tubing. She stated it was the facility's routine procedure to date the oxygen tubing when it was replaced. She stated not dating oxygen tubing when it was replaced and having oxygen tubing on the floor was not acceptable practice. During an interview on2/16/23 at 02:30 p.m., the Administrator stated oxygen tubing was changed weekly and PRN and it should have been dated and initialed by staff when changed and oxygen tubing should not be on the floor when not in use. He also stated that not dating, changing, and bagging the tubing when not in use is not acceptable practice. Respiratory Care Based on observations, interviews, and record reviews, the facility failed to ensure that residents who needed respiratory care were provided with such care, consistent with professional standards of practice for 1 (Resident #15) of 1 resident reviewed for respiratory care, in that: The facility failed to: A.) Resident #15 oxygen tubing was last changed on 1/27/23. B.) Resident #15's oxygen tubing was observed laying on the floor next to the Resident on 2/14/23 and 2/15/23. These deficient practices could place residents that receive oxygen therapy at risk for inadequate care and respiratory infection. Findings Included: Resident #15 Record Review of Resident #15's face sheet dated 01/11/23 revealed the resident was an [AGE] year-old female admitted on [DATE]. Her diagnoses were congestive heart failure, anxiety, urinary tract infection and dementia. Resident was also on hospice care and requires total assistance in all ADL's 675826 Page 2 of 6 675826 02/16/2023 Sunset Home 1800 West 9th St Clifton, TX 76634

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation and interview on 2/14/23 at 11:20 a.m. and 2/15/23 at 10:00 a.m. revealed Resident #15 resting in chair in no apparent distress with an oxygen concentrator oxygen tubing laying on floor next to Resident. The oxygen concentrator was turned off. The change date on the tubing was labeled 1/27/23. Resident #15 was non- interview able. Record review of Resident #15's clinical physician orders dated as of 04/26/22 revealed for oxygen to be administered through the nostrils at 2-4 liters per minute as needed. During an interview on 2/14/23 at 11:36 AM, LVN A stated oxygen tubing was changed every Sunday night and the tubing should be dated when it was changed. LNVA A also stated oxygen tubing should be placed in a plastic bag when not in use. During an interview on 2/16/23 at 2:00 p.m., the DON stated oxygen tubing was changed weekly and as needed. She stated when oxygen tubing was changed, staff were supposed to replace and date the oxygen tubing. She stated it was the facility's routine procedure to date the oxygen tubing when it was replaced. She stated not dating oxygen tubing when it was replaced and having oxygen tubing on the floor was a detriment to the facility's residents. During an interview on2/16/23 at 02:30 p.m., the Administrator stated oxygen tubing was changed weekly and PRN and it should have been dated and initialed by staff when changed and oxygen tubing should not be on the floor when not in use. He also stated was a detriment to the facility's 96 residents. Review of the facility's policy Safety Items, dated 12/9/2022 revealed, .Oxygen tubing must be changed out weekly on Oxygen concentrators and nebulizers Oxygen tubing must be bagged when not in use .Oxygen tubing must be dated with the date that it was changed. Use a piece of tape and write the date on it; place the tape on the bag . 675826 Page 3 of 6 675826 02/16/2023 Sunset Home 1800 West 9th St Clifton, TX 76634

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, interview and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident. The facility failed to provide a system of medication records that enables periodic accurate reconciliation and accounting for all controlled medications for 1 of 3 medication carts that were reviewed for pharmacy services. This deficient practice placed the residents at risk for not receiving the therapeutic effects from controlled narcotics due to from controlled narcotics not reconciled every shift. The findings include: 1.During an observation and record review on 2/16/23 at 11:30 a.m., an inspection of the medication cart on Hope Hall, revealed a form titled, Controlled Drugs-Count Record (Narcotic count sheet at each change of nursing shift), with missing signatures with the following dates: 2/1/23, 2/2/23, 2/3/23, and 2/4/23. During an interview on 2/16/23 at 11:30 a.m., LVA A stated she was aware of the missing signatures and stated that it can be a detriment to the residents by not having professional accountability for the narcotic count each shift. During an interview on 2/16/23 at 2:30 p.m., LVN B stated she misjudged the shift times when she did not sign the 7-3 shift narcotic count sheet. LVN B stated it is not best practice by not having professional accountability for the narcotic count each shift. During an interview on 2/16/23 at 02:00 pm the Director of Nursing stated she has acknowledged the noncompliance and stated that it is not best practice. She has also stated, This is an issue and all the nurses have been consulted about signing the narcotic count sheet. During an interview on 2/16/23 at 02:30 p.m. with the Administrator, the above findings were discussed. The Administrator acknowledged the above findings and states that the nurse not signing the narcotic count sheet is out of compliance. Record review of the facility's policy titled, Controlled Substances, dated April 2019, revealed, .8 .Controlled substances are reconciled upon receipt, administration, disposition, and at the end of each shift .9 .b .Both individuals sign the controlled substance record of receipt 10 .a. The nurse administering the medication is responsible for recording: .(6) .signature of nurse administrating medication 12 .a. Controlled medication are counted at the end of each shift. The nurse coming on duty and the nurse going off duty determine the count together. 675826 Page 4 of 6 675826 02/16/2023 Sunset Home 1800 West 9th St Clifton, TX 76634

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 one of one kitchen reviewed for food storage. The DS failed to ensure all items in the walk-in refrigerator and freezer were covered, labeled, dated, and discarded prior to their expiration date. These failures placed residents at risk of foodborne illness. Findings included: Observations on 02/13/2023 at 8:51 AM of poster titled FIRST IN FIRST OUT posted on the outside of the walk in refrigerator informing the staff to label food the day food was received and when it should be used. Store food so labels are clearly visible and use products expiring first. Check food expiration dates and throw away at or before expiration. Observations of the walk-in refrigerator on 02/13/2023 from 8:52 AM to 9:17 AM revealed the following: 1. Five heads of cabbage uncovered and undated sitting in white plastic bin. 2. One brown cardboard box, opened, uncovered, and undated, containing approximately 75 sliced mushrooms. 3. Six one pint contains of cherry tomatoes stored in commercial plastic boxes of approximately 15 tomatoes each undated with no manufacture's expiration date marked on the packages. 4. Brown cardboard box containing individual serving sized pieces of cake covered in plastic wrap, unlabeled and undated. 5. Sealed plastic zip locked bag of sliced red onions weighing approximately .5 lbs. unlabeled with date of 02/09/2023 6. Sealed plastic zip locked bag labeled potatoes (cut into cubes) weighting approximately 1 lb. with 675826 Page 5 of 6 675826 02/16/2023 Sunset Home 1800 West 9th St Clifton, TX 76634

F 0812 date of 02/13/2023. Level of Harm - Minimal harm or potential for actual harm 7. Residents Affected - Some Plastic container with white printed label listing item: steak fires, prepared date: 02/13/2022 use by was left blank and employee was left blank, 8. Three-pound bag lettuce blend previously opened, wrapped in plastic, undated with visible sections of browning lettuce. 9. Plastic zip locked bag labeled lettuce dated 02/10/2022. 10. Four zip locked bags each containing 6-10 slices of bread coated in butter unlabeled and undated. 11. One plastic bag containing approximately 6 waffles undated. 12. Five zip locked bags of chicken breasts unlabeled and undated. Interview on 02/13/2023 at 9:30 AM with the DS, she revealed that all staff should be following the directions on the FIRST IN FIRST OUT poster and label foods with the contents enclosed, the date the food was first placed in the refrigerator and freezer and the date the food should be used. The DS said she would, get this straightened up. When asked the DS what could happened if residents consumed spoiled food, she replied they could get sick. Interview on 02/17/2023 at 12:33 PM the admin revealed he was aware that food should be both dated when food it was opened and have a date when it should be used. He revealed food currently in the kitchen was obviously not dated according to policy and the lack of dating food according to the policy could cause food spoilage and this could be averse to the health of residents or cause residents to become ill. Review on 02/17/2023 of facility Dietary Services policy, undated, revealed all food should be appropriately dated to ensure proper rotation by expiration dates. Received dates, the dates of their delivery, will be marked on cases and on individual items removed from cases for storage. Used by dates will be completed with expiration dates on all prepared food and refrigerators. Expiration dates on unopened food will be observed and used by dates indicated once food is opened. Supervisors will be responsible for ensuring food items in pantry, refrigerators, and freezers are not expired or passed parish dates. Supervisors should contact the vendors or manufacturers when expiration dates are in question or to decipher codes. 675826 Page 6 of 6