Health inspection·November 21, 2024

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure residents were free from verbal abuse for 1 of 5 residents (Resident # 1) reviewed for abuse. The facility failed to prevent Med Aide A, on 11/18/2024, from verbally abusing Resident # 1 when he used foul language. These failures could place residents at risk of emotional distress, fear, decreased quality of life and further abuse. Findings included: Review of face sheet for Resident # 1, dated 11/21/2024, reflected he was admitted to the facility on [DATE] with diagnoses of : Major Depressive Disorder(is a serious mood disorder that can affect how someone feels, thinks, and acts), Unspecified Osteoarthritis ( is a type of arthritis that affects an unspecified joint), and Anxiety Disorder (a mental health condition that involves persistent and uncontrollable feelings of fear and anxiety that can significantly impact a person's life). Review of the Quarterly MDS Assessment for Resident # 1, dated 11/6/2024 reflected Resident # 1 BIMS score was 15 and he had the ability to express ideas and wants. His physical assessments reflect. He needed extensive assistance with bed mobility, transfers, and ADL's. He needed limited assistance with eating. He was assessed as always incontinent of bladder and bowel. Review of the Care Plan for Resident # 1 revision date 7/2/2024 reflected interventions were in place for: bathing/showering bed mobility and personal hygiene. Provide supportive care, assistance with mobility as needed. Review of the facility investigation reflected the incident was reported on 11/19/2024 and occurred on the evening of 11/18/2024. Review of the incident report reflected Resident # 1 was to by Med Aide A FU Resident # 1. CNA B said Med Aide A said, FU Resident # 1. On interview by the DON Resident # 1 corroborated the statement. Resident # 1 said he has shoulder pain. Assessment of Resident # 1 showed no signs of physical injury. In an interview on 11/21/2024 at 2:00 pm Resident # 1 stated on 11/18/2024 CNA A needed to give him Page 1 of 4 675848 675848 11/21/2024 Focused Care at Webster 17231 Mill Forest Webster, TX 77598

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few a bed bath. He stated CNA A needed to place a sheet under him. He stated CNA A needed him to turn to his right side. He stated CNA A was new, and she did not know how to handle him. He stated CNA A asked CNA B to assist. He said he was trying to tell CNA A and CNA B how to position him. He stated CNA A said they needed assistance from an aide who was familiar with working with him and CNA A got Med Aide A to assist them. He said Med Aide A arrived at his room and immediately began to be rude. He stated Med Aide A told him Come on Resident # 1 we have things to do, and we cannot be in your room all day. Resident # 1 stated he can turn himself and hold on to the bed rail. He said CNA A and CNA B used a bed sheet to help roll him to the left side. He stated Med Aide A was shrugging and pushing his right shoulder. Resident # 1 said he told Med Aide A to stop because he was too rough. Resident # 1 said he asked Med Aide A to leave his room. He said Med Aide A told him Resident # 1 Ioing to let you have it. F it. He said Med Aide A remained in the room and he asked him to leave again. He stated as Med Aide A was leaving the room he said F you Resident # 1. Resident # 1 stated he felt fine and safe since Med Aide A was removed from the building. He stated Med Aide A had demonstrated a bad attitude on different occasions. He stated that he immediately reported this incident to LVN A and the DON. In an interview on 11/21/2024 at 3:45 pm CNA A stated she and CNA B went to give Resident # 1 a bed bath. She stated Resident # 1was a huge patient, and this was the first time she worked with him. She stated she left the room to get linen and wipes. She stated when she returned to the room, she and CNA B did a comfort bath on Resident # 1. She stated Resident # 1 was disrespectful to her and CNA B. She stated Resident # 1 told her how to properly bathe him. She stated she asked Med Aide A to assist as Med Aide A was Resident # 1's CNA in the past. She stated Resident # 1 seen Med Aide A and said, get the F out my room. She stated Med Aide A continued to assist with the patients care. She stated Resident # 1 had a draw sheet under him and this sheet made it easier to turn Resident # 1. She stated Resident # 1 was holding the bed rail while Med Aide A was positioning the sheets under Resident # 1. She stated she was trying to clean Resident # 1. She stated Resident # 1 yelled again for Med Aide A to get out of his room. She stated Med Aide A was walking out of Resident # 1's room and Med Aide A said, F it. She stated that she continued to provide care to Resident # 1. She stated that Resident # 1 told her that if she wanted to know how to care for him, to ask him. She stated that LVN A and the DON immediately came to Resident # 1's room. She stated she provided a written statement to the DON. Review of a Statement from CNA B dated 11/18/2024 reflected she had overheard Med Aide A tell Resident # 1 FU Resident # 1 In an interview on 11/21/2024 at 4:10 pm CNA B stated she was assisting CNA A with Resident # 1's bed bath. She stated when she arrived at Resident # 1's room both Resident # 1 and CNA A were aggravated. She stated Resident # 1 was trying to tell CNA A how he wanted things done. CNA B stated both she and CNA A were new, therefore, she left the room to find the nurse as she wanted to make certain they were following the proper protocol for Resident # 1's line of care. She stated she could not find the nurse, so she returned to Resident # 1's room. She said Med Aide A offered to assist. She stated Med Aide A entered Resident # 1's room and he said to Resident # 1 let's get this done. She said Med Aide A was a little rough with Resident # 1. She stated she witnessed Med Aide A Grab Resident # 1's arm and pull it up as Med Aide A was trying to force Resident # 1 roll over. CNA B stated she had worked with Resident # 1, and he can roll over he was just a little slow. CNA 675848 Page 2 of 4 675848 11/21/2024 Focused Care at Webster 17231 Mill Forest Webster, TX 77598

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few B stated Resident # 1 told Med Aide A to leave his room. Resident # 1 told Med Aide A he wanted me and CNA A to finish his care. She stated Med Aide A refused to leave Resident # 1's room. She stated Resident # 1 told Med Aide A I told you to leave my room. She stated Med Aide Asaid, F it. She said as Med Aide A was leaving the room he turned around and told Resident # 1 FU Resident # 1 and he walked out the room. She stated Med Aide A should have left the room when first asked. She stated she and CNA finished cleaning Resident # 1. CNA B felt Resident # 1 was verbally abused by Med Aide A. CNA B stated that she immediately reported this abuse to LVN A. In an interview on 11/21/2024 at 3:06 pm LVN A stated Resident # 1 reported that CNA A and CNA B were providing care to him. He stated that the CNA's were completing their care when Med Aide A came in the room to assist them. She stated Resident # 1 reported that Med Aide A was trying to turn him, and Med Aide A pulled his right arm. She said Resident # 1 reported when Med Aide attempted to pull his right arm again, he asked Med Aide A to stop. She stated Resident #1 told her Med Aide A told him FU Resident # 1. LVN A stated Resident # 1 reported Med Aide A hurt his right shoulder when he pulled him. LVN A stated she assessed Resident # 1 and reported the incident to the DON. LVN A stated based on what Resident # 1 reported to her she felt as though Resident # 1 was verbally abused by Med Aide A. In a telephone interview on 11/21/2024 at 3:30 pm, Med Aide said he also worked as a CNA. He stated he has been Resident # 1's CNA. He stated he was working the medication cart on 11/18/2024 when CNA A asked for assistance with Resident # 1. He stated CNA A was new, and she informed him she was trying to give Resident # 1 a bed bath and she asked if I could assist with turning Resident # 1. He stated Resident # 1 can assist with turning as Resident # 1 will grab the bed rail for support and turn. He stated Resident # 1 was turned by scooching over to the left and Resident # 1 will grab the bed rail while he pushed his shoulder with the sheet and tuck the sheet under him. He stated this day Resident # 1 wanted to be pushed by the hip. He stated while the CNA was cleaning Resident # 1, he took the lining and rolled it up so Resident # 1 could turn on the other side. He said Resident # 1 started yelling I'm not clean yet. He stated Resident # 1 had things when it was a new worker, he tried to go above and beyond. He stated Resident # 1 wanted to guide staff through the whole thing by telling them how to clean him. He stated Resident # 1 was turned to side, and he was getting ready to put his diaper on him. He stated Resident # 1 told him Boy you better get out of here. He said Resident # 1 let the rail go and he landed flat on his back. He said Resident # 1 tried to swing at him and told him to leave the room. He said he told Resident # 1 Resident # 1 you got this and he left out the room. He denied speaking to Resident # 1 inappropriately. He denied saying FU or F it. Med Aide said he was trained in Abuse, Neglect and Exploitation. In an interview on 11/21/2024@ 4:27 pm with the DON on 11/18/2024 LVN A informed her the CNA needed to report something that was going on with Resident # 1. She stated she went to Resident # 1's room and Resident # 1 informed her that he was verbally abused by Med Aide A. She stated she immediately asked Med Aide A to get off the floor and to go to her office. The DON stated she spoke with Resident # 1 who informed her that Med Aide A told him FU Resident # 1. She stated she assessed and interviewed Resident # 1. She stated Resident # 1 said Med Aide A was rough with him. He stated Med Aide A pushed him too hard. He stated that Resident # 1 told her he was trying to turn to hold the bar when Med Aide A pushed his shoulder. She stated she called Resident # 1's doctor and he ordered a stat x ray of the shoulder. She stated Resident # 1 told her he told Med Aide A to get out his room and Med Aide A said, FU Resident # 1. The DON stated that skin and pain assessment was performed on Resident # 1. The DON stated at the time of the assessment Resident # 1 675848 Page 3 of 4 675848 11/21/2024 Focused Care at Webster 17231 Mill Forest Webster, TX 77598

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few reported he was in pain because he had received pain medications. The DON stated Med Aide A was suspended that day and was removed from the floor immediately. The DON stated safety surveys have been conducted to make sure all residents feel safe. The DON stated if Med Aide A said to Resident # 1 FU Resident #1that was verbal abuse. The DON stated interviews were conducted with Resident # 1, Med Aide A, LVN A, CNA A and CNA B. The DON stated all staff have been trained in abuse, neglect, and exploitation. In an interview on 11/21/2024 at 4:56 pm with the Administrator, he said he expected his team to be professional, including no profanity or abuse. The Administrator stated he expected staff to follow rules and regulations passed by the State of Texas. He stated he was notified about the incident between Resident # 1 and Med Aide A on Monday night. He stated the incident report was sent to the state on Tuesday. He stated the investigation has been done to include interviews with Resident # 1, CNA's, Med Aide A and LVN A. He stated Med Aide A was suspended. He stated abuse Inservice and safe surveys were conducted. The Administrator stated all staff have been in serviced on abuse and neglect. Review of Med Aide A's employee record reflected he was hired on 7/23/2024 background check. completed; his last abuse prevention training was done on 7/23/2024. Review of a Statement from LVN A dated 11/18/2024 reflected that Resident # 1 reported that Med Aide A told him FU Resident # 1 FU Review of the Facility Policy on Abuse Neglect dated 2/1/2027 reflected the resident has a right to be free from any type of Abuse, . The facility staff will adhere to the policies and procedure and will follow the guidelines in the written policy and procedure. Examples of verbal abuse threats of harm, saying things that frighten a resident, name calling, bullying, demeaning, intimidating, or controlling. 675848 Page 4 of 4