Health inspection·October 19, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain a safe, functional, sanitary, and comfortable environment for four (Residents #12, #59, #76, and #81) of twenty-one residents reviewed for resident rights. 1. The facility failed to ensure Residents #81 and #76's room did not have stained and soiled carpeting and multiple flies. 2. The facility failed to ensure Resident #59's room did not have six various sized holes in her bathroom door, multiple flies and a water bug in her room. 3. The facility failed to ensure Resident #12's room did not have a large hole in the window screen and multiple flies in his room. These deficient practices could place residents at risk of a diminished quality of life due to an unsafe and unmaintained environment. Findings included: Observation and interview on 10/17/23 at 10:53 AM in Resident #59's room revealed she was sitting up in a chair in her room. Multiple flies were observed in her room . Resident #59 stated she had seen large water bugs as well. She stated she had seen them crawling out of the holes in her bathroom door. Observation of her bathroom door revealed 6 holes of various size in the lower half of her door. No bugs were seen exiting the holes, but a water bug was observed on her bathroom floor behind the toilet. Resident #59 stated she had reported it in the past to a CNA or two but did not remember the names of the CNAs. She stated the nursing staff had come in and try to kill them for her. She did not recall ever seeing anyone from maintenance or a pest control company come by to treat her room. An observation on 10/17/2023 at 11:35 AM revealed multiple flies in room residents #81 and #76's room. A fly swatter was observed on the dresser. The carpeting in their room was visibly stained, had food crumbs, and sticky when walked on. Interviews on 10/17/2023 at 11:35 AM with Residents #81 and #76 revealed the flies were in their room for a while. Resident #81 said he was not sure why there were so many flies in their room, but they were bothersome. Observation and interview on 10/17/23 at 12:00 PM in Resident #12's room revealed him sitting on Page 1 of 13 675891 675891 10/19/2023 Bridgeport Medical Lodge 2108 15th Street Bridgeport, TX 76426

F 0584 Level of Harm - Minimal harm or potential for actual harm his bed. Multiple flies were observed in the room. Resident #12 stated they had been there for a long time. The window blinds were open revealing a bird feeder just outside the window. The window was closed. A large hole was observed in the window screen approximately 12 inches in diameter. Resident #12 stated the hole had been there for a while and he did not open his window. He did not know if staff were aware and had not previously complained about it. Residents Affected - Some In an interview on 10/17/2023 at 11:43 AM, in the doorway to Residents #81 and #76's room, ADON G said she saw all the flies and they should not be in the room. She said the facility wanted to ensure the rooms were clean and free of pests to ensure residents' comfort. She said the fly swatter in the room indicated to her that the flies had been in the room for some time. In an interview on 10/17/2023 at 12:14 PM, the Housekeeping Supervisor stated management performed daily rounds to check for cleaning issues, but he had not done so that day. He said the floors should not be stained and dirty and housekeeping was responsible to ensure rooms were cleaned properly. He said files in the room posed a risk of spreading disease and residents should not have to deal with them. He said the room needed to be deep cleaned. During an interview on 10/18/23 at 7:10 AM, LVN D stated she was the charge nurse on the 500 Hall. She stated there was a maintenance log and pest control log at the nurse's station for reporting pest or maintenance issues. LVN D denied seeing any water bugs recently and was not aware of the holes in the bathroom door in Resident #59's room. During an interview on 10/19/23 at 10:10 AM, ADON A stated department heads were assigned rooms and made rounds daily. Any maintenance issues or pest control issues should be logged in the books at the nurse's station as a best practice. She was unaware of the issues in Resident #59 or #12's rooms. Observation and interview with the Maintenance Supervisor on 10/19/23 at 10:15 AM revealed he was aware of the problem with flies in the building. He stated he was not responsible for pest control in the building as they had a company to handle the task . When shown the bathroom door in Resident #59's room, the Maintenance Supervisor stated he was not previously aware of the problem, or he would have taken care of it quickly. He stated he depended on the nursing staff to enter any maintenance issues they find in the maintenance logbook at the nursing station. He stated he checked it every day. The Maintenance Supervisor stated the staff would sometimes catch him in the hall and verbally report a problem, but he really needed them to use the book. When asked about the window screens, he stated he was responsible for checking those and was aware there were some that needed replacement. He stated he was working on some higher priority issues at that time and planned to get to the screens as soon as he could. He was not aware of any residents who liked to open their windows and did not feel it was contributing to the problem with the flies. Observation and interview on 10/19/23 at 10:39 AM in Resident #59's room revealed CNA E was normally assigned to the 500 Hall but had not noticed the holes in the bathroom door. She stated she would document the issue in the maintenance log. She stated she was aware of the flies in the rooms but did not recall seeing water bugs in the resident's rooms. She stated she would kill them and document them in the pest control log if she had seen any. Record review of in-service records titled, Room rounding - inspecting rooms for foul odors, cleanliness, dated 3/8/23 and 4/20/23. Record review of the facility's Maintenance Request logs for the past three months revealed there 675891 Page 2 of 13 675891 10/19/2023 Bridgeport Medical Lodge 2108 15th Street Bridgeport, TX 76426

F 0584 was no entry related to the bathroom door in Resident #59 or the window screen in Resident #12's room. Level of Harm - Minimal harm or potential for actual harm Record review of the facility's current pest control log revealed there were no entries related to flies in 2023. The most recent entries reflecting roaches/water bugs occurred on 10/9/23 in room [ROOM NUMBER] and 5/11/23 in room [ROOM NUMBER]. Residents Affected - Some Record review of the facility's policy titled, Pest Control, dated Revised 9/22/23 reflected, Our facility shall maintain an effective pest control program .1. This facility maintains an on-going pest control program for insects and rodents .3. Windows are screened to assist with insect and rodent entry .6. Maintenance services assist, when appropriate and necessary, in providing pest control services. Record review of the facility's policy titled, Quality of Life - Homelike Environment, revised May 2017, reflected, Residents are provided with a safe, clean, comfortable, and homelike environment .The facility staff and management shall, maximize, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting. These characteristics include a. Clean, sanitary and orderly environment . 675891 Page 3 of 13 675891 10/19/2023 Bridgeport Medical Lodge 2108 15th Street Bridgeport, TX 76426

F 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed conduct an initial Comprehensive Assessment within 14 calendar days after admission for 2 of 22 residents (Resident #254 and Resident #255) reviewed for Comprehensive Assessments and timing. The facility failed to ensure Comprehensive MDS Assessments for Resident #254 and Resident #255 were completed within 14 days after their admissions to the facility. This failure could place residents at risk for improper or incorrect care and services necessary for their physical, mental, and psychosocial well-being. Findings included: Review of Resident #254's Face Sheet, dated 10/19/23, reflected she was an [AGE] year-old female who admitted to the facility on [DATE]. She had diagnoses including dementia (a group of thinking and social symptoms that interferes with daily functioning), type 2 diabetes mellitus (a disease that occurs when your blood glucose, also called blood sugar, is too high), and hypertension (high blood pressure). Review of Resident #254's electronic health records on 10/19/23 revealed that an initial MDS Assessment had not been completed and submitted by the facility as required. Review of Resident #255's Face Sheet, dated 10/19/23, reflected he was a [AGE] year-old male who admitted to the facility on [DATE]. He had diagnoses including dementia (a group of thinking and social symptoms that interferes with daily functioning), bipolar disorder (mental illness that causes unusual shifts in mood, ranging from extreme highs to extreme lows), and legal blindness. Review of Resident #255's electronic health records on 10/19/23 revealed that an initial MDS Assessment had not been completed and submitted by the facility as required. During an interview with the MDS Coordinator on 10/19/23 at 2:15PM, she stated she was responsible for completing Comprehensive MDS Assessments within 14 days of each resident's admission to the facility. She confirmed that Resident #254 and Resident #255's Comprehensive MDS Assessments had not been fully completed and submitted within the required timeframe, based on their admission dates. She stated she did not feel as though this posed a risk to resident care, but there could be a risk of delayed payment to the facility due to the Comprehensive MDS Assessments not being submitted within the required timeframes. Review of the facility's MDS Completion and Submission Timeframes policy, dated 07/2017, reflected, .Our facility will conduct and submit resident assessments in accordance with current federal and state submission timeframes . 675891 Page 4 of 13 675891 10/19/2023 Bridgeport Medical Lodge 2108 15th Street Bridgeport, TX 76426

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents received adequate supervision and assistance devices were put into place to prevent accidents for one (Resident #81) of eight residents reviewed for quality of care. The facility failed ensure Resident #81's call light was placed where the resident could reach it, to prevent potential fall and injury. This failure could place the resident who require supervision assistance due at risk for falls with injuries, hospitalization, and a decreased quality of life. Findings included: Review of Resident #81's Face sheet dated 10/19/2023 reflected and [AGE] year-old male admitted to the facility on [DATE] with diagnosis which included: Prophylactic surgery (surgery whose purpose is to minimize or prevent the risk of developing cancer in an organ or gland that has yet to develop cancer, hypertension (the pressure in your blood vessels is too high ), hyperlipidemia (blood has too many lipids (or fats), such as cholesterol and triglycerides), cognitive communication deficit Attention and communication difficulties), moderate dementia (forgetful of recent events), anxiety disorder (persistent and excessive worry that interferes with daily activities), hypothyroidism (thyroid doesn't create and release enough thyroid hormone into your bloodstream), type 2 diabetes (cells don't respond normally to insulin; this is called insulin resistance.) Review of Resident #81's quarterly MDS assessment, dated 8/7/2023 reflected severely impaired cognition and daily decision making. Resident #81 was a one-person limited assist for bed mobility, transfers, extensive assist with dressing, toileting, and personal hygiene. Review of Resident #81's care plan dated 4/8/2023 and updated 6/9/2023 falls, with goals not to have major falls / poor safety awareness and interventions of that included encourage call light use and bed in low position and keep walker within reach. The care plan was updated again on 10/18/2023 with an intervention of signage call don't fall, and again on 10/19/2023 - PT and OT screen. A review of Resident #81's nursing notes dated 10/18/2023 at 11:28 PM revealed, Resident on post fall 2/3, no delayed injury noted, resident was sent to ER earlier today due to recent fall and was sent right back, no abnormal findings, continue neuro checks. An observation and interview on 10/19/2023 at 9:20 AM in Resident #81's room revealed him sat in his wheelchair by the window. Resident #81's call light was on the floor between A and B beds in the room, on the opposite side of Resident #81's bed from where he was siting. The call light clip was missing. Resident #81 said he was always reminded by staff to use his call light if he needed assistance. He said he was not sure where the call light was but when it was pointed out to him he was able to recognize it. In an interview on 10/18/2023 at 8:30 AM, Resident #81's family member said Resident #81 slid out of his wheelchair last night. Resident #81's family member stated Resident #81 would often get up, forgetting he was not strong enough to stand. 675891 Page 5 of 13 675891 10/19/2023 Bridgeport Medical Lodge 2108 15th Street Bridgeport, TX 76426

F 0689 Level of Harm - Minimal harm or potential for actual harm In an interview on 10/18/2023 at 11:40 AM, RN F said Resident #81 slid out of his wheelchair onto his butt at 7:00 PM on 10/17/2023. She said she received the information in the report that morning. She stated Resident #81 was assessed with no injuries or pain. She said when she came on shift morning, his vitals had dropped and after consulting the physician, she sent him to the hospital. She said Resident #81 was a fall risk and his call light should have been placed to allow him to call for assistance when needed. Residents Affected - Few In an interview on 10/18/2023 at 11:50 AM, ADON G said when Resident #81 fell, she assessed him. She said he was on his butt on the left side of the bed. She said he did not have any injuries and did not complain of any pain. She said Resident #81 said he was trying to get into him bed. She said Resident #81's call light should always be placed where he could reach it. In an interview on 10/19/2023 at 9:30 AM, LVN H said Resident #81 returned from the hospital with no injuries or follow up. She stated Resident #81's call light should have been within his reach to enable him to call for assistance as needed especially since he fell yesterday. She said the call light was on the floor in Resident #81's room and the clip was missing. She said she replaced the clip and placed it within reach of Resident #81. She said staff knew to remind him to call for assistance. In an interview on 10/19/2023 at 10:05 AM, the Administrator said Resident #81 was a fall risk and interventions for him included call light in reach and reminders to use it. He said the call light should not have been on the floor because it placed resident #81 at risk of accidentally falling if he did not have access to it. In an interview on 10/19/2023 at 1:31 PM, with CNA I revealed Resident #81 liked to move around a lot so she checked on him often. She said he needed reminders to use his call light. She said she had left the call light on Resident #81's bed but he may have put it on the floor. She said no matter what, the call light needed to be accessible to Resident #81 to allow him to call for assistance and minimize his risk of falling. Record review of the facility's policy titled, Resident call light system, revised 6/2023, reflected The purpose of this procedure is to respond to the resident's requests and needs. Ensure the call light is easily reachable by the resident. 675891 Page 6 of 13 675891 10/19/2023 Bridgeport Medical Lodge 2108 15th Street Bridgeport, TX 76426

F 0759 Ensure medication error rates are not 5 percent or greater. 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 medication error rate of less than 5 percent. There were 2 errors out of 34 opportunities, resulting in an 5% percent medication error rate involving 1 (Resident #31) of 3 residents reviewed for pharmaceutical services. Residents Affected - Few The facility failed to ensure LVN B did not crush and attempt to administer two medications, Metoprolol Succinate ER (extended-release, given for blood pressure) and potassium chloride ER (extended-release potassium supplement), which should not have been crushed. This failure could place the resident at risk for not receiving the therapeutic effect of their medication or cause a drug intended for slow release to be absorbed all at once resulting in potentially harmful side-effects. Findings included: Record review of Resident #31's Face Sheet dated 10/19/23 revealed she was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including hypokalemia [low potassium level in the blood], and essential primary hypertension [high blood pressure]. Record review of Resident #31's MDS assessment dated [DATE] revealed she had a BIMS score of 10, indicating she had moderately impaired cognition, and had no swallowing disorders. Record review of Resident #31's Active Orders dated 10/18/23 revealed the following entries: .May crush crushable medication Dated 9/28/23. Potassium Chloride ER oral tablet Extended release 10 mEq Give 1 tablet by mouth four times a day related. to hypokalemia. Start date 10/03/2023. Metoprolol Succinate ER Oral Tablet Extended Release 24 Hour 25 MG give 1 tablet by mouth one time a day related to essential primary hypertension. Start date 10/03/2023. Observation and interviews on 10/18/23 at 7:34 AM revealed LVN B prepared multiple medications for administration for Resident #31 which included a potassium chloride ER 10 mEq tablet, and a metoprolol succinate ER 25 mg tablet. When the medications were brought into Resident #31's room, she informed LVN B she was getting her medications crushed and mixed in pudding at that time so she would not have to swallow so many pills. She told him there were a few she could swallow but wanted the others crushed. LVN B returned to his medication cart with the medications and stated he was confused because he had cared for this resident before and she did not get her medications crushed then. He explained he was not her usual charge nurse and was helping out that morning. LVN B stated he would check the orders to see which medications could be crushed. He utilized the computer on his cart and began checking her medication administration record. LVN C approached and was identified as the usual Charge Nurse for the hall and had arrived late that morning. The two LVNs discussed Resident #31 and LVN C confirmed she had been crushing medications for her and stated there was an order on her record. The order was pulled up which reflected May crush crushable medications. When asked how they determined which medications were crushable, LVN C stated she looked them up. She named a few of Resident #31's medications she knew should not be crushed but stated she did not have the list in front of 675891 Page 7 of 13 675891 10/19/2023 Bridgeport Medical Lodge 2108 15th Street Bridgeport, TX 76426

F 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few her to know them all (the medications named did not include metoprolol or potassium). LVN C was observed walking away. LVN B was observed sorting the pills and removing only the medications named by LVN C and placing them in a separate medication cup. LVN B began crushing the other medications including the metoprolol ER and potassium ER tablets. He combined all the crushed medications and mixed them pudding for administration. LVN B administered the pills identified by LVN C as not crushable, Resident #31 swallowed them without difficulty. He was asked by this surveyor to stop before administering the crushed medications. Interview with LVN B revealed he knew ER meant extended-release and was a that type of medication that should not be crushed. He acknowledged he had crushed the metoprolol and potassium in error. He discarded the crushed medications. LVN B pulled new medications from the cart, checked them, then administered them appropriately. An interview with the DON on 10/18/23 at 8:41 AM revealed the facility had a list of medications that could not be crushed available to the nurses to help them determine if a medication could or could not be crushed. The DON stated, if there was any confusion at all, the nurses should have contacted the pharmacist or physician prior to administering the medications. She stated the staff had been trained on utilizing the lists. During an interview with the DON on 10/19/23 at 8:34 AM, the medication error rate was discussed. The interview revealed additional in-service trainings were being conducted with all nurses related to use of the Do Not Crush list. She ensured the list was available on all medication carts. The DON stated the risks associated with crushing extended-release medications included possible decrease in therapeutic effect and adverse outcomes for the resident as it could affect the rate of absorption of the medication. Interview with LVN B on 10/19/23 at 10:40 AM revealed he had received additional in-service training. He stated the risk of crushing extended-release medications included decreased therapeutic effect and the resident could receive too much medication all at once and cause harm. Record review of the facility's Medications Not To Be Crushed list dated 2002, rev 02/17 revealed the following medications were included: Metoprolol (extended release) tablet Reason: Time release formulation Potassium Chloride tablet Reason: Time release formulation Record review of the facility's policy, Medication Crushing Guidelines dated 2001 revealed: Medications that Should not be Crushed or Chewed-When a resident's condition prohibits the administration of solid dosage forms (tablets, capsules, etc.), the nurse administering the medication should check to see that there is no contraindication to crushing the medications in question. If crushing is contraindicated, the nurse should consult the pharmacist for assistance in obtaining the medication in liquid form, if possible. The rationale for not crushing some medications includes: .D. Timed Release Tablets are designed to release medication over a sustained period, usually 8 to 24 hours. These formulations are utilized to reduce stomach irritation in some cases and to achieve prolonged medication action in other cases. In either case, the medication should not be crushed 675891 Page 8 of 13 675891 10/19/2023 Bridgeport Medical Lodge 2108 15th Street Bridgeport, TX 76426

F 0812 Level of Harm - Minimal harm or potential for actual harm 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 in the facility's only kitchen. Residents Affected - Some The facility failed to ensure foods were dated and stored properly. These failures could place residents at risk for food borne illness. Findings included: An observation of the facility's only kitchen on 10/17/23 beginning at 8:15AM revealed the following: -three opened bags of cereal which were undated (not identifying the expiration date or the date in which the food was received/opened) and placed on a shelf for dry food storage -one opened cardboard box with a package of ground beef in it, sitting on the floor of the walk-in freezer During an interview with Dietary Aid J on 10/17/23 at 8:20AM, she confirmed the three bags of cereal were undated (not identifying the expiration date or the date in which the food was received/opened). She stated items should be labeled and dated by whomever opened the food items. She also confirmed the opened cardboard box, which contained a package of ground beef, was sitting on the floor in the walk-in freezer. She stated the box should have been placed on one of the storage shelves in the freezer. Review of the facility's Food Receiving and Storage policy, dated 07/2014, reflected, .Foods shall be received and stored in a manner that complies with safe food handling practices . 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 The Food and Drug Administration Food Code dated 2022 reflected, .3-305.11 Food Storage (A) . FOOD 675891 Page 9 of 13 675891 10/19/2023 Bridgeport Medical Lodge 2108 15th Street Bridgeport, TX 76426

F 0812 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; and (3) At least 15 cm (6 inches) above the floor . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 675891 Page 10 of 13 675891 10/19/2023 Bridgeport Medical Lodge 2108 15th Street Bridgeport, TX 76426

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. 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 maintain an effective pest control program so that the facility was free of pests in 4 (Hall 100, 300, 500, and 600) of 4 halls reviewed for pests, and the main dining room. Residents Affected - Many The facility failed to ensure an effective pest control program was implemented to prevent the presence of flies and water bugs within the facility. This failure placed residents at risk for foodborne illness and/or disease spread by pests. Findings included: An observation and interview on 10/17/23 at 9:30 AM in room [ROOM NUMBER] revealed flies were observed in the room during incontinent care. Following care, Resident #17 described the flies as a nuisance. An observation on 10/17/23 at 9:55 AM revealed flies were observed in the hallway on Hall 500. An observation on 10/17/23 at 10:18 AM in room [ROOM NUMBER] revealed multiple flies were observed in the room. Observation and interviews on 10/17/23 at 10:25 AM in room [ROOM NUMBER] revealed numerous flies were in the room, landing on residents and tables. Resident #71 stated the flies had been bad as long as she had been there, for 3-4 months. Resident #91 stated the flies were terrible. An observation on 10/17/23 at 10:50 AM in room [ROOM NUMBER] revealed multiple flies were observed in the room. Observation and interview on 10/17/23 at 10:53 AM in room [ROOM NUMBER] revealed there were multiple flies in the room. Resident #59 stated the flies were bad. Resident #59 stated she had been seeing those large water bugs as well. She said she had one crawl out of the top drawer of her nightstand recently. She stated she believed they were coming out of the door in her bathroom, there were holes in the door and she had seen them crawling out of the door and around her toilet. Observation in the bathroom revealed the inside of her bathroom door had six various sized holes in the lower portion if her door. There was a live water bug approximately one inch long on her bathroom floor behind her toilet. Resident #59 stated she had reported it in the past to a CNA or two but did not remember the names of the CNAs. She stated the nursing staff had come in and try to kill them for her. She did not recall ever seeing anyone from maintenance or a pest control company treat her room. An observation and interview on 10/17/23 at 11:30 AM in room [ROOM NUMBER] revealed there were multiple flies were observed in the room. Resident #78 stated the flies come and go. An observation and interview on 10/17/23 at 11:35 AM in room [ROOM NUMBER] revealed there were multiple flies were in the room. Resident #58 stated the flies had been there for years. An observation on 10/17/2023 at 11:35 AM revealed multiple flies in Residents #81 and #76's room. A fly swatter was observed on the dresser. 675891 Page 11 of 13 675891 10/19/2023 Bridgeport Medical Lodge 2108 15th Street Bridgeport, TX 76426

F 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Interviews on 10/17/2023 at 11:35 AM with Residents #81 and #76 revealed the flies were in their room for a while. Resident #81 said he was not sure why there were so many flies in their room, but they were bothersome. In an interview on 10/17/2023 at 11:43 AM, in the doorway to Residents #81 and #76's room, ADON G said saw all the flies and they should not be in the room. She said the facility wanted to ensure the rooms were clean and free of pests to ensure residents' comfort. She said the fly swatter in the room indicated to her that the flies had been in the room for some time. An observation on 10/17/23 at 11:45 AM revealed flies were seen in the hallway on Hall 600. During an interview on 10/17/23 at 11:53 AM , Resident #92 stated he had not had a problem with flies in his room but did see them often when he is out in the facility. Observation and interview on 10/17/23 at 12:00 PM in room [ROOM NUMBER] revealed multiple flies were observed in the room. Resident #12 stated they had been there for a long time. An observation on 10/17/23 at 1:25 PM in room [ROOM NUMBER] revealed there were multiple flies observed in the room, many were landing on Resident #68's bedside table. Resident #68 stated the flies had been a problem for a while. He stated he was waving them away from his breakfast tray that morning and had one land in his milk. He stated the staff brought him another glass of milk. Resident #68 stated the staff had tried to help and had come in occasionally with a fly swatter. He stated he also saw water bugs in his room on occasion and the staff had come in and stomped on them. An observation on 10/17/23 at 1:48 PM revealed multiple flies were observed in the main dining room. Observation and interview on 10/18/23 at 7:10 AM revealed there were still multiple flies in room [ROOM NUMBER]. During an interview, LVN D acknowledged the flies were bad. She stated they were worse over the past summer and the nurses had purchased some natural fly traps to use at the nurse's station. She stated there was a maintenance log and pest control log at the nurse's station for reporting, but it had been an ongoing issue. LVN D denied seeing any water bugs recently. During an interview on 10/18/23 at 9:00 AM, LVN C stated she had seen the flies around the facility and in the resident's rooms and they entered through the doors. She stated she had only seen one water bug and had killed it herself. LVN C stated they had a bug book at the nursing station where they were supposed to document any pests seen. During an interview on 10/19/23 at 10:10 AM, ADON A stated department heads were assigned rooms and made rounds daily. Any maintenance issues or pest control issues should be logged in the books at the nurse's station as a best practice. Observation and interview with the Maintenance Supervisor on 10/19/23 at 10:15 AM revealed he was aware of the problem with flies in the building. He stated he was not responsible for pest control in the building as they had a company to handle the task. He was not aware of an issue with water bugs in the building. The Maintenance Supervisor stated he only learned the day before that flies were not included in the pest control company's contract as he had no access to it. He stated it was added yesterday and the company had already come out to begin addressing the issue. He stated the company representative believed the source was the outside dumpster . He stated he would see the pest 675891 Page 12 of 13 675891 10/19/2023 Bridgeport Medical Lodge 2108 15th Street Bridgeport, TX 76426

F 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many control representatives within the facility frequently and they would mention the flies to each other. He stated he believed each one thought the other was handling the issue and is glad the problem was getting addressed. When shown the bathroom door in room [ROOM NUMBER], the Maintenance Supervisor stated he was not previously aware of the problem, or he would have taken care of it quickly. He stated he depended on the nursing staff to enter any maintenance issues they find in the maintenance logbook at the nursing station, and he checks it every day. He stated the staff would sometimes catch him in the hall and verbally report a problem, but he really needed them to use the book. When asked about the window screens, he stated he was responsible for checking those and was aware there were some that needed replacement. He stated he was working on some higher priority issues at that time and planned to get to the screens as soon as he could. He was not aware of any residents who like to open their windows and did not feel it was contributing to the problem with the flies. Observation and interview on 10/19/23 at 10:39 AM in room [ROOM NUMBER] revealed CNA E was normally assigned to the 500 Hall but had not noticed the holes in the bathroom door. She stated she would document the issue in the maintenance log. She stated she was aware of the flies in the rooms but did not recall seeing water bugs in the resident's rooms. She stated she would kill them and document them in the pest control log if she had seen any. During an interview on 10/19/23 at 10:50 AM, the Operations Manager stated he was unaware until 10/18/23 that flies were not part of the facility's pest control contract. He stated the previous Administrator was there until mid-September. He stated he did not know the maintenance supervisor was also previously unaware flies were not being treated by their pest control company. He stated he had met with housekeeping and maintenance the day before as well as the pest control company. The Operation Manager stated flies were added to the contract. He stated flies could carry disease and were very annoying to the residents and their goal was the elimination of them from the facility. Record review of the facility's pest control contract titled, Commercial Pest Control Proposal and Annual Service Agreement dated 1/30/2015 revealed: [Pest control company name] will perform regular service twice monthly for the control of Roaches, Rats, Mice, Fire Ants. Record review of the facility's current pest control log revealed there were no entries related to flies in 2023. The most recent entries reflecting roaches/water bugs occurred on 10/9/23 in room [ROOM NUMBER] and 5/11/23 in room [ROOM NUMBER]. Record review of the facility's policy titled, Pest Control, dated Revised 9/22/23 reflected, Our facility shall maintain an effective pest control program .1. This facility maintains an on-going pest control program for insects and rodents .3. Windows are screened to assist with insect and rodent entry .6. Maintenance services assist, when appropriate and necessary, in providing pest control services. 675891 Page 13 of 13