Health inspection·August 5, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record review, the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for 1 of 6 residents (Resident #1) reviewed for quality of care, in that:The facility failed to conduct weekly skin assessments for Resident #1 on 7/10/25 and 07/17/25. These failures placed residents at risk of physical harm, pain, and a decreased quality of life. Findings included: Record review of Resident #1's admission record, dated 08/05/2025, reflected a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #1 had diagnoses which included: seizures (sudden, temporary disruption of the brain's normal electrical activity, resulting in changes in behavior, movement, feelings, or consciousness), lack of Coordination (having difficulty controlling your movements and making them work together smoothly), protein calorie malnutrition (not getting enough food or the right food to maintain a healthy body), and unspecified dementia severe without behavioral disturbance, psychotic disturbance, mood disturbance and anxiety (memory loss and thinking difficulties). Record review of Resident #1's Quarterly MDS assessment, dated 05/01/2025, reflected the resident had a BIMS score of 15, which indicated cognitively intact. Resident #1 required setup or clean assistance in the areas of toileting hygiene, shower/bathe self, lower body dressing, putting on/taking off footwear, and person hygiene. Record review of Resident #1's care plan, dated 08/05/2025, reflected Resident #1 was care planned for potential for pressure ulcer development r/t required assist with bed mobility with an intervention of follow facility policies/protocols of prevention/treatment of skin breakdown. Review of Resident #1's weekly skin assessment in the EMR on 08/05/2025, reflected Resident #1 did not have a weekly skin assessment 07/10/25 & 07/17/25. During an interview and observation Resident #1 on 08/05/2025 at 11:30am., Resident #1 stated he could not remember if he had his weekly skin assessment on 07/10/25 & 07/17/25. Resident #1 stated he did not have any current skin issues. Resident #1 did not have any visible bruising or skin issues. During an interview with LVN A on 08/05/2025 at 1:15 PM, LVN A stated the purpose of a weekly skin assessment was to identify any new skin issues and monitor current skin issues. LVN A stated that the weekly skin assessment was completed on the same day of the week each week by the charge nurse. LVN A stated that 6/2 charge nurse was responsible for the 100 and 200 halls and 2/10 charge nurse was responsible for the 300 and 400 halls. LVN A stated that she was not sure what nurse was worked on 07/10/25 & 07/17/25. LVN A stated if a resident's weekly skin assessment was not completed then the resident could have a skin issues go untreated. During an interview with the DON on 08/05/2025 at 2:55 PM, the DON stated the purpose of a skin assessment was to identity and address any new skin concerns. The DON stated all residents were supposed to receive weekly skin assessments. The DON stated it was the charge nurse's responsibility to complete the weekly skin assessments. The DON was not aware that Resident #1 had not had a skin assessment on 07/10/25 & 07/17/25. The DON stated that if a resident did Residents Affected - Few Page 1 of 2 675903 675903 08/05/2025 Mexia Ltc Nursing and Rehab 601 Terrace LN Mexia, TX 76667

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few not receive weekly skin assessments, then the resident could have a skin condition go untreated. The DON stated she expected for weekly skin assessments to be conducted as scheduled. During an interview with the ADM on 08/05/2025 at 3:45 PM, the ADM stated the purpose of a skin assessment was to ensure residents did not have any adverse skin issues from the previous week. The ADM stated all residents were supposed to receive weekly skin assessments. The ADM stated it was the charge nurse's responsibility to complete the weekly skin assessments. The ADM stated it was the DON and ADON responsibility for ensure the charge nurses were completing the weekly skin assessments as scheduled. The ADM was not aware that Resident #1 had not had a skin assessment 07/10/25 & 07/17/25. The ADM stated that if a resident did not receive weekly skin assessments, then the resident could have skin integrity issues that go untreated. The ADM stated she expected for weekly skin assessments to be conducted as scheduled. The ADM stated the facility did not have a weekly skin assessment policy. A record review of the facility's Resident Examination and Assessment policy, dated February 2014, reflected, The purpose of this procedure is to examine and assess the resident for any abnormalities in health status, which provides a basis for the care plan. Physical Exam 8. Skin: a. intactness: b. moistures c. color d. texture; and e. presence of bruises, pressure sores, redness, edema, rashes. Documentation The following information should be recorded in the resident's medical record:1. The date and time to procedure was preformed2. The name and title of the individual(s) who performed the procedure.3. All assessment data obtained during the procedure.4. How the resident tolerated the procedure.5. If the resident refused the procedure, the reason (s) why the intervention taken.6. The signature and title of the person recording the data.Reporting1. Notify the supervisor if the resident refuses the examination.2. Notify the physician of any abnormalities such as, but not limited to e. wounds or rashes on the resident's skin. 675903 Page 2 of 2