Health inspection·June 21, 2023

F 0679 Provide activities to meet all resident's needs. 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 provide an ongoing program of activities designed to meet the interests and support the physical, mental, and psychosocial well-being for 12 of 12 residents (#10, #11, #15, #16, #17, #18, #19, #20, #21, #22, #23, #24) on the Memory Care Unit reviewed for activities, in that Residents Affected - Some 1. 12 of 12 residents in the Memory Care Unit did not have an ongoing activity program designed to meet their interest. This deficient practice could place residents at risk for isolation, low self-esteem, and decline in mental status. Findings include: Face sheet review reflected Resident #15, was a female 69 diagnosed with Alzheimer's disease. MDS dated [DATE] for Resident #15 reflected a BIMS of 00 (severely impaired cognition), Care Plan dated 5/9/23 for Resident #15 reflected for Activities it stated activities in room [ROOM NUMBER] times per week, nails, reading and music. Observation on 6/20/23 at 10:35 am revealed Resident #15 sitting on bed in room [ROOM NUMBER]-A, and there was no activity calendar posted in the room. Observation on 6/20/23 at 1:45pm revealed Resident #15 sitting in a chair in the hallway. Observation on 6/21/23 at 9:12 am revealed Resident #15 was sitting in the TV room watching TV. Face Sheet review reflected Resident #16 was a female aged 71 and was diagnosed with Alzheimer's disease. MDS dated [DATE] for Resident #16 reflected a BIMS of 10 (moderately impaired cognition) Care Plan dated 3/31/23 for Resident #16 reflected for Activities it stated attends activities 3 Page 1 of 5 675927 675927 06/21/2023 Focused Care at Crane 699 Campus Dr Crane, TX 79731

F 0679 times per week. Level of Harm - Minimal harm or potential for actual harm Interview on 6/21/23 at 9:20 am, Resident #16 stated she does not know when the activities are or what time they start. Resident #16 does not recall doing any activities in her room. Residents Affected - Some Observation 6/21/23 at 9:22am, revealed Resident #16 does not have an Activity Calendar posted in room. Face Sheet review reflected Resident #17 was a Female aged 83 and was diagnosed with Major depression. MDS dated [DATE] for Resident #17 reflected a BIMS of 4 (severely impaired cognition) Care Plan dated 3/15/23, reflected for activities, Resident #17 will attend activities 3 times per week, and an Activity calendar will be posted in room. Observation on 6/21/23 at 9:30 am revealed Resident #17 sitting on her bed. There was no Activity calendar posted in room. Face Sheet reflected Resident #18 was a female aged 74 and was diagnosed with Dementia. MDS dated [DATE] for Resident #18 reflected a BIMS of 2 (severely impaired cognition) Care Plan dated 5/2/23, reflected for Activities, Resident #18 will attend activities 3 times per week, nails, music, reading, and an Activity calendar will be posted in room. Observation on 6/21/23 at 9:35 am revealed Resident #18 was in bed sleeping, and no activity calendar was posted in room. Face Sheet reflected Resident #19 was a female aged 80 and was diagnosed with Congestive Heart Failure. MDS dated [DATE] for Resident #19 reflected a BIMS of 3 (severely impaired cognition) Care Plan dated 5/29/23, reflected for Activities Resident #19 will have an Activity calendar posted in room. Observation on 6/21/23 at 9:38 am, revealed Resident #19's room did not have an Activity calendar posted. Face Sheet reflected Resident #20 was a female aged 87 and was diagnosed with Dementia and anxiety. MDS dated [DATE] for Resident #20 reflected a BIMS of 2 (severely impaired cognition) Care Plan dated 6/3/23, for Resident #20 reflected for activities, in room activities. Face Sheet, reflected Resident #21 was a female aged 75 and was diagnosed with Alzheimer's disease, MDS dated [DATE] for Resident #21 reflected a BIMS of 00 (severely impaired cognition) 675927 Page 2 of 5 675927 06/21/2023 Focused Care at Crane 699 Campus Dr Crane, TX 79731

F 0679 Care Plan dated 6/5/23, for Resident #21 reflected for activities, in room activities, nails, music and reading. Level of Harm - Minimal harm or potential for actual harm Face Sheet, reflected Resident #24 Female aged 78 was diagnosed with encephalopathy, MDS dated [DATE] for Resident #24 reflected a BIMS of 6 (severely impaired cognition) Residents Affected - Some Care Plan dated 4/13/23, for Resident #24 reflected, for activities, in room activities, and Activity calendar posted in room. Observation on 6/21/23 at 9:45 am, revealed Resident #24 room [ROOM NUMBER]-A in bed watching TV, and no Activity Calendar was posted in room. Face Sheet, reflected Resident #22 Female aged 92 was diagnosed with Alzheimer's disease, MDS dated [DATE] reflected a BIMS of 00 (severely impaired cognition) Care Plan dated 3/31/23, reflected for activities, Activity calendar posted in room. Observation on 6/21/23 at 9:49 am, revealed Resident #22 lying in bed sleeping, and no Activity calendar posted was in room. Face Sheet, reflected Resident #10 Female aged 81 was diagnosed with Alzheimer's disease, MDS dated [DATE] reflected a BIMS of 10 (moderately impaired cognition) Care Plan dated 4/13/23, reflected for activities, can attend activities in main activity room. Observation on 6/21/23 at 9:55 am, revealed Resident #10 sitting in room [ROOM NUMBER]-B. There was no Activity calendar posted in room. Interview on 6/21/23 at 9:55 am, Resident #10 stated that they have no activities for the residents in this unit. Resident #10 stated she must go in the main area for BINGO or any other type of activity. Resident #10 stated sometimes she misses activities and would like to have a calendar in her room. Interview on 6/21/23 at 10:21 am family member of Resident #10 stated that he has no problem with the facility, is involved in Care plan, and the facility contacts him if something happens. The family member stated that the facility does not provide any activities for the residents in the memory care unit. The family member stated Resident #10 sometimes will go into the main facility and play BINGO if she knows about it. Face Sheet, reflected Resident #23 Female aged 79 was diagnosed with Dementia, MDS dated [DATE] reflected a BIMS of 6 (impaired cognition) Care Plan dated 4/19/23, reflected for activities, Activity calendar posted in room. Observation on 6/21/23 at 10:05 am, revealed Resident #23 sitting in the TV room looking out the 675927 Page 3 of 5 675927 06/21/2023 Focused Care at Crane 699 Campus Dr Crane, TX 79731

F 0679 window. Observation of Resident #23's room [ROOM NUMBER]-A, revealed no Activity calendar was posted in the room. Level of Harm - Minimal harm or potential for actual harm Face Sheet, reflected Resident #11 Female aged 66 was diagnosed with encephalopathy, Residents Affected - Some MDS dated [DATE] reflected a BIMS of 8 (moderately impaired cognition) Care Plan dated 6/6/23, reflected for activities, Activity calendar posted in room, and main room activities. Observation on 6/21/23 at 10:16 am, revealed Resident #11 room [ROOM NUMBER]-A sitting on bed, and no Activity calendar was posted in room. Interview on 6/21/23 at 10:17 am, Resident #11 stated that there is nothing to do in this unit. Resident #11 stated she goes out into the main activity room for activities. Resident #11 stated she does not know when the activities are or when the activities start. Resident #11 stated she would like to have a calendar in her room. Observation on 6/21/23 at 10:25 am, revealed a Large Activity calendar was posted in the TV room. Interview on 6/21/23 at 10:25 am, LVN C stated no activities are done on a regular basis. LVN C stated that they have no one to do the activities in the memory care unit. LVN C stated a couple of residents (residents #10 and #11) go out to the main facility for activities when they can, but most do nothing. LVN C stated sometimes they have someone from outside the facility come in and sing but generally nothing other than coloring or the TV is the only activity they have. LVN C did not know how residents are informed of activities other than the one posted in the TV room. LVN C said she did not know if the residents were to have an activity calendar posted in their rooms. Interview on 6/21/23 at 10:34 am CNA D stated sometimes she sings to residents, but they do not do activities. CNA D stated they do not have anyone to help with activities. CNA D did not know how residents were to know of activities, CNA D did not know residents were to have activities calendars posted in rooms. Interview on 6/21/23 at 11:25 am, the AD stated the activity calendar was only posted in the TV room of the Memory unit. The AD stated she did not know that activity calendars were to be posted in the resident's room per the resident's Care Plans. The AD stated she was aware of the activities not being performed in the Memory unit. The AD stated she has tried to encourage the staff to do activities and has told them what to do. The AD stated she knows that some of the equipment or items to do activities come up missing, and sometimes they find the missing items in the resident's room. The AD stated she has not in-serviced or tried hard enough to help staff with activities in the Memory unit. Review of facility's 'Life Enrichment Activity Guidelines' date 04/2020 reflected: The community will provide, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community. The Life Enrichment Director/Coordinator is 675927 Page 4 of 5 675927 06/21/2023 Focused Care at Crane 699 Campus Dr Crane, TX 79731

F 0679 responsible for maintaining appropriate departmental documentation. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 675927 Page 5 of 5