Health inspection·July 11, 2023

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility did not make sure that resdients withloss of bladder control received treatment or services to prevent infections and help get normal bladder control for 1 of 18 resident (Residents #30) reviewed in that: CNA-A failed to provide incontinent care in a manner to prevent potential spread of infection. This failure could place residents at risk for the spread of infection and skin complications. Findings include: Record review of Resident #30 Annual MDS, dated [DATE], revealed a [AGE] year-old male who was admitted to the facility on [DATE] with an active DX list that included: CAD (CAD Acronym or abbreviation to medical concept or diagnosis of coronary artery disease - common type of heart disease), Hypertension (High Blood Pressure), Hyperlipidemia (an elevated level of lipids - like cholesterol and triglycerides - in your blood), Neurogenic Bladder (the name given to a number of urinary conditions in people who lack bladder control due to a brain, spinal cord or nerve problem) and MS (a long-lasting [chronic] disease of the central nervous system). Resident #30 had a BIMS of 15, which meant the resident was cognitively intact. Resident #30 required ADL care needs of 2-person physical assistance. He had always been incontinent of bowel and bladder During observation on 07/10/2023 at 10:18 AM of peri care, the CNA-A performed peri care for Resident #30. While resident was on his side for peri care, CNA-A wiped the resident from back to front with a sanitary wipe. During interview on 07/10/2023 at 1:10 PM, CNA-A stated the procedures for peri care were to wipe the resident with sanitary wipes from front to back with one swipe and throw away. She stated when performing resident care, she should have never cleaned a resident from back to front with not being taught any other way. She stated it was a habit to perform perineal care the way she did. CNA-A stated if the resident was not wiped in the right direction it could cause the resident harm such as infection. During interview on 07/10/2023 at 1:17 PM, the DON stated while performing peri care on a resident, the staff member should wipe with a sanitary wipe once and throw away and definitely did not teach to wipe from back to front. She stated she did not teach her staff those procedures any other way. She stated best procedure for perineal care would be to wipe front to back. The DON stated there could be a negative impact to a resident of possible contamination. She stated the failures were that Page 1 of 4 675959 675959 07/11/2023 Songbird Lodge 2500 Songbird Cir Brownwood, TX 76801

F 0690 Level of Harm - Minimal harm or potential for actual harm her CNA was nervous. Her expectation was to do perineal care correctly the first time as well as every time. She stated her trainings were done by observing her staff as well as having one on one, telling them they should carry out completely with each resident the right way, every time. Record review of the facility policy titled Perineal Care, dated 04/27/2022, revealed: Residents Affected - Few .male Resident . 21. Gently perform care to the buttocks and anal area working from front to back without contaminating the perineal area. 675959 Page 2 of 4 675959 07/11/2023 Songbird Lodge 2500 Songbird Cir Brownwood, TX 76801

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review the facility did not make sure that residents receive adequate dialysis care for for 2 (Resident #25 and Resident # 43) of 3 residents in that: Residents Affected - Some The facility failed to ensure physician orders were written for Resident #25 and Resident #43. This failure could place residents at risk of having errors in care and treatment. Findings include: Review of Resident # 25's face sheet dated 07/11/2023 revealed a [AGE] year-old female who was admitted to the facility on [DATE] with a diagnosis of which included chronic kidney disease. Review of Resident #25's Quarterly MDS, dated [DATE], revealed Section C - Cognitive behavior a BIMS score of 9, which meant she had moderate cognitive impairment. Review of Resident #25's physician orders revealed no evidence of orders for dialysis. Review of Resident #43's face sheet, dated 07/11/2023, revealed a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses which included chronic kidney disease and dependence on renal dialysis. Review of Resident #43's Quarterly MDS, dated [DATE], revealed in Section C - Cognitive Behavior, a BIMS score of 13, which meant she was cognitively intact. Review of Resident #43's physician orders revealed no evidence of orders for dialysis. During an interview on 07/09/23 at 3:44 PM, Resident # 25 stated she received dialysis three days per week. During an interview on 07/11/23 at 1:56 PM, the DON stated she did not think there should have been an order for dialysis but was not sure what the policy stated. After the DON reviewed the policy she stated there should have been an order for dialysis per their policy. The DON stated her expectation was staff followed the policy. The DON stated what led to failure was the lack of knowledge on the DON's part. The DON stated there was no negative impact on the residents. The DON stated she was responsible for monitoring resident charts for accuracy. The DON confirmed that Resident #25 and Resident #43 had been receiving dialysis weekly. Review of the facility MDS Resident Matrix, dated 07/09/2023, revealed Resident #25 and Resident #43 received dialysis. Review of the facility policy titled, Dialysis, dated November 2013, revealed, Procedure 1. Review and confirm the physician's order for dialysis. Follow the specifications of the medical regiment including dietary restrictions and medical management. 675959 Page 3 of 4 675959 07/11/2023 Songbird Lodge 2500 Songbird Cir Brownwood, TX 76801

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review the facility failed to maintain medical records on each resident, in accordance with accepted professional standards and practices, that were complete and accurate for 2 (Resident #25 and Resident # 43) of 3 residents reviewed for resident records. The facility failed to ensure physician orders were written for Resident #25 and Resident #43. This failure could place residents at risk of having errors in care and treatment. Findings include: Review of Resident # 25's face sheet dated 07/11/2023 revealed a [AGE] year-old female who was admitted to the facility on [DATE] with a diagnosis of which included chronic kidney disease. Review of Resident #25's Quarterly MDS, dated [DATE], revealed Section C - Cognitive behavior a BIMS score of 9, which meant she had moderate cognitive impairment. Review of Resident #25's physician orders revealed no evidence of orders for dialysis. Review of Resident #43's face sheet, dated 07/11/2023, revealed a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses which included chronic kidney disease and dependence on renal dialysis. Review of Resident #43's Quarterly MDS, dated [DATE], revealed in Section C - Cognitive Behavior, a BIMS score of 13, which meant she was cognitively intact. Review of Resident #43's physician orders revealed no evidence of orders for dialysis. During an interview on 07/09/23 at 3:44 PM, Resident # 25 stated she received dialysis three days per week. During an interview on 07/11/23 at 1:56 PM, the DON stated she did not think there should have been an order for dialysis but was not sure what the policy stated. After the DON reviewed the policy she stated there should have been an order for dialysis per their policy. The DON stated her expectation was staff followed the policy. The DON stated what led to failure was the lack of knowledge on the DON's part. The DON stated there was no negative impact on the residents. The DON stated she was responsible for monitoring resident charts for accuracy. The DON confirmed that Resident #25 and Resident #43 had been receiving dialysis weekly. Review of the facility MDS Resident Matrix, dated 07/09/2023, revealed Resident #25 and Resident #43 received dialysis. Review of the facility policy titled, Dialysis, dated November 2013, revealed, Procedure 1. Review and confirm the physician's order for dialysis. Follow the specifications of the medical regiment including dietary restrictions and medical management. 675959 Page 4 of 4