Health inspection·October 17, 2023

F 0791 Provide or obtain dental services for each resident. 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 assist residents in obtaining routine and 24-hour emergency dental care for 3 (Resident #1, Resident #2, Resident #3) of 5 residents reviewed for dental care in that: Residents Affected - Some Resident #1, Resident #2, and Resident #3 had various dental needs that had not been met per facility policy. This failure could place residents at risk of quality of life, nutritional decline, or infection. Findings included: Resident #1 Record review of Resident #1's face sheet revealed an [AGE] year-old female admitted to the facility initially on 1/4/21 and readmitted [DATE]. Her diagnoses included but were not limited to Heart Failure, dementia with behavioral disturbance, bipolar disorder, and borderline personality disorder. Resident #1 was currently on hospice services. Record review of Resident #1's MDS, dated [DATE], revealed a functional status of total dependence for personal hygiene. Functional status for eating was scored as extensive assistance. Resident #1's MDS indicated a BIMS of 02 which indicated severe cognitive impairment. Resident #1's MDS under Functional Abilities and Goals indicated an 01 indicating Resident #1 was dependent on oral hygiene care. Resident #1's MDS in Section L indicated choice Z which states none of the above were present. The options were broken or loosely fitting full or partial denture, no natural teeth or tooth fragments, abnormal mouth tissue, obvious or likely cavity or broken natural teeth, inflamed or bleeding gums or loose natural teeth, mouth or facial pain, discomfort or difficulty with chewing, unable to examine, or none of the above were present. Record review of Resident #1's care plan, dated 10/4/2023, revealed a care plan goal of having dentures with an intervention of monitor for/record poor fitting/missing dental appliances. Additional intervention to coordinate arrangements for dental care, transportation as needed/ as ordered. Record review of Resident #1 orders, dated 9/28/23, revealed an order for a regular diet, pureed texture, nectar consistency. Resident #1 progress note, dated 8/3/23 by ADON, revealed that Resident #1 continues to remove dentures and states they were bothering her. Page 1 of 4 675970 675970 10/17/2023 Memphis Convalescent Center 1415 N 18th St Memphis, TX 79245

F 0791 Level of Harm - Minimal harm or potential for actual harm During an interview on 10/17/23 at 3:52 PM, DON indicated that dental services were provided in May 2023, and they were declined by Resident #1. Prior to this date, it was indicated the social worker was helping. Resident #2 Residents Affected - Some Resident #2 was a [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included but were not limited to unspecified dementia without behavioral disturbance, dental root caries, and need for assistance with personal care. Record review of Resident #2's orders, dated 11/3/2016, revealed an order for dental care PRN. Record review of Resident #2's care plan, dated 8/29/23, revealed a focus of Resident #2 has oral/dental health problems and missing teeth. Resident #2 is signed up to see in house dentist with an intervention stating to monitor/document and report to MD regarding oral/dental problems needing attention: teeth missing, loose, broken, eroded, or decayed. Record review of Resident #2's MDS, dated [DATE], revealed a BIMS of 05 which indicated severe cognitive impairment. Resident #2's MDS, Section L for oral/dental status indicated broken or loosely fitting full or partial denture and mouth or facial pain, discomfort, or difficulty with chewing. In an observation and interview on 10/17/23 at 2:49 PM, Resident #2 indicated that the dental issue was irritating. Resident #2 indicated she was unable to chew well but was able to eat foods she liked. Observation of Resident #2's teeth revealed severe tartar/plaque buildup with approximately 3 teeth missing from top row. In an interview on 10/17/23 at 2:24 PM, SW revealed that partial upper for Resident #2 has been worked on for about 3 years. SW indicated that this last May, the paperwork was sent for dental services and then the resident declined due to the time lapsed of services being provided. Resident #3 Resident #3 was a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #3's diagnoses included but not limited to Parkinson's Disease, reduced mobility, and need for assistance with personal care. Resident #3's care plan, dated 10/4/2023, revealed a focus of oral/dental health problems. Resident has broken, carious, and missing teeth with a focus of coordinate arrangements for dental care, transportation as needed/ordered. Record Review of Resident #3's MDS, dated [DATE], revealed a BIMS score of 10 indicating moderate cognitive impairment. Resident #3's MDS, section L, indicated an oral/dental status of broken or loosely fitting full or partial denture and mouth or facial pain, discomfort, or difficulty with chewing. Record review of Resident #3's orders indicated may have dental consult PRN dated 6/20/23. An interview on 10/17/23 at 4:25 PM, Resident #3 indicated that they were still waiting for dentures and not having them bothers him very much. 675970 Page 2 of 4 675970 10/17/2023 Memphis Convalescent Center 1415 N 18th St Memphis, TX 79245

F 0791 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an interview on 10/17/23 at 2:15 PM, DON stated that there was a flip-flop with dental company. DON indicated that when the dental company visits, they come with a list that has resident's names who were no longer residing at the facility. DON stated the SW who was employed before worked on the dental coordination but has not been employed for a couple of months. In an interview on 10/17/23 at 2:24 PM, SW stated she was employed at facility in 2017 and retired in August 2023. SW indicated that the dental company ceased contact with SW in December 2022 and contact was going to DON. SW stated she was sending referrals but was unable to obtain any information. SW indicated that dental needs of the residents were not being met. The SW indicated that all the residents had complaints about the dental company. SW stated there was a lack of communication. In an interview on 10/17/23 at 2:37 PM, MDS Nurse found a card on the social worker's old desk to MDM Dental. MDS Nurse also stated that there had been no new residents since the SW retired. DON stated she would oversee dental when asked who oversaw the services. Record review of CMS 802, dated 10/17/23, indicated that the last resident to be entered into facility was on 9/21/23. In an interview on 10/17/23 at 2:37 PM, DON indicated dental emails received by corporate office only. In an interview on 10/17/23 at 2:42 PM, DON stated the dental company had not been contacted. DON indicated a negative outcome would be tooth pain and alter how the resident eats. In an interview on 10/17/23 at 2:44 PM, MDS Nurse revealed a negative outcome would be an infection if resident's dental needs were not met. In an interview on 10/17/23 at 2:50 PM, DON provided number to an alternate dental company. On 10/17/23 at 3:37 PM, attempted to call dental companies provided with one being disconnected and one out of business. In an interview on 10/17/2023 at 3:57 PM, DON indicated third dental company and has been since January 2023. DON confirmed last visit by dental company prior was in May. DON stated that the visits have never been consistent. Record review of Dental Services, dated 2003, revealed that Routine and emergency dental services are available to meet the resident's oral health services in accordance with the resident's assessment and plan of care. Implementation of the policy included: Oral health services are available to meet the resident's needs. 2. Routine and emergency dental services are provided to our residents through: o A contract agreement with a local dentist; o Referral to the resident's personal dentist; o Referral to community dentists; or o Referral to other health care organizations that provide dental services. 675970 Page 3 of 4 675970 10/17/2023 Memphis Convalescent Center 1415 N 18th St Memphis, TX 79245

F 0791 Level of Harm - Minimal harm or potential for actual harm 3. The Director of Nursing Services, or his/her designee, is responsible for notifying Social Services of a resident's need for dental services. 4. Social Services personnel will be responsible for assisting the resident/family in making dental appointments and transportation arrangements as necessary. Residents Affected - Some 675970 Page 4 of 4