Health inspection·July 14, 2023

F 0641 Ensure each resident receives an accurate assessment. 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 complete an assessment that accurately reflected the resident's status for 1 of 24 sampled residents (Residents #79) whose records were reviewed for MDS accuracy, in that: Residents Affected - Few The facility failed to ensure Resident #79's MDS Assessment accurately reflected her limited range of motion on her left upper and lower extremities. This failure could place residents at risk for not receiving care and services to meet their needs. Findings include: Review of Resident #79's electronic Face Sheet dated 07/14/2023 revealed she was a [AGE] year-old female admitted to the facility 03/05/23. She had diagnoses which included cerebral infarct (stroke), current long-term use of anticoagulants, and left side hemiplegia and hemiparesis (paralysis and weakness with loss of muscle control to the left side of the body). Observation and interview on 07/11/2023 revealed Resident #79 had a rolled washcloth in her left hand. The fingers of her left hand were curled around the rolled wash cloth. Resident #79 was on a low bed and was leaning to the left side and her left shoulder and hand were against the wall. She stated she was uncomfortable because she had a stroke on her left side and could not move herself. Review of Resident #79's admission MDS dated [DATE], section G revealed Resident #79 had limited range of motion in both her upper and lower extremities. Review of Resident #79's Quarterly MDS assessment dated [DATE] revealed: Section C Cognitive Patterns BIMS Score of 9 indicating moderate cognitive impairment; Section G functional status indicated the resident required extensive assistance with toileting, dressing, hygiene, and bathing but required total assistance with transfers. G0400 reflected she had no impairment in range of motion in her upper or lower extremities. Section O of the residents Quarterly MDS indicated the resident received speech therapy and occupational therapy for 5 days, and physical therapy for 6 days during the last week. Review of Resident #79's care plan revealed she required assistance with activities of daily living. Her interventions included: assess resident for weakness and contractures, in all extremities and assess needs for braces and support. In an interview on 07/14/2023 at 2:16 PM, the Regional Reimbursement nurse stated she had completed Page 1 of 6 675988 675988 07/14/2023 Hilltop Park Rehabilitation and Care Center 970 Hilltop Dr Weatherford, TX 76086

F 0641 Level of Harm - Minimal harm or potential for actual harm Resident #79's MDS. She revealed she had completed the MDS because the MDS Nurse was on vacation at the time the assessment was due. She stated the inaccuracy occurred because she did not see documentation in her medical record that Resident #79 had limited range of motion or contractures. She stated the inaccuracy could result in the resident not receiving needed care. Residents Affected - Few In an interview on 07/14/2023 at 2:30 PM the MDS-LVN stated she was the nurse responsible for doing MDS assessments. She stated She completed the admission MDS for Resident #79 which was dated 03/05/2023. She stated she was on vacation at the time the Quarterly MDS dated [DATE] and Section G of Resident #79's Quarterly MDS dated [DATE] was not accurate. She stated the resident had left sided weakness and limited range of motion in both her upper and lower extremities ON THE LEFT SIDE documented as a diagnoses on admission. She stated the nurse completing the assessment was responsible for the accuracy of the MDS. She stated an inaccuracy on the residents MDS could lead to the resident not receiving necessary care and services. In an interview on 2/24/23 at 4:47 PM, MDS-LVN stated she referred to MDS 3.0 RAI Manual provided by CMS for instructions on how to complete assessments. She stated the facility did not have a written policy regarding resident assessment. Review of CMS'S RAI Version 3.0 Manual version 1.17.1 dated October 2019 revealed: The RAI process has multiple regulatory requirements. Federal regulations at 42 CFR 483.20 (b)(1)(xviii), (g), and (h) require that (1) the assessment accurately reflects the resident's status (2) a registered nurse conducts or coordinates each assessment with the appropriate participation of health professionals (3) the assessment process includes direct observation, as well as communication with the resident and direct care staff on all shifts. Nursing homes are left to determine (1) who should participate in the assessment process (2) how the assessment process is completed (3) how the assessment information is documented while remaining in compliance with the requirements of the Federal regulations and the instructions contained within this manual. 675988 Page 2 of 6 675988 07/14/2023 Hilltop Park Rehabilitation and Care Center 970 Hilltop Dr Weatherford, TX 76086

F 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 that a Residents Affected - Few resident who needs respiratory care, is provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, the residents' goals, and preferences for 1 of 1 Resident (Resident #10) reviewed for respiratory care. A. The facility failed to ensure Resident #10's nebulizer was kept in a bag and dated while not in use. This failure could place the resident at risk for infections and transmission of communicable diseases. Findings included: Record review of Resident #10's Face Sheet dated 07/14/2023 revealed an [AGE] year-old female, who was admitted to the facility on [DATE]. Resident #10's diagnoses included dementia (memory loss) Hypertension (high blood pressure), and Dysphagia (difficulty swallowing). Record review of Resident #10's MDS quarterly assessment dated [DATE] revealed a BIMS score of 99 (severe cognitive impairment). Section I: Active diagnosis revealed chronic pulmonary disease, or chronic lung disease. Section O: Respiratory Treatments was unmarked. Record review of Resident #10's Care Plan, 04/13/2023, revealed a care plan for [Resident #10] has COPD (obstructive pulmonary disease) nebulizer treatments every six hours prn. The Care Plan did not address interventions regarding when the nebulizer tubing and mask needed to be changed. Record review of Resident #10's Physician's Orders dated 07/14/2023 revealed an order for nebulizer treatments every six hours as needed. In an observation and interview on 07/11/2023 at 09:45 AM during initial rounds, revealed Resident #10 was lying in her bed resting. Her nebulizer was sitting on her nightstand and the tubing and mask were lying on the floor. She was unable to answer to answer any questions regarding whether her oxygen tubing had been changed. In an Interview on 07/14/2023 at 3:45 PM the DON stated the nebulizer mouthpiece and tubing should be changed per doctor's orders and should be stored in a plastic bag with the date on it when not in use to prevent cross contamination and infection. If the plastic bag was not dated, she stated she would discard them and replace them with a new tubing and mask. Record review of the facility policy Respiratory Therapy -Prevention of Infection, dated 2001 revised November 2011, revealed the following [in part]: Purpose: The purpose of this procedure is to guide prevention of infection associated with respiratory therapy tasks and equipment, including ventilators, among residents and staff. Procedure: Product: Oxygen delivery devices (no-aerosol producing) Ex: venturi masks, nasal 675988 Page 3 of 6 675988 07/14/2023 Hilltop Park Rehabilitation and Care Center 970 Hilltop Dr Weatherford, TX 76086

F 0695 cannulas, oxygen supply tubing. Level of Harm - Minimal harm or potential for actual harm Infection Control Considerations Related to Medication Nebulizers/Continuous Aerosol: 7. Store the circuit in plastic bag between uses. Residents Affected - Few 9. Discard the administration set-up every seven (7) days as needed. 675988 Page 4 of 6 675988 07/14/2023 Hilltop Park Rehabilitation and Care Center 970 Hilltop Dr Weatherford, TX 76086

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 one of one kitchen observed, by failing to ensure: Facility staff cleaned or sanitized their hands during meal services when three nursing staff members (LVN1, CNA2 and CNA3) failed to sanitize hands between serving plates to residents in the dining room. LVN1 was observed placing ice in a drinking glass and then placing the ice scoop into the ice bucket, burying the scoop up to the handle. This failure by the facility places all residents at risk of acquiring a foodborne illness. Findings included: Observation on 07/11/2023 from 12:05 PM to 12:15 PM, revealed three nursing staff members, LVN1, CNA2 and CNA3, serving residents their meals without sanitizing between residents plates, instead they would place plates in front of residents, return back to the serving line and grab another resident's plate. At no time were they observe washing their hands prior to or during the meal. Observed LVN1 taking ice from a clear, square plastic container with an ice scoop and then burying the ice scoop back into the container up to the handle. In an interview on 07/12/2023 at 01:40 PM the DON said she was aware of staff not using hand sanitizer the previous day and had already in-serviced staff on hand sanitizing during meal service. She said she did not know why her staff would put the ice scoop into the ice when not removing ice from the bucket. The DON said residents could get sick from contaminated food. In an interview on 07/12/2-23 at 02:30 PM CNA3 said she just didn't think about using hand sanitizer between serving residents their lunch and knew she should have. In an interview on 07/12/2023 at 02:39 PM LVN1 said she was nervous with the state being in the building and did not want to mess anything up. LVN1 said residents could get sick if she spread an illness between them. In an interview on 07/13/2023 at 3:10 PM, the ADM said he was aware of what happened that day in the facility and the facility in-serviced their staff about proper use of hand sanitizing during meals. The ADM declined to offer a resident outcome. Record review of a document titled Hand Antiseptic, undated, revealed the following: Policy: Hand antiseptic or antimicrobial gel used by staff will be limited to situations that involve no direct contact with food by the bare hands. Hand antiseptic may be applied between washing hands as long as hands are not visibly soiled. Procedure 675988 Page 5 of 6 675988 07/14/2023 Hilltop Park Rehabilitation and Care Center 970 Hilltop Dr Weatherford, TX 76086

F 0812 3. Hand antiseptic use should be limited to situations where direct contact of food with bare hands does not occur. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 675988 Page 6 of 6