Health inspection·January 24, 2025

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to maintain an effective pest control program to remain free of pests and rodents for four of four residents and one of four halls. Residents Affected - Some The facility failed to ensure the building is free of cockroaches. This failure could place residents at risk of, infection, skin irritation, allergies, which could result in unsanitary living conditions and decline in health and well-being. Finding included: In an interview with Resident #37 on 01/23/2025 at 10:42am, Resident #37 stated the facility did have roaches and it's because a few residents eat in their rooms. Resident #37 stated there were times when they would try to stomp on the roaches with their shoe and would miss. When addressing the issue to the facility staff, Resident #37 was told it was a delusion of seeing the roaches, but an exterminator was brought in shortly after speaking with facility staff. The exterminator did place pellets along the side of the walls to kill any sighting of roaches. In an interview with Resident #21 on 01/24/2025 at 10:25am Resident #21 stated there was a concern with the roaches in the facility. Resident #21 also stated the last sighting of roaches was a couple of days ago in their room. Resident #21 also stated the roaches use to be worse, but things have gotten better over time. In an interview with MAINT on, 01/24/2025 at 9:08 am, MAINT stated the facility used an electronic request, which all staff members have access to log for seen pest, regardless of if they are alive or dead. There was also a logbook for any sightings of roaches that was reported by staff, which was checked daily, several times a day. The facility has had a roach issue within the last three months and used a pest control service. When there was a sighting of roaches in a specific hallway, the pest control company focused more on the hall that has the most sighting of roaches. The pest control does come out twice a month and is on call as needed. In an interview with CMA2 on 01/24/2025 at 10:34 am CMA2 said she had been at the facility for less than a month and normally worked a rotating shift CMA2 stated if a roach was in front of them, they would kill it, pick it, and contact maintenance or housekeeping to address the issues. In an observation on 1/24/25 at 11:25am, a small roach was seen in the conference room, crawling on the back of a chair by the Survey team. Page 1 of 2 675991 675991 01/24/2025 Park Manor of Humble 19424 McKay Dr Humble, TX 77338

F 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview with ADMN on 01/24/2025 at 11:34am the ADMN was informed that the Survey team saw a roach crawling on the chair in the conference room. ADMN stated the first thing that could be done was to clear the room and contact someone from the maintenance facility to come in and spray. ADMN also stated that if that wasn't necessary at the time, pest control would be called, due to a sighting of the live roach in the conference room. The ADMN said there had been recent foundation work completedin the facility and it was unknown where the roaches were coming from. ADMN was questioned about the can of RAID (commercial bug spray) that was sitting on the desk in the office and ADMN stated they were unsure why it was there, but possibly brought in by someone on the maintenance team. ADMN confirmed pest control does come to the facility once a week and the maintenance team at the facility does spray as needed or if an issue was brought to their attention. ADMN stated there were no other concerns at this time with pests, just roaches. In an interview with ADON on 01/24/2025 at 12:33pm she said she had been with the facility for seven years and had experienced the pest control issue with roaches for some time. ADON stated the facility does have a treatment plan with the pest control company, as they do come out and spray. ADON has seen reports of residents who have complained about the issue and does follow up with the resident in a substantial amount of time to see if the issue has been resolved but cannot recall when the last time was it was reported individually to them. Record review of the Pest Control Logbook, Perfect Pest Control, where facility staff was to provide sighting of dead or alive roaches starting 09/2024 to the most recent physical sighting of roaches, 01/22/2025. The halls of the roaches were within the halls of 100-400. There were also sightings of roaches within this time frame in the admissions office, conference room, laundry, and in the hallways. Record review of Pest Control Service Inspection Report for the last 90 days dated, 11/18/2024,revealed in this weekly visit the technician treated the following rooms: 111, 112, 114, 115, and 117 as it was reported of live roaches and they were observed during the visit for treatment. It was noted that in room [ROOM NUMBER], there was poor sanitation in the room, which many roaches were seen by the technician. Record review of the Pest Control Service Inspection Report for the last 90 days dated, 12/09/2024 with several sightings of live roaches in the following rooms: 110, 112, 114, 115, 116, and 117. It was noted some of the rooms had food in the drawers and rooms need storage improvement. The facility was using weekly service treatment at this time. Record review of Perfect Pest Control Service Inspection Report for the last 90 days dated, 01/06/2025 from the pest technician for a weekly visit. It was documented by the technician of the pest control company the focus of the week was the 300 hallway and treated. A room on the 400 hall was logged for roach issues and treated. There were multiple cockroaches observed in the laundry room. The facility was using weekly service treatment at this time. Record review of the facility policy and procedure for Pest Control, revised August 2008 read in part: Policy Statement - Our facility shall maintain an effective pest control program. Policy Interpretation and Implementation - 1. This facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents. 2. Pest control services are provided by pest control company. 3. Windows are always screened 5. Garbage and trash are not permitted to accumulate and are removed from the facility daily. 6. Maintenance services assist, when appropriate and necessary, in providing pest control services. 675991 Page 2 of 2