Health inspection·March 27, 2025

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to submit a complete and accurate request for nursing facility specialized services in the LTC Online Portal within 20 business days after the date of the Interdisciplinary Team meeting for one of one resident reviewed. The facility failed to submit a NFSS form request by the specific deadline for Resident #2 for a pressure reducing mattress and a motorized wheelchair. This failure could place residents at risk of not receiving or benefiting from specialized equipment they may require. Findings included: Record review of Resident #2's Face Sheet reflected the resident was a [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included Muscle weakness (generalized), Muscle wasting and Atrophy, and Unsteadiness on feet. Record review of the MDS dated [DATE] revealed that Resident #2 was PASARR positive, and her Cognitive status was rated with a BIMS of 2. The MDS also revealed recommendation for the resident to be provided with a pressure reducing device for the bed due to her risk for developing pressure ulcers. Record review of Resident #2's Baseline Care Plan of 07/01/2024 revealed she needed assistance with mobility and had the risk for the development of pressure ulcers. In an interview with the ADM on 03/26/2025 at 3:08PM she confirmed that the request for the medical equipment should be submitted by the 20th day after the Interdisciplinary Team meeting in which the resident's needs were identified. In an interview with the MDS Coordinator on 03/27/2025 at 11:27AM, the MDS Coordinator stated the process for implementing the recommendations from the IDT was as follows: once a determination of need was made, the DOTS was to contact the DME. The DME was then responsible for getting any measurements needed and estimating a price. Once the information was received, the DOTS was to enter the information in the PASARR portal. She stated failure to enter the information in a timely manner could result in the resident not receiving the approved medical equipment. In an interview with the DOTS on 03/27/2025 at 11:45 AM he stated he did notify the DME of the recommended medical equipment; however, he did not keep any written documentation of the contacts. He Page 1 of 7 676026 676026 03/27/2025 Will-O-Bell 412 N Dalton Bartlett, TX 76511

F 0644 also stated he was aware that he did not enter the required request for the equipment in a timely manner. He stated the failure could result in the resident not receiving the optimal equipment in a timely manner. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 676026 Page 2 of 7 676026 03/27/2025 Will-O-Bell 412 N Dalton Bartlett, TX 76511

F 0645 PASARR screening for Mental disorders or Intellectual Disabilities 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 failed to ensure individuals with mental health disorders were provided an accurate PASARR for 1 of 2 residents (Residents #38) reviewed for PASARR Level 1 screenings. Residents Affected - Few The facility failed to notify the local authority of the PASARR I screen for Residents #38. This failure could affect residents with mental illness placing them at risk for a diminished quality of life and not receiving necessary care and services in accordance with individually assessed needs. Findings included: Record review of a Face Sheet dated 03/25/25 for Resident #38 revealed a [AGE] year-old male admitted to the facility on [DATE]. His diagnoses included major depressive disorder (a mental health condition that causes a persistently low or depressed mood and a loss of interest in activities that once brought joy); anoxic brain damage non else classified (a catastrophic and potentially fatal injury characterized by the brain's complete deprivation of oxygen. It distinguishes from hypoxic brain injuries, where oxygen flow to the brain is reduced); other psychoactive substance abuse with psychoactive substance induced psychoactive disorder unspecified (is characterized by hallucinations and/or delusions due to the direct effects of substance or withdrawal from substance in the absence or delirium); type 1 diabetes mellitus with ketoacidosis without coma (a serious complication of diabetes that occurs when the body can't produce enough insulin). Record review of Resident #38's diagnosis report revealed that he was diagnosed with alcohol abuse, in remission on 3/28/18 and psychoactive substance abuse with psychoactive substance induced psychoactive disorder unspecified on 04/19/18. Record review of Resident #38's Quarterly MDS dated [DATE] revealed a BIMS score of 00 which indicated a severe impairment in section C. Record review of Resident 38's care plan dated 03/01/2023 revealed a focus that Resident #38 had a behavior problem if kicking and shouting r/t brain damage: anxiety disorder, depression and psychotic disorder (with a goal to have fewer episodes of kicking and shouting by the review date. Interventions in place were to anticipate and meet the resident's needs. Caregivers to provide opportunity for positive interaction, attention. Stop and talk with him/her as passing by. Record review of Resident #38's PASARR Level 1 Screening dated 06/19/21 indicated the resident did have a Mental Illness, Intellectual Disability, or Developmental Disability in section C. During an interview with the MDS Coordinator on 03/27/2025 at 11:27AM, she stated failure to enter the PASARR request in a timely manner could result in the resident not receiving the services needed to have a productive life. During an interview with the DOTS on 03/27/2025 at 11:45 AM he stated not submitting the PASARR in a timely manner to the local authorities, this failure could result in the resident not receiving services. 676026 Page 3 of 7 676026 03/27/2025 Will-O-Bell 412 N Dalton Bartlett, TX 76511

F 0645 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview with the Administrator on 03/26/2025 at 3:08 PM she confirmed that the request should be submitted by the 20th day after the Interdisciplinary Team meeting in which the resident needs were identified. If the request is not submitted, it can cause the resident not to receive the services they need. The facility stated they did not have a PASARR policy as they follow the policy and procedure per Health and Human Services Commissioner website. 676026 Page 4 of 7 676026 03/27/2025 Will-O-Bell 412 N Dalton Bartlett, TX 76511

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, it was determined the facility failed to ensure drugs and biological's were stored under proper temperature in the Front Medication Room and the Back Medication Room reviewed for medication storage. The facility's failures could place residents receiving medication at risk for lack of drug efficacy. Findings included: During an observation on 03/26/2025 at 09:55 AM of the back medication room revealed that the refrigerator temperature log for the medications was out of range 25 of 26 days of March 2025. The log reflected the temperatures ranged from 28 degrees Fahrenheit to 32 degrees Fahrenheit. On 03/26/2025 the temperature was observed in the fridge at 28 degrees when visually checked. At the time of the observation, the fridge contained insulin pens. During an observation on 03/26/2025 at 11:55 AM of the front medication room revealed that the refrigerator temperature log for the medications was out of range 24 of 24 days of March 2025. The log reflected the temperatures ranged from 28 degrees Fahrenheit to 31 degrees Fahrenheit. On 03/26/2025 the temperature was observed in the refrigerator at 28 degrees when visually checked. At the time of the observation, the refrigerator contained insulin pens. During an interview on 03/26/25 at 11:55 AM DON stated that it was the night nurse's responsibility to check the carts and the temperatures of the medication refrigerators. She also stated they had recently implemented a Performance Improvement Project to ensure the refrigerators' temperatures were consistently monitored. The DON stated that the negative outcome for having medications stored below their recommended storage temps could lead to the medications being compromised and losing their efficacy. During an interview with the Pharmacist on 03/26/2025 at 4:30 PM he stated the refrigerator/freezer combos tended to be harder to control and tended to run colder. When the refrigerators were thawed, they tend to get colder. He had not ever seen anything in there frozen during his monthly inspections. He stated his first recommendation would be to replace the thermometers to ensure accurate readings. Additionally, he stated he believed the med's in the refrigerators were still safe and the integrity of med's was intact. Record review of the facility policy titled, Storage and Expiration Dating of Medications and Biological's revealed the following: 16. Facility should ensure medications and biological are stored at their appropriate temperature according to the United States Pharmacopeia guidelines for temperature ranges and manufacturer guidance. 16.2 Refrigeration: 36-46 [degrees] F or 2-8 [degrees] C. 676026 Page 5 of 7 676026 03/27/2025 Will-O-Bell 412 N Dalton Bartlett, TX 76511

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, interviews, and record review, the facility failed to store, prepare, distribute, and serve food following professional standards for food service safety for 1 of 1 kitchen reviewed for kitchen sanitation in that: - Food items were not labeled and/or dated. - Moldy and rotten food was present during inspection of the walk-in refrigerator. These failures could place all residents who received meals from the main kitchen at risk for food-borne illness. Findings include: Observation on 3/25/2025 at 9:15 am of the walk-in refrigerator reflected the following: Potatoes that were dated 3-9-25 had green sprouts growing from the potato. The lunch meat dated 3-8-25 was expired. Diced chicken was dated 3-24-25 with no discard date. 15 Sandwiches dated 3-25-25 had no discard date. Ranch dressing was not in the original container, dated 3-8-25, with no discard date. Grated cheese was not in the original container, dated 3-21-25, with no discard date. Grated cheese was not in the original container, dated 3-21-2028, with no discard date. Tomato soup was not in the original container, dated 3-21-2028, with no discard date. 676026 Page 6 of 7 676026 03/27/2025 Will-O-Bell 412 N Dalton Bartlett, TX 76511

F 0812 - Level of Harm - Minimal harm or potential for actual harm Was an unknown drink in the refrigerator with a name and no date. An observation of the pantry on 3/25/2025 at 9:25 am reflected the following: Residents Affected - Some A loaf of bread on the shelf that had no open date or discard date on the bag. During an interview on 3/28/2025 at 10:25 AM, the KC said a sheet in the kitchen told them how long an item could be kept in the refrigerator before it must be thrown out. The KC said prepared food should not be kept in the fridge for more than 7 days and should have an expiration date. The KC said the refrigerator was checked regularly for moldy food. The KC said that if expired food was used, residents could get sick. Interview on 3/28/2025 at 10:35 AM, KC said that when food is received, it will have an expiration date on the package. The KC said that outdated food should be thrown away immediately. Prepared food cannot stay in the fridge for more than 5-7 days before it must be thrown out. The KC said that if residents were to eat expired food, they could get sick. Interview on 3/28/2025 at 10:45 AM, the DM said that prepared food in the fridge should have an open date and an expiration date on the container. The DM said out-of-date food should be thrown out. The DM said all the food in the kitchen should be dated. The DM said that food in the refrigerator should be checked daily for out-of-date products. The DM said that residents can get sick if outdated food is used to feed the residents. Interview on 3/28/2025 at 1:15 PM the ADM said that all food in the kitchen should be dated. The ADM said that prepared food in the refrigerator should be labeled with an expiration date. Food that has expired should be thrown in the trash. If the residents are served outdated or moldy food, they could get sick. Record Review Will O Bell Policy & Procedure Manual on 3/28/2025 at 2:20 PM. Will O Bell Food Storage Policy Statement: Storage facilities will be provided to keep foods safe, wholesome, and appetizing. Food will be stored in an area that is clean, dry, and free of contaminants. Food will be stored, at appropriate temperatures and by methods designed to prevent contamination or cross contamination. 12. Leftover food should be stored in covered containers or wrapped carefully and securely and clearly labeled and dated before being refrigerated. Leftover food must be used within 7 days or discarded as per the 2017 Federal Food Code. 13 f. All foods should be covered, labeled, dated, and routinely monitored to assure that foods, including leftovers, will be consumed by their safe use by dates, or frozen (where applicable), or discarded. 676026 Page 7 of 7