Health inspection·February 29, 2024

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, and record reviews, the facility failed to provide food that accommodates resident's preferences for eight (Resident #1, #2, #3, #4, #5, #6, #7, and #8) of eight residents reviewed for food preferences and the accommodation of resident's meal choices. The facility kitchen failed to offer alternative meals for residents. This failure placed residents at risk for dissatisfaction, poor intake, weight loss and decline in health. Findings include: Resident #1 Record review of Resident #1's face sheet revealed a [AGE] year-old male admitted to the facility on [DATE]. Diagnosis include Parkinson's Disease (progressive disorder that effects the nervous system), Anemia (low red blood cells that carry oxygen), Heart Failure, and Muscle Weakness. Record review of Resident #1's admission MDS dated [DATE] revealed a BIMS score of 15 indicating intact cognition. Resident #2 Record review of Resident #2's face sheet revealed a [AGE] year-old female admitted to the facility on [DATE]. Diagnosis include Type 2 Diabetes, Peripheral Vascular Disease (circulatory condition which narrows blood vessels) and Hypertension (high blood pressure). Record review of Resident #2's admission MDS dated [DATE] revealed a BIMS score of 15 indicating intact cognition. Resident #3 Record review of Resident #3's face sheet revealed a [AGE] year-old female admitted to the facility on [DATE]. Diagnosis include Follicular Lymphoma, Gastro Esophageal Reflux Disease (stomach acid flows back into the tube connecting your mouth and stomach), and Lower Back Pain Record review of Resident #3's admission MDS dated [DATE] revealed a BIMS score of 08 indicating Page 1 of 4 676034 676034 02/29/2024 Brady West Rehab & Nursing 2201 Menard Hwy Brady, TX 76825

F 0806 moderate cognitive impairment. Level of Harm - Minimal harm or potential for actual harm Resident #4 Residents Affected - Some Record review of Resident #4's face sheet revealed a [AGE] year old male admitted to the facility on [DATE]. Diagnosis include Heart Failure, Dependence on Supplemental Oxygen, Cerebral Infarction (stroke) and Hypotension (low blood pressure). Record review of Resident #4's admission MDS dated [DATE] revealed a BIMS score of 08 indicating moderate cognitive impairment. Resident #5 Record review of Resident #5's face sheet revealed a [AGE] year-old female admitted to the facility on [DATE]. Diagnosis include Mild Protein-Calorie Malnutrition, Hypertension and Muscle Wasting/Atrophy (hardening of the muscles). Record review of Resident #5's admission MDS dated [DATE] revealed a BIMS score of 10 indicating moderate cognitive impairment. . Resident #6 Record review of Resident #6's face sheet revealed a [AGE] year-old male admitted to the facility on [DATE]. Diagnosis include Cerebral Palsy (group of disorders that affect a person's ability to move and maintain balance/posture), Hypertension, Chronic Kidney Disease, Spinal Stenosis (narrowing of the spaces between the spine bones), and Heart Disease. Record review of Resident #6's admission MDS dated [DATE] revealed a BIMS score of 15 indicating intact cognition. Resident #7 Record review of Resident #7's face sheet revealed a [AGE] year-old male admitted to the facility on [DATE]. Diagnosis include Moderate Protein-Calorie Malnutrition, Hypertension, Gastro-Esophageal Reflux Disease, and Adult Failure to Thrive. Record review of Resident #7's admission MDS dated [DATE] revealed a BIMS score of 8 indicating moderate cognitive impairment. Resident #8 Record review of Resident #8's face sheet revealed a [AGE] year-old female admitted to the facility on [DATE]. Diagnosis include Heart Failure, Cerebral Infarction (stroke), Muscle Weakness, Vitamin Deficiency, and Hypertension. Record review of Resident #8's admission MDS dated [DATE] revealed a BIMS score of 15 indicating intact cognition. 676034 Page 2 of 4 676034 02/29/2024 Brady West Rehab & Nursing 2201 Menard Hwy Brady, TX 76825

F 0806 Level of Harm - Minimal harm or potential for actual harm Interview on 02/21/2024 at 10:35 AM Resident #1 stated that he is a vegetarian and in the past he was able to pick food preferences from the two alternative meals for the day. Resident #1 stated that he feels that he doesn't have a choice of what he is able to eat daily. Resident #1 stated that the kitchen staff had not talked with him (in a while- unable to state how long) in regard to his preferences so he feels like he gets the same foods weekly. Residents Affected - Some Interview on 02/21/2024 at 10:50 AM Resident #2 stated that she has only been at the facility for one week but does not like the food offered. Resident #2 stated that she did not know that there were alternative meals offered. Stated that she is brought her meal trays (in her room) and has never been informed that she could ask for an alternative meal. Interview on 02/21/2024 at 11:08 AM Resident #3 stated she wasn't happy with the meals served. Resident #3 stated that she was not aware of alternative meals choices. Interview on 02/21/2024 at 11:21 AM Resident #4 stated that in the past the facility would allow him to choose which alternative meal he wanted for the day but has not in a long time. Stated that he will just eat what is served to him (he stated he eats in his room). Interview on 02/21/2024 at 11:35 AM Resident #5 stated that she has never been offered options when it comes to the meals at facility. Resident #5 stated she feels that the same foods are served over and over and would like a larger variety. Interview on 02/21/2024 at 1:10 PM Resident #6 stated that he is not given a choice when it comes to the meals served. Resident #6 stated that he was not informed of alternative meals. Stated that he has his family bring in food from outside the facility since he does not always like what is served. Interview on 02/21/2024 at 1:30 PM Resident #7 stated he does not have choices with his meals and stated that he cannot always eat what is served. Resident #7 stated that some meals are too sweet or too salty and will cause him to have diarrhea. Interview on 02/21/2024 at 1:54 PM Resident #8 stated that the facility used to allow her to choose her preference but the facility stopped doing this. She stated that she believes this stopped approximately 5-6 months ago. Resident #8 stated that she had not asked why this happened. Resident #8 stated that she is not offered alternative meals when she does not eat her meal. Interview on 02/21/2024 at 2:30 PM The Dietary Manager stated that she started in this position three days ago and is in the process of reviewing the current dietary meal book to update recipes, to check for repeat meals and work on alternative diet meals. The Dietary Manager stated that the kitchen staff informed her that the last manager did not order food correctly and the staff would have to cook what was available which resulted in the cook not following the scheduled menu. The Dietary Manager stated that the regional PRN Dietary Manager (that used to supervise over the kitchen) has been ordering food after the last manager quit two weeks ago and stated she has not had any staff inform her that they were not able to follow scheduled menu due to lack of supplies. Interview on 02/21/2024 at 3:00 PM The Dietary Assistant stated that the last Dietary Manager would not order enough supplies to cover the menu and the kitchen staff would have to work with the food available. The Dietary Assistant stated that residents would ask for alternative meals, but the kitchen staff would not be able to provide alternatives due to not having substitute menu supplies 676034 Page 3 of 4 676034 02/29/2024 Brady West Rehab & Nursing 2201 Menard Hwy Brady, TX 76825

F 0806 Level of Harm - Minimal harm or potential for actual harm available. The Dietary Assistant stated that she was not aware that the residents were not receiving a form where they could request a preference between two meal choices. The Dietary Assistant stated that since the previous Dietary Manager quit (approximately two weeks ago) the regional PRN Dietary Manager has been ordering the food for the facility and they are now able to follow the scheduled menu and have enough food to provide an alternative menu. Residents Affected - Some Interview on 02/21/2024 at 3:22 PM The Dietary [NAME] stated that when she was working under the previous Dietary Manager, she tried to follow the scheduled menu but due to lack of food/supplies ordered she was not always able to do this. She stated that she spoke with the previous Dietary Manager during this time and could not get resolution to the ordering issues. The Dietary [NAME] stated that she spoke with the administrator and Regional Consultant about the issues she was experiencing and was not getting solutions provided., She stated that the regional consultant would take the Dietary Manager's word that he was ordering enough supplies. The Dietary [NAME] stated that after the previous Dietary Manager quit, they have not had issues getting enough food/supplies to follow the scheduled. Interview on 02/29/2024 at 1:18 PM with The Regional Facility Consultant stated that she was not aware that that the previous Dietary Manager was not ordering supplies/food for the kitchen correctly. She stated that she did not recall speaking with the Kitchen Cook. She stated that she arrived at the facility today to assist the new Dietary Manager with upgrading the scheduled weekly menu and to check on the supplies/food available in the kitchen. She stated that she has put a new monitoring system in place with the Dietary Manager to ensure alternate meals are offered, to have check and balances on hall tray temperatures and times it takes for residents to receive their trays. She stated that she is going over all the procedures in the kitchen to see if she needs to implement new systems. but will speak with the Dietary manager about implementing this process. Interview on 02/29/2024 at 3:00 PM The Administrator stated that she was aware of process to allow residents to pick alternatives with meals, but was not aware that this process was discontinued. The Administrator stated that this process had already been put back into place. The Administrator stated that she did not recall the Kitchen [NAME] informing her of inadequate supplies/food being ordered for the kitchen when the previous Dietary Manager was working at the facility. Record review of all sampled residents with weight loss revealed that weight loss was due to medical conditions and not due to failure to provide alternative menu options. Review of facility's policy Diets, Nutrition and Hydration revision dated 8/2023, did not address alternative meals but did reveal, in part, diets may be liberalized to allow more freedom in meal selection .therapeutic and calorie restricted diets are available for residents who are candidates for liberalized diets. 676034 Page 4 of 4