Health inspection·February 29, 2024

F 0690 have any skin break down due to foley catheter. Level of Harm - Minimal harm or potential for actual harm Interventions: Use catheter securing device to reduce excessive tension on the tubing and facilitate urine flow. Residents Affected - Few Record review of Resident #39's physician's order summary dated 02/28/2024 revealed check catheter securing device to resist excessive tension on the tubing and facilitate urine flow every shift. Related to bladder-neck obstruction. Order dated 02/15/2024. Observation and interview on 02/28/2023 at 8:34 AM revealed Resident #39 in bed resting on her back. The head of the bed was elevated. Resident #39 was awake and alert. Resident #39's catheter drainage bag was hanging on the left side of the resident's bed. Resident #39 removed the sheet from her left leg. Observation revealed the catheter drainage tube was under the resident's left leg. Observation revealed there was no catheter anchor to secure the tube in place. Resident #39 stated she did not know how the tube got under her leg. Resident #39 stated the tube did not pull or cause her any pain or discomfort. Resident #39 stated sometimes she would forget she had the catheter. Resident #39 stated she had a strap holding the tube in place a few days ago. Resident # 39 stated she did not know when it came off. Observation and interview on 02/28/2024 at 8:41 AM RN A stated she was the nurse caring for Resident #39. Observation of Resident #39's catheter tube assisted by RN A revealed the resident's catheter tube was under her left leg without a catheter anchor device. RN A stated the first thing she saw was the tube under the resident's leg. RN A stated the tube should not be under her leg. The RN continued and stated when the tube was under her leg the risk was it could interfere with the drainage flow of urine from her bladder. RN A stated she will get a securing device to secure the drainage tube in place. RN A stated the catheter tube should be secured to prevent the risk of pulling and trauma. RN A stated she did not know why the tube was not secured except the device must have come off. RN A stated if the CNA saw it came off the CNA was to notify the nurse. RN A Stated everyone who cared for the resident was responsible for monitor there was a securing device on the resident's catheter. RN A stated she rounded every eight hours to check but she had not checked yet this morning. Interview on 02/28/2024 at 9:14 AM CNA B stated when a resident had a catheter it was important to anchor the catheter tube in place over the resident's leg. CNA B stated she had not cared for Resident #39 yet this morning. CNA B stated if the tube were under her leg, she would fix it. CNA B stated she would notify the nurse if the tube was not secured to her leg. Interview on 02/28/2024 at 10:04 AM the DON stated foley catheter tubing was to be secured in place over the resident's leg. The risk of the tube not being secured was pulling and dislodgment of the catheter. The DON stated she did not know why Resident #39's tube was not secured to her leg. The DON stated Resident #39 did not like to be cared for until after breakfast that was why it was not found earlier this shift. The DON stated the nurses were responsible for monitoring the tube placement every shift. The DON stated Resident #39 had a physician's order to secure the tubing. Interview on 02/28/2024 at 10:18 AM the Administrator stated she was not clinical. The Administrator stated she was told the resident catheter tubing was to be secured over the resident's leg. The administrator stated we started in-services over this already. Attempted telephone interview on 02/29/2024 at 11:30 AM with the 6:00 AM 02/28/2024 night shift nurse D without success. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 2 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676040 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Prairies 106 Del Norte Dr El Campo, TX 77437 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Record review of facility's Nursing Policies and Procedures revised dated 06/2019 read in part: Subject: Catheter Care Policy: It is the policy of this facility that indwelling urinary catheters will be cleaned and maintained to reduce risk of urinary tract infections or other urinary complications . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 3 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676040 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Prairies 106 Del Norte Dr El Campo, TX 77437 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to dispose of garbage and refuse properly for one of one waste receptacle observed for garbage disposal. Residents Affected - Few The waste receptacle on the right had its top right lid opened when no one was disposing of trash. These failures could place residents at risk for exposure to germs and diseases carried by vermin and rodents. Findings include: Observation on 02/27/2024 at 12:05 PM the dumpster lid was observed open. Interview and Observation on 02/29/2024 at 10:41 AM the Dietary Manager said following the facility's policy was responsibility of the Dietary department and they were supposed to ensure the dumpster lids were closed. She said she thought the failure occurred because the garbage truck had recently come, but there were trash bags inside of the dumpster. She said she talked with the kitchen staff and instructed them that when they are caught up, to check on the dumpster because they were not the only staff to use the dumpster. She said she did not recall when she last had training on the disposing of trash or the dumpster. She said she was responsible for ensuring oversight of following policy for waste disposal. She said the risk to the resident when policy was not followed was rodents could get into the dumpster, and it can attract animals. She said the worst thing that can happen to the resident when proper protocols are not practiced was death to a resident. Interview on 02/29/2024 at 10:49 AM the Administrator said the policy for disposing of waste was when you put trash in the dumpster that the lid was supposed to be closed afterwards. She said she thought the failure occurred because someone placed trash in the dumpster and did not close the lid. She said before yesterday she could not tell when she was last in-serviced on waste disposal and the dumpster. She said the facility developed a new policy for waste disposal. She said she was responsible for overseeing protocol was followed. She stated the risk to residents of not following protocol was pests getting in the trash. She said the worst thing that can happen to the resident when proper protocols are not practiced was the pests could get into the building and the residents encountered said pests and got sick. Record review of the Nutrition Services Policies and Procedures dated 06/2019 read in part . Waste is not disposed of by garbage disposal. It is kept in leak proof non-absorbent containers with close fitting lids. Cover waste containers and close dumpsters at all times . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 4 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676040 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Prairies 106 Del Norte Dr El Campo, TX 77437 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 5 of 6 residents food trays reviewed for infection control practices, in that: Residents Affected - Few 1. CNA C did not utilize appropriate hand hygiene during the food tray pass to Residents . These failures could place residents at risk of infection, transmission of communicable diseases and a decline in health. The findings included: Observation and interview on 02/29/2024 at 12:05 PM- 12:10 PM, during the food tray pass, revealed CNA C going from resident's room directly to the food tray cart and handling other resident's trays without sanitizing their hands. CNA C repeated these actions for six residents. Interview on 02/29/2024 at 12:13 PM with CNA C. She said when serving trays, they go in the resident's rooms and of the trays, take off the lids for them and ensured they had condiments if allowed. CNA C said she thought she may have sanitized her hands on one of the 5 trays she recently passed out. She said they did not sanitize their hands until they were done passing out the meal trays. She said the ADON and Administrator were responsible for ensuring staff followed protocol and policy. She said she did not clean her hands between trays when passing them to residents in the dining room. She said the risk to residents of staff not following policy was a resident could get an infection. She said the worst thing for residents of staff not following policy was a resident could get sick. Interview on 02/29/2024 at 1:03 PM with the DON. She said policy/procedure when passing our food trays was staff are supposed to sanitize between every tray and wash when visibly soiled. She said what happened was that the nurse aides on Station 2 did not sanitize their hands between trays. She said she was last in serviced on hand hygiene last month. She said staff were in-service on hand hygiene monthly and she randomly picks staff and conducts hand hygiene training. She said she was responsible for ensuring policy was followed, but all staff were responsible for ensuring all staff were following protocols, and particularly the charge nurse and unit managers. She said the risk to residents if policy were not followed was infection control risk- another residents tray could be contaminated. She said the worst thing that could happen to the resident when proper protocols are not practiced was illness resulting in death. She said the failure occurred because there was a lack of education. Interview on 02/29/2024 at 1:15 PM with the Administrator said when handing out food trays s staff were supposed to sanitize between trays. She said the maintenance person was setting up a sanitizer closer to the kitchen and that staff have started getting in-serviced on hand sanitation. She said the failure occurred because there was not a sanitizer there near the kitchen where the staff pass out trays. She said she was last in-serviced on hand hygiene at end of January 2024 to the beginning of February 2024 . She said the Administrator ensured policy was followed. She said the risk to residents when policy was not followed was residents could get an illness and the worst thing that could happen to residents if policy were not followed was residents could get sick. Record review of the facility's Infection Control Policy dated 02/2022 read in part . Hand Hygiene: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 5 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676040 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Prairies 106 Del Norte Dr El Campo, TX 77437 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Basic concepts of hand hygiene, include why, when, and how to perform hand hygiene; Correct techniques for hand washing and use of alcohol-based hand sanitizer. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 6 of 6