Health inspection·March 28, 2024

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 interviews and record review the facility failed to refer all residents with possible serious mental disorders or a related condition for level II resident review upon a significant change in status assessment for 1 of 5 Residents (Resident #52) whose records were reviewed for mental disorders. The facility failed to refer Resident #52 for a PASRR evaluation based on mental disorder diagnoses including Schizoaffective Disorder, Bipolar type. This deficient practice could affect residents with a mental illness and contribute to a delay in services needed. Findings included: Review of Resident # 52's face sheet dated 3/28/2024 revealed a [AGE] year-old female with admission date of 12/07/2022 and a readmission date of 1/27/2023 with diagnoses that included Type 2 Diabetes Melllitus without complication (consistent elevated blood sugar), Cardiac Arrhythmia (abnormal heart rate), and Diaphragmatic Hernia without obstruction or gangrene (a hole in the diaphragm a muscle that is used in respiration without tissues damage). Diagnosis added on 3/15/2024 included bipolar disorder (episodes of mood swings ranging from depressive lows to manic highs), schizoaffective disorder, bipolar type (a mental illness that affects your mood and thoughts with symptoms of bipolar disorder). Review of Resident # 52's Quarterly MDS assessment dated [DATE], revealed a BIMS score of 12 which indicated a moderate cognitive impairment. Section I revealed diagnoses that include anxiety disorder, bipolar disorder, and Schizophrenia. Review of Resident # 52's PASRR level 1 screening dated 12/12/2022 revealed no mental illness, intellectual disorder, or developmental disability. Facility was unable to provide PASSR screening for readmission date of 1/27/2023 or when new diagnosis was made on 3/15/2024. Review of Resident # 52 's Care Plan revised 5/19/2023 requires antipsychotic medications (Abilify) for diagnosis of behavior management. In an interview with the MDS Coordinator on 3/27/2024 at 1:00 pm, she stated that the Level 1 screening was not sent when the new mental illness was identified, and that it should have been. She continued that she was not sure how it got missed but she would send it in today (3/27/2024). She stated that she was responsible to make sure all PASSR level 1 screenings that were positive were sent to Page 1 of 7 676071 676071 03/28/2024 Groesbeck Ltc Nursing and Rehabilitation 607 Parkside Dr Groesbeck, TX 76642

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the local authority . She stated the PASSR level 1 screening not being the local authority could cause a delay in the resident receiving needed services. In an interview with DON on 3/27/2024 at 3:30 pm, he stated that his expectations were the MDS coordinator was responsible for making sure the facility meets requirements for PASRR reporting. He stated that a PASRR no submit can put the resident at risk for not receiving recommended services. In an interview with the ADM on 3/28/2024 at 10:30 am, she stated that her expectation was the PASRR level 1 be submitted per facility policy. She stated this was the responsibility of the MDS coordinator. If not done timely the PASSR screening can prevent potential treatment for the resident. Review of Policy titled Policy and Procedure for PASRR Level 1/PASRR compliance 6/27/2014 dated 6/27/2014, 3/28/2024 11:00 am revealed F. If at any time a resident has a significant change or you receive information that might indicate the resident may have a mental illness, intellectual disorder or developmental disability, or condition not contained in the medical record, please submit PASRR level 1 screening for the resident to be evaluated by the local authority. 676071 Page 2 of 7 676071 03/28/2024 Groesbeck Ltc Nursing and Rehabilitation 607 Parkside Dr Groesbeck, TX 76642

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, which included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs for 1 of 2 residents (Resident #50) reviewed for care plans. The facility failed to follow comprehensive care plan interventions for Residents #50. This failure could place residents at risk for not receiving necessary care and services or having important care needs identified and met. Findings included: Review of Resident #50's face sheet dated 06/14/23 revealed Resident #50 was a [AGE] year-old male admitted on [DATE] with diagnoses including cerebral infarction (a result of disrupted blood flow to the brain due to problems with the blood vessels that supply it), dysphagia (difficulty in swallowing), hypertension (a condition in which the force of the blood against the artery walls is too high), and hyperkalemia (elevated level of potassium in the blood). Review of the MDS dated [DATE] reflected Resident #50 had a BIMS score of 14 indicating Resident #50 was cognitively intact and Resident #50 was independent for bed mobility, transfers, and eating. Resident #50 required extensive assistance for dressing and required limited assistance for toileting and personal hygiene. MDS reflected Resident #50 used tobacco. Review of Resident #52's clinical record revealed comprehensive care plan initiated 09/18/23 revealed: Resident #50 is a smoker. Goal: Resident #50 will not smoke without supervision through the next review date. Interventions: Instruct him about the facility policy on smoking times and safety concerns, and Monthly smoking assessments. Resident #50 requires supervision with smoking apron. Resident #50's smoking supplies are kept at nurse's station. Review of Resident #50's assessments dated from 07/02/22 to 03/25/24 in electronic medical record revealed there were no initial or monthly smoking assessments completed. In an interview on 03/27/24 at 2:55 PM with Resident #50, he stated he was doing fair, and the staff all treated him pretty good. He stated he had a call button to use to call for help and staff got to him in a timely manner when he called them. He stated he felt safe in the facility. He stated he smoked cigarettes during designated smoke times, and he wore an apron to protect his clothing when 676071 Page 3 of 7 676071 03/28/2024 Groesbeck Ltc Nursing and Rehabilitation 607 Parkside Dr Groesbeck, TX 76642

F 0656 he smoked. He stated he had no concerns about anything at the facility. Level of Harm - Minimal harm or potential for actual harm In an interview on 03/27/24 at 2:07 PM with the MDS, she stated Resident #50 did not smoke cigarettes when he had first admitted to the facility. She stated Resident #50 had begun smoking sometime last summer but she was not sure of the date. She stated Resident #50 had begun asking other residents for cigarettes and started out with an electronic cigarette. She stated smoking assessments should be done monthly. She stated all smokers were supervised when smoking but if the care plan interventions were not followed, it could put residents at risk for not wearing their safe smoking aprons or may not allow resident to be kept safe by staff. She stated Resident #50's MDS which was done on admission was correct and did not reflect that Resident #50 was a smoker. The MDS assessment which was done in July did reflect Resident #50 was a smoker, so she did not know the exact date, but it was sometime in between April and July of 2023 when Resident #50 began smoking. Residents Affected - Few In an interview on 03/27/24 at 3:30 PM with the ADM, she stated Resident #50 was currently a smoker, but he did not smoke before when he first admitted to the facility. She stated the admitting nurse was responsible for completing the admission smoking assessment but smoking admitting assessments were only done for residents that were smokers. She stated the monthly smoking assessments should have been completed by the charge nurses. She stated staff should follow care plan interventions. She stated staff have been trained on following care plans and completing smoking assessments. She stated if care plan interventions were not followed, it could cause all kinds of problems for residents such as them receiving the wrong care or wrong diet . In an interview on 03/27/24 at 3:38 PM with the DON, he stated Resident #50 was a smoker at that time, but he had not been a smoker when he first admitted to the facility. He stated he was aware that Resident #50 did not have any smoking assessments at that time but that they had corrected those. He stated smoking assessments were done upon admit and then monthly and only for residents that were smokers. He stated that the charge nurses were responsible for the assessments. He stated staff should always follow care plan interventions and staff had been trained on following care plan interventions and completing smoking assessments. He stated if care plan interventions were not followed, the proper care would not be given to the residents and that no staff should have ever hit the floor to work without being trained on how to read the care plans and follow them or how to access the residents records which indicate the care that should be received . Review of facility policy dated 2001 (revised April 2006) titled Care Plans - Goals and Objectives revealed Policy Statement: Care plans shall incorporate goals and objectives that lead to the resident's highest obtainable level of independence. 1. Care plan goals and objectives are defined as the desired outcome for a specific resident problem. 3. Care plan goals and objectives are derived from information contained in the resident's comprehensive assessment and: a. Are resident oriented, b. Are behaviorally stated, c. Are measurable; and d. Contain timetables to meet the resident's needs in accordance with the comprehensive assessment. 4. Goals and objectives are entered on the resident's care plan so that all disciplines have access to such information and are able to report whether or not the desired outcomes are being achieved. 5. Goals and objectives are reviewed and/or revised: a. When there has been a significant change in the resident's condition; b. When the desired outcome has not been achieved, c. When the resident has been readmitted to the facility from a hospital/rehabilitation stay, and d. At least quarterly. 676071 Page 4 of 7 676071 03/28/2024 Groesbeck Ltc Nursing and Rehabilitation 607 Parkside Dr Groesbeck, TX 76642

F 0812 Level of Harm - Minimal harm or potential for actual harm 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 under sanitary conditions in the facility's kitchen for one out of one ice machines. Residents Affected - Many The facility failed to ensure the ice machine was free of mold. This failure placed the residents at risk for foodborne illnesses. Findings included: Observation on 3/26/2024 at 09:02 am of the only ice machine had pink and black residue on the outside of the internal plastic covering over the ice drop, the level of ice was up to the bottom edge of covering. Observation on 3/26/2024 at 12:30 pm of ice machine after cleaning faint pink coloring remains, no black residue present on the internal plastic covering over the ice drop. In an interview with the DM on 3/26/2024 at 09:02am, she stated that she was surprised by the pink and black residue on the ice machine as it was cleaned by maintenance on Thursday. She stated she would have it cleaned again. She stated a potential outcome would be the residents would be at risk of getting sick. In an interview with the DA on 03/26/2024 at 09:51 am, she stated she has been at the facility for 3 months and she was not sure what the policy about cleaning the ice machine stated. In an interview with DON on 3/262024 at 4:00 pm, he stated his expectation was that the ice machine be maintained in a sanitary condition and cleaned as scheduled. He stated he was the infection preventionist and monitored the cleaning schedule weekly. He stated maintenance was responsible for the cleaning and sanitation of the ice machine weekly. He stated failure to maintain the cleaning schedule could put the residents at risk for foodborne illnesses. In an interview with the ADM on 3/26/2024, she stated her expectation was that the ice machine was cleaned as scheduled by maintenance. Maintenance did clean the ice machine this morning. She stated that because residents use the ice machine several times a day, at least during meals, they can be at risk for illness . Record review of Kitchen cleaning schedule dated January 2024 on 3/28/2024 at 10:00 am revealed the ice machine was cleaned on 1/2/2024, 1/3/2024, 1/12/2024, 1/17/2024, and 1/24/2024. Record review of Kitchen cleaning schedule dated February 2024 on 3/28/2024 at 10:00 am revealed the ice machine was cleaned on 2/8/2024, 2/14/2024, 2/21/2024, and 2/28/2024. Record review of Kitchen cleaning schedule of cleaning dated March 2024 on 3/28/2024 at 10:00 am revealed that the ice machine was cleaned on 3/6/2024 and 3/14/2024. Record review of Statement made by MD undated on 3/28/2024 at 10:00 am revealed Ice machine 676071 Page 5 of 7 676071 03/28/2024 Groesbeck Ltc Nursing and Rehabilitation 607 Parkside Dr Groesbeck, TX 76642

F 0812 received preventative maintenance cleaning/sanitizing on 3/21/2024. Level of Harm - Minimal harm or potential for actual harm Record review of Policy ice machine and ice storage chests revised January of 2012 on 3/28/2024 at 10:00 am revealed 3. Our Facility has established procedures for cleaning and disinfecting ice machines which adhere to the manufacturer's instructions. The infection preventionist (or designee) maintains a copy of these procedures. Residents Affected - Many The facility failed to ensure the ice machine was free of mold. This failure placed the residents at risk for foodborne illnesses. Findings included: Observation on 3/26/2024 at 09:02 am of the only ice machine had pink and black residue on the outside of the internal plastic covering over the ice drop, the level of ice was up to the bottom edge of covering. Observation on 3/26/2024 at 12:30 pm of ice machine after cleaning faint pink coloring remains, no black residue present on the internal plastic covering over the ice drop. In an interview with the DM on 3/26/2024 at 09:02am, she stated that she was surprised by the pink and black residue on the ice machine as it was cleaned by maintenance on Thursday. She stated she would have it cleaned again. She stated a potential outcome would be the residents would be at risk of getting sick. In an interview with the DA on 03/26/2024 at 09:51 am, she stated she has been at the facility for 3 months and she was not sure what the policy about cleaning the ice machine stated. In an interview with DON on 3/262024 at 4:00 pm, he stated his expectation was that the ice machine be maintained in a sanitary condition and cleaned as scheduled. He stated he was the infection preventionist and monitored the cleaning schedule weekly. He stated maintenance was responsible for the cleaning and sanitation of the ice machine weekly. He stated failure to maintain the cleaning schedule could put the residents at risk for foodborne illnesses. In an interview with the ADM on 3/26/2024, she stated her expectation was that the ice machine was cleaned as scheduled by maintenance. Maintenance did clean the ice machine this morning. She stated that because residents use the ice machine several times a day, at least during meals, they can be at risk for illness . Record review of Kitchen cleaning schedule dated January 2024 on 3/28/2024 at 10:00 am revealed the ice machine was cleaned on 1/2/2024, 1/3/2024, 1/12/2024, 1/17/2024, and 1/24/2024. Record review of Kitchen cleaning schedule dated February 2024 on 3/28/2024 at 10:00 am revealed the ice machine was cleaned on 2/8/2024, 2/14/2024, 2/21/2024, and 2/28/2024. Record review of Kitchen cleaning schedule of cleaning dated March 2024 on 3/28/2024 at 10:00 am revealed that the ice machine was cleaned on 3/6/2024 and 3/14/2024. Record review of Statement made by MD undated on 3/28/2024 at 10:00 am revealed Ice machine 676071 Page 6 of 7 676071 03/28/2024 Groesbeck Ltc Nursing and Rehabilitation 607 Parkside Dr Groesbeck, TX 76642

F 0812 received preventative maintenance cleaning/sanitizing on 3/21/2024. Level of Harm - Minimal harm or potential for actual harm Record review of Policy ice machine and ice storage chests revised January of 2012 on 3/28/2024 at 10:00 am revealed 3. Our Facility has established procedures for cleaning and disinfecting ice machines which adhere to the manufacturer's instructions. The infection preventionist (or designee) maintains a copy of these procedures. Residents Affected - Many 676071 Page 7 of 7