Health inspection·August 18, 2023

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that drugs and biologicals used in the facility were secured properly for Resident #10 reviewed for pharmacy services as evidenced by: The facility failed to ensure Resident #10's liquid intravenous medication bag hanging on the pole at bedside and unattended on top of the bedside table was labeled with the name of nurse, time or date of reconstitution (restoring something dried to its original state by adding water to it). This deficient practice could place residents at risk for harm and place the facility at risk for a possible drug diversion. The findings include: Record review of Resident #10 face sheet, dated 8/15/23, reflected a [AGE] year old male, admitted to the facility on [DATE] with diagnoses Chronic kidney disease (CKD) is a long-term condition where the kidneys do not work as well as they should, Peripheral vascular disease (PVD) is a slow and progressive circulation disorder. Narrowing, blockage, or spasms in a blood vessel. Minimum Data Set (MDS) dated [DATE] reflected Brief Interview of Mental Status (BIMS) of 00, which indicated decreased cognition. Observed on 8/15/23 at 9:34 a.m., on a pole at bedside of Resident #10, a bag of liquid intravenous medicine labeled Cefepime (antibiotic) 1 gram (gm) with 100 milliliter (ml) normal saline (NS) (a solution to supply water and salt (sodium chloride) to the body) attached to the antecubital area (the inner or front surface of the forearm). The bag of liquid intravenous medicine was not labeled with the name of the nurse or the time or date of reconstitution. Observed on 8/15/23 at 9:35 a.m., on top of the Resident #10's bedside cabinet, a bag of liquid intravenous medicine labeled Cefepime 1 gram (gm) with 100 milliliter (ml) normal saline (NS) unattended in residents' room. The bag of liquid intravenous medicine was not labeled with the name of the nurse or the time or date of reconstitution During an interview on 8/15/2023 at 9:44 AM, LVN A denied preparing any IV medications to be hung. LVN A and stated all IV medications prepared and hung for infusion by nursing staff must be signed, dated, timed, and initialed by the nurse. LVN A reported no medications were to be in a resident's room. LVN A stated the reason medications should be locked up or in medication cart is a residents could take too much medication, a confused resident could walk into the room and take medications that Page 1 of 10 676081 676081 08/18/2023 East View Healthcare 15880 Wallisville Road Houston, TX 77049

F 0761 are not for them, causing an adverse effect. Level of Harm - Minimal harm or potential for actual harm During an interview on 8/15/2023 at 9:48 am, LVN B stated she did not see any medications on Resident #10's bedside table and stated all IV medications prepared and hung for infusion by nursing staff must be signed, dated, timed, and initialed by nurse. LVN B stated she knows that medications are not allowed in patient rooms as it is dangerous if the resident takes too much, or another resident takes medications that is not theirs. Residents Affected - Few During an interview on 8/15/2023 at 11:10 AM with the Director of Nurses (DON revealed medications should not allowed at bedside unless there is a doctor's order. She stated she does not have any residents, that have a doctor's order for medications to be at bedside. DON stated is not good to have medication at bedside as it can be taken by another resident( drug diversion) or a resident could have adverse effects if they take medication that's not for them. DON stated the policy for intravenous medications is that the nurse should place the time medication is hung, date the medication is hung, and initial of nurse that hung the medication. During an interview on 8/16/2023 at 5:02 pm, LVN C stated she had seen the IV medication attached to Resident #10 on the evening of 8/14/23. She put Resident #10's Cefepime 1 gram (gm) with 100 milliliter (ml) normal saline (NS) on the bedside table for the 9:00 PM dose, she stated she did not date, time, and initial the medication. She stated all IV medications prepared and hung for infusion by nursing staff must be signed, dated, timed, and initialed by nurse. LVN C stated she forgot, and she was aware that medications were not allowed in patient rooms unless there was a doctors' order, as it was dangerous if the resident takes a medicine not ordered for them. Record review of the facility policy titled Policy / Procedure - Nursing Clinical (Revised: 05/2007) read in part: Section: Medication Administration; Subject: IV Administration of Drugs; Policy Number: NCMA 6; Policy: It is the policy of this facility that IV drugs shall be administered by a registered nurse or IV Certified Licensed nurse.; Procedures: 3. IV solutions must be labeled in accordance with established procedures governing all Labeling IV Solutions. 676081 Page 2 of 10 676081 08/18/2023 East View Healthcare 15880 Wallisville Road Houston, TX 77049

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 ensure food was stored, prepared, and served in accordance with professional standards for food service safety in 1 of 1 kitchen, in that: Residents Affected - Some Food was found unsealed in dry storage Food was found not labeled and dated in the walk-in cooler Meals from the kitchen were served without first taking temperatures of the food. Dietary aide A was touching her face mask and handling ready-to-eat foods without proper hand hygiene. These failures increased residents' risks of consuming contaminated foods and getting a foodborne illness. Findings included: Observations of the kitchen and interview with Dietary Aide A on 08/15/2023 at 8:15 AM revealed Dietary Aide A plating food from the breakfast line. Dietary Aide A was seen wearing gloves, shifting around her mask, and touching ready-to-eat toast to add to the plate. When asked about temperature for their breakfast line, she stated she knew how to use a thermometer, but she did not use it prior to serving breakfast because she did not know where it was. Observations of the kitchen and interview with Dietary Manager on 08/15/2023 at 8:25 AM revealed an open bag of grits dry storage that was not resealed and four trays of tangerines in the walk-in cooler that were not labeled or dated. Dietary Manager stated all food was supposed to be dated and labeled. Record review of the undated temperature log revealed no temperatures were recorded for breakfast on 08/15/2023 In an interview with the Dietary Manager on 08/18/2023 at 8:20 AM, the Dietary Manager stated that Dietary Aide A just started working last week, so she is still in training. She stated Dietary Aide A knew the temperatures were supposed to be recorded before starting the tray line but forgot where the thermometer was. In an interview with the Cluster Dietary Resource on 08/18/2023 at 12:58 PM she stated it was 676081 Page 3 of 10 676081 08/18/2023 East View Healthcare 15880 Wallisville Road Houston, TX 77049

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some necessary to reseal, date, and label all food, in storage, to prevent service of expired foods. She said it was necessary for Dietary Aide A to perform hand hygiene prior to touching ready to eat food in order to prevent possible spread of infections. She also stated it was necessary to record temperatures of all food prior to meal service to ensure limited risk of foodborne illness due to undercooked food. The facility's policy on food and nutrition services food temperatures, dated November 2019, revealed Holding temperatures should be check prior to meal service to ensure appropriate temperatures have been maintained; document these on the temperature log . The policy provided did not address storage requirements of food of food handling. Record review of the FDA Food Code, dated 2022, revealed, The person in charge shall ensure that . (D) EMPLOYEES are effectively cleaning their hands, by routinely monitoring the EMPLOYEES' handwashing . 676081 Page 4 of 10 676081 08/18/2023 East View Healthcare 15880 Wallisville Road Houston, TX 77049

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to implement its infection control policies for 6 of 7 residents (Residents #11, #71, #74, CR #69, CR #1 and CR #2) reviewed for infection control, in that: Residents Affected - Some The facility failed to ensure Residents #71, #74 and #11's rooms had isolation precautions in place on 08/15/2023 despite their being orders for contact isolation. The facility failed to prevent CNA F from serving a meal tray to a contact isolation room on 08/15/2023 without using necessary PPE. The facility failed to ensure there was tracking and trending documentation for Resident #69, CR #1 and CR #2 during the months of January to April 2023. This failure placed residents an increased risk for continued infection and lack of proper treatment. Findings included: Record review of Resident #71's face sheet, dated 08/18/2023, revealed a [AGE] year-old male who was admitted into the facility on [DATE] and was diagnosed with mild vascular dementia and hypertension. Record review of Resident #71's MDS assessment, dated, 07/09/2023, revealed the resident had a BIMS score of 15, indicating that his cognition was intact and the resident was dependent for toileting. Record review of Resident #71's MAR, dated August 2023, revealed the resident was ordered to have strict contact isolation related to Extended Spectrum Beta Lactamase (ESBL) in the urine starting on 08/07/2023 without an end date. It also revealed the resident was ordered to take Bactrim DS oral tablet 800-160mg 2 times a day for 7 days and Ciprofloxacin HCl 500mg tablet 1 table by mouth every 12 hours for 7 days for UTI ESBL Record review of Resident #74's face sheet, dated 08/18/2023, revealed a [AGE] year-old male who was admitted into the facility on [DATE] and was diagnosed with urinary tract infection and hypertension. Record review of Resident #74's MDS, dated , 07/09/2023, revealed the resident had a BIMS score of 15, indicating that his cognition was intact, and the resident needed maximum assistance with toileting. Record review of Resident #74's MAR, dated August 2023, revealed the resident was ordered to have strict contact isolations related to ESBL in the urine started on 08/07/2023, discontinued on 676081 Page 5 of 10 676081 08/18/2023 East View Healthcare 15880 Wallisville Road Houston, TX 77049

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 08/14/2023 and restarted on 08/15/2023 again without an end date. It also revealed the resident was ordered to take Tetracycline HCl oral capsule 500mg 4 times a day for 3 days. and Ciprofloxacin HCl 500mg tablet 1 table by mouth two times a day for 5 days for UTI. Record review of Resident #11's face sheet revealed an [AGE] year-old female who was admitted into the facility on [DATE] and diagnosed with dementia and hemiplegia/hemiparesis - paralysis of one side of the body). Record review of Resident #11's MARs revealed the resident had orders for contact isolation for ESBL in the wound starting on 08/02/2023 until 08/17/2023. Observations on 08/15/2023 at 9:30 AM revealed Resident #71 and #74 were roommates. Resident #11, Resident #71 and Resident #74 were observed in their rooms without contact isolation signage on the door and with a PPE station located 5 feet away on the left from the door to Resident #11 and #74's room without any gowns or gloves stocked inside. An observation and interview with CNA F on 08/15/2023 at 9:30 AM, revealed CNA F was asked by the surveyor why the PPE station was there and if any residents on hall 300 were under isolation precautions. She said she believed only Resident #71 and #74's room was under isolation, but she needed to confirm with her charge nurse, LVN R, first. CNA F was observed to go LVN R, then she returned to the surveyor and said Resident's #71 and #74's room was under contact isolation and the PPE station was for their room. When asked where the sign was, CNA F stated she did not know where it was. In an interview with LVN R on 08/15/2023 at 9:40 AM, she revealed that she was a PRN nurse and she had just returned to work with the patients. She stated she referred to a list to know which residents received antibiotic treatments, type of infection they had, as well as orders for isolation precautions if necessary. She stated based on that list, only Residents #71 and #74 had orders for strict contact isolation, both for ESBL in their urine. She stated they are supposed to have PPE stations for their room and a sign on their door; Central Supply Aide was taking care of that at the moment. In an interview with the DON on 08/15/2023 at 10:50 AM, she stated Resident #71 and #74's room was supposed to have signs posted on their door with the PPE station stocked. She stated herself and the ADONs were responsible for rounding to ensure signs were posted and PPE was present for immediate use. The DON said the ADON was late so she did not get the chance to make rounds but that was not an excuse for contact isolation signs and PPE to not be present. She also stated the infections Resident #71 and #74 had, were infections contained to their catheters and in that case, PPE was not required unless a healthcare staff was working directly with the resident, but it was still encouraged for all staff to wear in the rooms. Observations on 08/15/2023 at 2:19 PM revealed Resident #11's room with contact isolation signage on the door and the PPE station right by the resident's door. Observations and interview with CNA F on 08/15/2023 at 2:19 PM, revealed CNA F was asked by the surveyor why the PPE station and sign was put up for Resident #11's room, she stated she needed to confirm with LVN R and could not confirm the isolation precautions was put up for Resident #11's room. In an interview with Resident #71 on 08/15/2023 at 3:34 PM, he stated he had been seeing staff entering his room with masks on but he had not seen staff wearing gowns until today. 676081 Page 6 of 10 676081 08/18/2023 East View Healthcare 15880 Wallisville Road Houston, TX 77049

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an interview with the Central Supply Aide on 08/16/2023 at 1:46 PM, she stated she had initially stocked the PPE station on Tuesday 08/15/2023 around 7AM and even at 8AM. She stated CNA F and other staff used a lot of gowns. She stated that she had been restocking it since last week. She said when she came into work by 7:30 AM, she saw the contact isolation sign was on the door but could not remember if the PPE station was placed for Resident #11, #71 and #74's room. She stated the risk of not having PPE available or signage at the door was spread of infection. In an interview with CNA F on 08/16/2023 at 2:02 PM, she said she believed she knew Resident #71 and 74's room were under precautions but wanted to check with the nurse to be more safe. She stated she did not know how long they have been on contact precautions but the isolation precautions were place for Resident #71 and #74's room throughout the weekend and on Monday, 08/14/2023. She said she was not sure about whether Resident #11's room was under isolation precautions until the sign was placed on the door on Tuesday, 08/15/2023. She stated she generally put a gown on to give Resident #71 and #74 a bed bath or change them. She stated on the morning of 08/15/2023, she was aware the PPE station was empty but served Resident #74 and #71 their breakfast meal tray without PPE because they did not need direct care. She said Central Supply Aide was responsible for restocking the PPE cart. When asked what the risk was for not having isolation precautions in place for residents with infections, she stated there was no risk because she cleaned her hands very well before coming out of their rooms. In an interview with the DON on 08/16/2023 at 3:15 PM, she stated Resident #11 was put under isolation precautions by 08/02/2023 for ESBL without a stop date to have the wound re-cultured first after the completion of antibiotic therapy to determine the need to discontinue or continue isolation. She said that was the likely reason for Resident #11's order being a continuous order without an end date. She stated the antibiotic treatment was completed yesterday on 08/15/2023 but the isolation precautions should have remained in place until the resident's wound doctor gave further instructions after a re-culture. She stated the charge nurses were responsible for giving reports shift to shift on needs regarding isolation precautions, and if the facility failed to ensure isolation precautions were in place when necessary, it increased the risk of spreading infections. In an interview with LVN R on 08/16/2023 at 3:50 PM, she stated she could not explain why Resident #11's room was initially found without an isolation precaution sign in place but she knew the morning of 08/15/2023 that both rooms (Resident's #71 and #74's room as well as Resident #11's room) needed isolation precautions in place. She said she was told Resident #11's roommate had took the sign down inquiring about it. She stated the sign was placed for both room for Resident #11, #71 and #74 and both rooms were recognized by her and her staff to be under isolation precautions. In an interview with a family member on 08/17/2023 at 3:14 PM, revealed the PPE was recently instilled a few days ago and they did not have PPE in place for her to use over the weekend when she visited the resident since last Friday, 08/11/2023. Interview with Resident #74 on 08/17/2023 at 3:14 PM, when asked if gowns were being worn by the staff since last week, he stated that's bullshit, this week. In a phone interview with LVN E on 08/18/2023 at 10:09 AM, LVN E stated Resident #74 came in on isolation precautions upon admission and Resident #71 was positive result for infection after a recent hospital visit. She stated necessary PPE to wear in a room under contact precaution included gloves, gowns, and masks, if appropriate. She said the PPE station was stocked while working the night shift on 08/14/2023 and she only went in the room once to administer medication to either Resident #71 676081 Page 7 of 10 676081 08/18/2023 East View Healthcare 15880 Wallisville Road Houston, TX 77049

F 0880 Level of Harm - Minimal harm or potential for actual harm or #74. She stated she had on all necessary PPE while providing care. She stated the risks of not wearing PPE was an increased risk of spreading the infection. She stated a sign was required as well for visitors and staff to be aware. She said there was a sign and isolation cart setup in between both of rooms where Residents #71, #74 and #11 resided and she observed this before leaving her shift at 6:00AM on 08/15/2023. Residents Affected - Some Record review of CR# 1's face sheet, dated 08/18/23, revealed a [AGE] year-old female resident who was admitted to the facility on [DATE]. Her diagnoses included: Acute Kidney Failure, Type 2 Diabetes, Zoster without Complications Record review of CR# 1's Medication Administration Record on 08/17/23 revealed, the resident was prescribed and administered Doxycycline Hyclate Tablet 100MG for Shingles from 02/11/2023-02/20/23. Record review of CR #2's face sheet, dated 08/18/23, revealed a [AGE] year-old male resident who was admitted to the facility on [DATE]. His diagnoses included: Syncope and Collapse (Fainting), Pneumonia, Paranoid Schizophrenia, and Depression Record review of CR #2's Medication Administration Record on 08/17/23 revealed, the resident was prescribed and administered Azithromycin Tablet 250 MG for Pneumonia from 01/20/23-01/23/23. Record review of Resident #69's face sheet, dated 08/18/23, revealed a [AGE] year-old female resident who was admitted to the facility on [DATE]. Her diagnoses included: Cerebral Infarction, Enterocolitis due to Clostridium Difficile, Acute Kidney Failure. Record review of Resident 69's Medication Administration Record on 08/18/23 revealed, the resident was prescribed and administered Vancomycin HCI Oral Capsule 125MG for Enterocolitis due to Clostridium Difficile from 02/23/23-03/03/23 and Vancomycin HCI Oral Solution Reconstituted 25MG/ML from 03/03/23-03/09/23. Record review of the facility's tracking and trending binder on 08.17.2023 revealed, there was no tracking and trending documentation for January 2023 to April 2023. In an interview on 08/17/23 at 3:15 PM with the Corporate DON, she stated the previous DON was responsible for doing tracking and trending. She stated Corporate Clinical Resource began doing tracking and trending in May when she noticed it was not being completed. She stated the risk of tracking and trending not being completed was spread of infection and infections that the facility is not aware of. Interview on 08/18/23 at 11:41 AM with the Administrator, revealed the facility was doing tracking and trending during the months of January 2023 through April 2023, but she did not have the paperwork. She stated the previous DON was doing the tracking and trending, and after the DON left the company, she could not find the documentation. She stated the risk of not completing tracking and trending is spread of infection. Record review of the facilities Infection Control policies dated 01/2022 stated, IP or designee will be responsible for infection surveillance and MDRO tracking. The facility's policy on infection control, dated October 2022, revealed, Contact precautions are used with a known infection that is spread by direct or indirect contact with the resident or the 676081 Page 8 of 10 676081 08/18/2023 East View Healthcare 15880 Wallisville Road Houston, TX 77049

F 0880 Level of Harm - Minimal harm or potential for actual harm resident's environment . wear a gown and gloves for all interactions that may involve contact with the patient or the patient's environment . the facility will implement a system to alert staff, resident and visitors that a resident is on TBP. 1. Post clear signage on the door or wall outside of the resident room indicating the type of precautions and required PPE . make PPE, including gowns and gloves, available immediately outside of the resident room . Residents Affected - Some FACILITY Infection Control 676081 Page 9 of 10 676081 08/18/2023 East View Healthcare 15880 Wallisville Road Houston, TX 77049

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 Based on observation, interview, and record review, the facility failed to maintain an effective pest control program in the kitchen, in that: Residents Affected - Some The facility failed to ensure 5 live roaches were not observed in the kitchen. This failure placed all residents who consume food prepared in the kitchen at increased risk of illness. Findings included: An observation of the kitchen on 08/15/2023 at 8:15AM, revealed 5 live roaches. In an interview with Resident #244 on 08/15/2023 at 2:37 PM revealed the resident reported she had seen a roach on her plate two days ago and sent the tray back to the kitchen because of it. In an interview with the Dietary Manager on 08/15/2023 at 8:30AM, she stated she was aware the kitchen had roaches but she did not believe it to be a major issue. In an interview with the Cluster Dietary Resource on 08/18/2022 at 12:58PM, she stated it was important to maintain effective pest control to prevent diseases from the kitchen to the residents. The facility's policy on pest control, dated 2013, revealed, . If pests are seen in the kitchen, the food service manager or appropriate staff shall be informed describing where the pest was seen and when. Appropriate action will be taken to eliminate reported pest situation in the department . 676081 Page 10 of 10