Health inspection·September 19, 2024

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few may be off for ADL care. Other general tube enteral feed orders such as checking G-tube placement and water flushes between medication administration were in place since 03/26/2023 reflecting Resident #52's long term use of the G-tube. Record review of Resident #52's weight log revealed the resident had a stable weight ranging from 109.3 112.6 lbs in the past 3 months (06/10/2024 - 09/09/2024). Record review of Resident #52's nutrition assessments dated 08/28/2024 revealed the RDN wrote: .TF provides: 1716 kcals, 77 g protein, 1155 mL of H2O, flush provides an additional 800 ml of fluid . Resident at increased risk for dehydration and/or weight fluctuations d/t EN and PMH. Staff provides flushes and EN remains appropriate at this time. Anthro: Ht: 71 Wt 111.2# DBW 172+-10% BMI 15.5, underweight . Est needs based on IBW: 78.2 kg (25-30) ~ 1563-1954 kcal . Recommendations: No new nutrition intervention needed at this time, continue current plan. RD will continue to monitor wt status and EN tolerance . Observations on 09/17/2024 at 10:34AM, revealed Resident #52 was lying in bed asleep. His tube feeding pump was on and documented to be hung up by 6:30AM. Out of the 1000ml bag of enteral feed, approximately 850 ml remained. The pump's screen was seen to have an error message and the feed was on hold. Observations on 09/17/2024 at 11:40AM, revealed Resident #52 was still lying in bed asleep with his tube feeding pump screen still showing an error message while the enteral feed was on hold. Out of the 1000ml bag of enteral feed, approximately 850 ml remained. Observations on 09/17/2024 at 12:10PM, revealed the error on Resident #52's pump was resolved and the feeding was flowing at the ordered rate of 65ml/hr. In an interview with Resident #52 on 09/17/2024 at 2:35PM, when asked if he felt hungrier than usual, he stated Yes. Interview with ADON B and observations of Resident #52's pump on 09/17/2024 at 2:37PM revealed the ADON checked the pump history and stated something was off about it and that she would have to investigate to find what the issue was. She stated Resident #52's pump was ran continuously but was turned off for ADL care. The pump history revealed that the enteral feed was stalled for at least 3 hours during the shift after 130ml was already administered, in the past 24 hours, the resident was only administered 537ml of enteral (equating to only 643kcals) and in the past 48 hours, the resident was only fed 1326ml (equating to only 1591kcals) of enteral feed and 1400ml of free water. In an interview with LVN B on 09/17/2024 at 3:14PM, she stated she was the charge nurse over Resident #52 and worked 6AM to 6PM. She said she did not know about the error message on Resident #52's pump. She stated she normally checked on her residents at 8am towards the beginning of her shift and again around 11AM or 12PM when she was done passing her medications. She stated she was not the one who checked on Resident #52 and fixed his pump but if the pump was noticed to have an error, it should have been brought to her attention so she could resolve it. She stated Resident #52 had been using the same pump and he had not left the facility recently for any reason. She stated nurses use to document the amount of enteral feed administered each shift and clear the history before shift change so they could better keep track of the amount that was administered to the patient, but they no longer did that. She stated that nurses just checked to ensure the flow rate matched the order. When (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676081 If continuation sheet Page 2 of 3 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 676081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE East View Healthcare 15880 Wallisville Road Houston, TX 77049 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few reviewing Resident #52's pump history, she acknowledged that the feed had stalled for three hours and the total amount of 537ml fed in the past 24 hours was too low to meet his needs. She said the only reasons the enteral feed should be paused was when ADL care was being provided. She stated there could be a delay in the aides reporting to nurses when care ADL care was completed, thus causing a delay when resuming the enteral feed. She stated the risk of a resident not getting enough enteral nutrition could include malnutrition and possible weight loss. In an interview with ADON B on 09/18/2024 at 02:27 PM, she stated since the observation of Resident #52's pump, she reported the issue to the RDN and asked her to review the pumps and provide an in-service on how to review administration history on the pumps. She said it seemed like there could have been an issue with the pump but she could not speculate why it was low. She stated she knew that the resident was at risk for dehydration, skin breakdown and malnutrition, especially being on hospice. In an interview with the DON on 09/19/2024 at 9:19AM, she stated a previous dietitian they had as part of staff recommended documenting a resident's enteral feed administered at the end of every shift, but since switching dietitians, they stopped doing so. She stated there could have been a complication with the pump that caused the resident to only get 0% of his needs. She stated she had never audited pumps to ensure they worked properly. She stated the risks of a resident not receiving enough enteral nutrition included skin break down, dehydration and a caloric deficit. In a phone interview with the RDN on 09/19/2024 at 01:09PM, the RDN stated Resident #52 had a continuous enteral feed order to be administered for approximately 22 hours leaving about 2 hours for ADL care throughout the day. She stated she calculated his enteral feed order based on his ideal body weight of 172lbs since he was already underweight. She stated if the resident was only fed 537ml or 644 kcals in the past 24 hours, and 1326ml or 1591 kcals over the past 48 hours, that was too low to meet the resident's nutritional needs. She stated it placed the resident at risk for malnutrition, dehydration, weight loss and instability. She stated she had never noticed any issues with the pumps before and had never had to do an in-service with the nursing staff on how to check pump history. Record review of the facility's policy on enteral nutrition, not dated, reflected, . Intake and output will be recorded every shift on enteral residents . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676081 If continuation sheet Page 3 of 3