Health inspection·June 5, 2025

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 interview and record review, the facility failed to ensure the comprehensive care plan was developed and implemented within a timely manner for each resident consistent with resident rights to include measurable objectives and timeframes to meet residents medical, nursing, mental, and psychosocial needs identified in the comprehensive assessment for 1 (Resident #39) out of 5 residents reviewed for care plans. The facility failed to review or revise Resident #39's care plan after a significant change in condition when Resident #39's code status changed from full code to DNR on [DATE]. This failure could place resident at risk for receiving inadequate care and services. Findings included: Record review of Resident #39's face sheet dated [DATE] revealed a [AGE] year-old male with an original admission date of [DATE] and a current admission date of [DATE]. Diagnoses included Chronic Kidney Disease - Stage 3 (a condition in which the kidneys are damaged and cannot filter blood properly), Type 2 Diabetes (a chronic condition which occurs when the body cannot use insulin effectively, leading to high blood sugar levels), Obstructive and Reflux Uropathy Unspecified (occurs when urine flow is blocked), Benign Prostatic Hyperplasia (a condition caused by an enlarged prostate which can cause urinary problems), and Acute Kidney Failure (sudden loss of kidney function). Record review of Resident #39's care plan initiated [DATE] and revised on [DATE] revealed Resident #39 was a full code (if a person's heart stopped beating and/or if they stopped breathing, all resuscitation procedures would be provided). Interventions for this care plan included initiate CPR and call 911, as well as mark chart and all pertinent documents with full code. Record review of Resident #39's physician orders revised [DATE] revealed an order for DNR. Further review of the physician orders revised [DATE] revealed an order to admit resident to hospice. Record review of Resident #39's Quarterly MDS assessment dated [DATE] revealed a BIMS score of 12, moderately impaired cognition. Record review of Resident #39's progress note dated [DATE] revealed resident returned to facility from hospital and would be a DNR and placed on hospice. Record review of Resident #39's Out of Hospital Do Not Resuscitate Order dated [DATE] revealed resident's signature for DNR. Page 1 of 8 676107 676107 06/05/2025 Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview on [DATE] at 5:47 PM with the DON she stated Resident #39's care plan should have been updated with the proper code status on [DATE] when it changed from full code to DNR. She stated the MDS nurse was the one responsible for updating the care plans when there had been a change in condition. She stated the care plan not having the proper code status could have caused confusion on what the nurses or staff should have done in a code situation. She also stated the nurses or staff could have accidently performed CPR on Resident #39 when they were not supposed to. In an interview on [DATE] at 5:53 PM with the MDS nurse she stated she was the one responsible for updating the comprehensive care plans, so it would have been her job to update Resident #39's care plan. She stated she was unsure of how it got missed, but she was still new and learning at the time. She also stated if nurses had only viewed the care plan and not known about the DNR order, they may have inadvertently performed CPR on Resident #39 when he was a DNR. Record review of the facility's Comprehensive Care Plans policy, implemented [DATE], revealed Policy Explanation and Compliance Guidelines: 3. The comprehensive care plan will describe, at a minimum, the following: a. The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being. F. Resident specific interventions that reflect the resident's needs and preferences and align with the resident's cultural identity, as indicated. 676107 Page 2 of 8 676107 06/05/2025 Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 ensure that residents received treatment and care in accordance with professional standards of practice and the comprehensive person-centered care plan for 1 of 5 residents (Resident #1) reviewed for wound care. Residents Affected - Few The facility failed to ensure the wound care nurse knew the proper technique for cleansing the venous stasis ulcer during wound care in order to prevent cross-contamination and infection. The deficient practice and failure could place residents at risk for cross contamination, infection, and improper wound healing. Findings included: Record review of Resident #1's face sheet, dated 05/05/25, revealed a [AGE] year-old-male with an original admission date of 05/02/24. Diagnoses included Peripheral Vascular Disease(a disorder of the blood vessels outside the heart which affects circulation), Hemiplegia (severe or complete unilateral loss of strength or paralysis), and Hemiparesis (weakness in one leg, arm or side of face), Type 2 Diabetes With Other Skin Ulcer (a chronic condition which occurs when the body cannot use insulin effectively), Chronic Venous Hypertension With Ulcer (characterized by increased pressure in the veins, often resulting from venous insufficiency). Record review of Resident #1's Quarterly MDS assessment dated [DATE], revealed a BIMS score of 14, intact cognition. MDS also revealed the presence of a venous and/or arterial ulcer. Record review of Resident #1's physician orders with a start date of 06/03/25 revealed an order for wound care to left medial lower leg which included to cleanse wound with wound cleanser. Record review of Resident #1's care plan initiated 05/02/24 and revised 04/25/24 revealed venous stasis ulcers of the bilateral lower legs with a goal to have no signs or symptoms of infection through review with a target date of 08/18/2025. In an observation on 06/04/25 at 11:05 AM the wound care nurse was observed cleansing Resident #1's wound with a folded gauze soaked in wound cleanser. She was observed scrubbing the center of the wound in an up and down motion, then moving to the outside of the wound with an up and down motion, and then she proceeded to go back to the center of the wound with an up and down motion. She was observed doing this process for approximately 1-2 minutes. She continued to use the same dirty, blood-soaked gauze to clean the outside and center of the wound many times. In an interview on 06/04/25 at 11:41 AM with the wound care nurse, she stated she was supposed to be using a scrubbing technique while cleansing Resident #1's wound, which was why she kept going back and forth over the wound from clean to dirty to clean. She stated she realized she should have scrubbed from inner to outer, clean to dirty, then discarded the blood-soaked gauze, and not continued to start the process over with the same blood-soaked gauze. She stated this could have caused cross-contamination of the wound, introduced bacteria, and placed the resident at risk for infection. In an interview on 06/04/25 at 11:49 AM with ADON-B, he stated when cleansing the wound the wound care nurse should have cleansed from the inner part of the wound to the outer area of the wound, 676107 Page 3 of 8 676107 06/05/2025 Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414

F 0684 Level of Harm - Minimal harm or potential for actual harm which was from clean to dirty, then disposed of the dirty gauze, and started the process over with a clean gauze if the wound still needed to be cleansed. He stated going in and out of the wound over and over creates cross-contamination and could have introduced bacteria and caused an infection. Also, you would not have continued to cleanse the wound with the gauze once it became blood-soaked, dirty, and contaminated. Residents Affected - Few In an interview on 06/04/25 at 4:48 PM with the DON, she stated wound care should have been performed from the inner part of the wound to the outer area of the wound, which was from the cleanest area to the dirtiest area, then disposed of the dirty, bloody gauze. She also stated going in and out of the wound could have created cross-contamination and introduced bacteria into the wound, which could have caused Resident #1 an infection. Record review of the facility's Infection Prevention and Control Program, implemented 05/13/23, revealed This facility has established and maintains 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 as per accepted national standards and guidelines. 676107 Page 4 of 8 676107 06/05/2025 Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record reviews, the facility failed to ensure that one (Residents #17) of one resident with an indwelling urinary catheter reviewed received the appropriate treatment and services to prevent Urinary Tract Infection (UTI's): The facility failed to ensure Resident #17 ' s urinary drainage tubing and catheter drainage bag were kept from touching and resting on the floor. This failure could affect any resident with an indwelling urinary catheter and place them at risk of developing or increased UTI's. The findings included: Record review of Resident #17's Face Sheet dated 06/03/25 documented an 82- year-old female admitted [DATE] and re-admitted [DATE] with the diagnoses of: Urine tract infection, Acute Pyelonephritis (kidney infection an illness in one or both kidney organs), and Hydronephrosis (a condition characterized by excess fluid in a kidney due to a backup of urine). Record review of Resident #17's MDS dated [DATE] documented: -Bed mobility: Substantial/maximal assistance - Helper does More Than Half the effort. A helper lifts or holds trunk or limbs and provides less than half the effort. -Toilet use: Totally dependent on assistance -Personal hygiene: Substantial/maximal assistance -Helper does More Than Half the effort. Record review of Resident #17's care plan dated 12/16/20 revised on 05/06/25 documented a urinary catheter, indwelling. Care Plan Goal: - The resident has bladder incontinence related to inability to control bladder. Interventions: - Incontinent check several times a shift and as required for incontinence. - Wash, rinse, and dry the perineum. - Change clothing as needed after incontinence episodes. - The resident uses disposable briefs. Change prn. - Clean peri-area with each incontinence episode. 676107 Page 5 of 8 676107 06/05/2025 Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of Resident #17 progress notes dated 06/03/25 indicated Catheter/ Foley care provided by staff and toileting program and assistive devices such as pads and or briefs provided. During an observation of Resident #17's catheter drainage bag on 06/03/25 at 10:12 AM revealed the catheter drainage bag hung from the lower bed frame on the right side of the bed and the tubing and catheter drainage bag rested on the floor. During an observation and interview on 06/03/25 at 10:40 AM, LVN E went into Resident #17's room to observe the foley catheter bag and tubing touching the ground. She stated, it [The Foley catheter bag and tubing] should not be touching the ground. while lifting the bed a little to get the drainage bag and tubing off the floor. LVN E stated it was important that the tubing and drainage bag should not touch the floor to prevent risk of infection. LVN E stated the catheter bag should be hung below the bladder to prevent back flow to the bladder. LVN E said she received infection control in-service approximately 1 week ago. During an interview with the ADON on 06/03/25 at 10:55 AM, he stated the catheter drainage bag should be hung on the bed frame below the bladder to prevent cross contamination from touching the dirty floor and with a privacy bag over it for resident ' s dignity. The ADON stated each of these scenarios can cause an infection to the resident. The ADON said all staff were to ensure that these measures were in place every time staff conducted their daily and shift rounds. The ADON stated the last infection control in-service was 1 week ago. Record review of the facility Incontinent Care skills checklist dated 05/13/23 documented Ensure the drainage bag is maintained below the level of the bladder at all times and does not rest on bed and kept off the floor According to the DON on 06/04/20245 and 5:43 PM, she said the facility did not have a Catheter Care/Maintenance policy and procedure but followed the Incontinent Care skills checklist. 676107 Page 6 of 8 676107 06/05/2025 Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on interviews and record review, the facility failed to maintain clinical records that were complete and accurately documented in accordance with accepted professional standards and practices for 4 (100 hall glucometer, 200 hall glucometer, 300 hall glucometer, and 400 hall glucometer) of 8 glucometers (device used to measure the amount of glucose in a resident's blood) reviewed for pharmacy services. 1. The facility failed to ensure the 2 glucometers in the 200-hall nurse cart and 2 glucometers in the 400-hall nurse cart were tested for accuracy and recorded in the glucometer logbook on 06/01/25, 06/02/25 and 06/03/25. 2. The facility failed to ensure the 2 glucometers in the 100-hall nurse cart and 2 glucometers in the 300-hall nurse cart were tested for accuracy and recorded in the glucometer logbook on 06/03/25. These failures could place residents at risk of receiving either too much insulin or not enough. The findings included: Record review of the glucometer logbook on 06/04/25 at 12:47 PM revealed the test results for the 2 glucometers in the 100-hall nurse cart were not recorded on 06/03/25. The test results for the 200-hall nurse cart were not recorded on 06/01/25, 06/02/25, and 06/03/25. The test results for the 300-hall nurse cart were not recorded on 06/03/25. The test results for the 400-hall nurse cart were not recorded on 06/01/25, 06/02/25, and 06/03/25. In an interview with ADON A on 06/05/25 at 1:46 PM, ADON A stated she worked from 6:00 AM to 2:00 PM on 06/01/25. ADON A stated she checked the glucometer logbook when she arrived at the beginning of her shift and noticed none of the log had been filled out for 06/01/25. ADON A stated it was the night shift nurses' responsibility to test the glucometers and record the results in the logbook. ADON A stated she tested all 8 of the glucometers on 06/01/25, but she forgot to record all the results in the logbook. ADON A stated the glucometers were supposed to be tested for accuracy every day. ADON A stated it was important to ensure the glucometers were working appropriately for the safety of the residents. ADON A stated if a glucometer was not accurate it could lead to a resident getting too much insulin causing hypoglycemia (low blood sugar characterized by blood glucose levels dropping below 70 mg/dL). In an interview with RN C on 06/05/25 at 1:58 PM, RN C stated the glucometers were supposed to be tested daily. RN C stated the night shift nurses tested the glucometers and recorded the results in the logbook. RN C stated if the glucometer was not accurate a resident may get too little or too much insulin. In an interview with LVN D on 06/05/25 at 2:19 PM, LVN D stated she worked the night shift at the facility. LVN D stated it was the night shift nurses' responsibility to test the glucometers daily and record the results in the logbook. LVN D stated they typically had two nurses working the night shift. LVN D stated she worked at the facility from 10:00 PM on 05/31/25 to 6:00 AM on 06/01/25. LVN D stated during that shift she forgot to test the glucometers in the nurse's carts. LVN D stated the glucometers were tested daily to ensure the residents did not receive too much or too little 676107 Page 7 of 8 676107 06/05/2025 Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414

F 0842 insulin. Level of Harm - Minimal harm or potential for actual harm In an interview with the DON on 06/05/25 at 2:36 PM, the DON stated it was important to ensure the glucometers were accurate so residents received the correct dose of insulin. The DON stated incorrect doses of insulin could cause hypoglycemia symptoms such as lethargy, profuse sweating, disorientation, and in severe cases even death. The DON stated she had been DON at the facility for approximately one year. The DON stated the glucometers were tested and the results recorded in the glucometer logbook every day since she had been employed at the facility. The DON stated it was the night shift nurses' responsibility to test the glucometers daily and record the results in the logbook. The DON stated she was not aware of any written facility policy that stated the glucometers were to be tested daily. The DON stated the manufacture's guidelines for the glucometers they used at the facility stated they only needed to be tested on ce per week. The DON stated she required the nursing staff tested the glucometers every day as a precaution and because of her previous nurse training and experience. Residents Affected - Some This state surveyor requested a facility policy from the DON on 06/05/25 at 2:36 PM dictating how often to test the glucometers but none was provided. 676107 Page 8 of 8