Health inspection·April 13, 2023

F 0623 Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** F623 Residents Affected - Few Based on interview, and record review, the facility failed to notify the resident and the resident's representative of the transfer or discharge and the reasons for the move in writing, failed to record the reasons for the transfer or discharge in the resident's medical record, resident discharged [DATE] and failed to send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman for 1 (Resident #1) of 1 resident reviewed for discharge. 1. The facility failed to notify Resident #1's representative (POA) of the discharge and reasons for the discharge in writing. The resident was discharged [DATE]. 2. The facility failed to record the reasons for the discharge in Resident #1's medical record. 3. The facility failed to notify the Ombudsman of Resident #1's discharge. These deficient practices could place all residents at risk for disruption in the continuum of care which could result in health complications. Findings included: Record review of Resident #1's face sheet not dated revealed an [AGE] year-old female who was re-admitted on [DATE] with a diagnosis of unspecified Dementia (Memory loss and Confusion), Unspecified Severity with other Behavioral Disturbance, Mood Disorder (Emotional Distortion) Due to Unknown Physiological Condition, Psychosis (Disconnection from Reality), Depressive (Sadness) Episodes. Record review of Resident #1's Discharge MDS dated [DATE], read: Section A, Code 11, Discharge assessment-return anticipated. The BIMS section C0500. BIMS Summary Score was left blank. Resident #1 required limited assistance with one person assist for bed mobility, transfers, locomotion on and off unit, dressing, and toilet use. Resident #1 required supervision with set up for eating and extensive assistance with one person assist for personal hygiene. Record review of Resident #1's Care Plan initiated on 1/15/19 and revised on 4/21/22 read . Focus: Resident #1 has a Deficit r/t Dementia, CVA, general weakness. Goal: Resident #1 will maintain current level of function in ADL's through the next review date. Interventions: Resident #1 requires Supervision and cueing X 1 staff with bathing/showering three times weekly and PRN; BED MOBILITY: Resident #1 requires Supervision and cueing X 1 staff with turning and repositioning; requires Supervision and cueing X 1 staff for dressing; requires Supervision and cueing X 1 staff for Page 1 of 5 676116 676116 04/13/2023 Focused Care at Westwood 8702 Course Drive Houston, TX 77099

F 0623 toileting/incontinent care and transfers. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #1's Transfer Form not dated revealed Resident #1 was discharged from the facility to the local Behavioral Health Hospital. Residents Affected - Few In an interview on 4/13/2023 at 9:00 am, Resident #1's family member said Resident #1 had been at the facility for four years. Family member said Resident #1's behavioral issues could not be controlled so every 90 days she would end up in psychiatric care. The family member said the facility never issued warning notices but in October of last year they were notified about a process for a thirty-day eviction notice. She said they never received the eviction notice they discussed in October. She said that in January 2023, there was an incident where Resident #1 stabbed a volunteer with a pencil, so the facility called the family two days after, and said the facility was sending Resident #1 for psychiatric evaluation and treatment. She said Resident #1 called POA to come to get her. She said she was under the impression that Resident #1 would be returning to the facility post psychiatric care. She said the POA got a text from the administrator noting Resident #1 was discharged to a personal care home. She said the facility called her the next morning 1/4/2023 and asked them to come and get Resident #1's personal property and personal funds. She said the resident was now at another nursing home facility. Record review revealed no documentation of notification of resident discharge from facility to POA in Resident #1's medical record. Record review revealed no documentation of the reasons for the discharge in Resident #1's medical record. Record review revealed no documentation of notification of resident discharge to Ombudsman from facility in Resident #1's medical record. In an interview on 4/13/2023 at 9:49 am with the Administrator she said Resident #1 had become a danger to residents and staff when she attacked the housekeeper and injured her neck on 1/2/2023. She said she had a conversation with the family to notify them that Resident #1 could not stay at the facility. She said the family was agreeable. She said contact with the resident's POA was made to discuss an incident that occurred which forced the facility to send Resident #1 to the local psychiatric facility on 1/3/2023 for evaluation and psychiatric treatment. She said she gave the resident a ride to the personal care home herself because there were transportation issues, and she did not want her sitting there waiting. She said Resident #1's family member knew about this, and he was looking at places as well. In an interview on 4/13/2023 at 12:15 pm with the Administrator she said the facility did not have discharge papers and a discharge summary for Resident #1. She said she could not explain why said documents were not in Resident #1's clinical record. In an interview on 4/13/2023 at 3:00 pm with the Administrator she said the facility was supposed to notify the family by mail in writing and call family when discharging a resident. She said the purpose was to ensure the necessary continuum of care for discharged residents. She said if the family was not notified in writing, there could be a lapse in continuum of care. In an interview on 4/13/2023 at 3:15 pm with the DON she said the importance of discharge notification was to ensure residents who were discharged were equipped with the necessary tools to continue 676116 Page 2 of 5 676116 04/13/2023 Focused Care at Westwood 8702 Course Drive Houston, TX 77099

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few their care without interruptions. She said it was important to document the reasons for discharge and the location of where the resident/s were being discharged to. Record review of facility's discharge policy titled, Transfer or Discharge Notice, dated 2016, read in part . The resident and/or representative will be notified in writing of the following information: The reason for the transfer or discharge; The effective date of the transfer or discharge; The location to which the resident is being transferred or discharged ; A copy of the notice will be sent to the Office of the State Long-Term Care Ombudsman. In determining the transfer location for a resident, the decision to transfer to a particular location will be determined by the needs, choices, and bests interests of that resident . 676116 Page 3 of 5 676116 04/13/2023 Focused Care at Westwood 8702 Course Drive Houston, TX 77099

F 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** F661 Based on record review and interview the facility failed to provide a discharge summary that included the required elements for 1 (Resident #1) of 1 resident reviewed for discharge summaries. 1. The facility failed to provide Resident #1's POA with a discharge summary for Resident #1 that included recapitulation of the resident's diagnoses, course of illness/treatment or therapy, and pertinent lab, radiology, and consultation results; final summary of the resident's status; Reconciliation of all pre-discharge medications with the resident's post-discharge medications (both prescribed and over-the-counter); post-discharge plan of care that is developed with the participation of the resident and, with the resident's consent, the resident representative(s), which would assist the resident to adjust to his or her new living environment. Findings included: Record review of Resident #1's face sheet not dated revealed an [AGE] year-old female who was re-admitted on [DATE] with a diagnosis of unspecified Dementia (Memory loss and Confusion), Unspecified Severity with other Behavioral Disturbance, Mood Disorder (Emotional Distortion) Due to Unknown Physiological Condition, Psychosis Disconnection from Reality), Depressive (Sadness) Episodes. Record review of Resident #1's Discharge MDS dated [DATE], read: Section A, Code 11, Discharge assessment-return anticipated. The BIMS section C0500. BIMS Summary Score was left blank. Resident #1 required limited assistance with one person assist for bed mobility, transfers, locomotion on and off unit, dressing, and toilet use. Resident #1 required supervision with set up for eating and extensive assistance with one person assist for personal hygiene. Record review of Resident #1's Care Plan initiated on 1/15/19 and revised on 4/21/22 read . Focus: Resident #1 has a Deficit r/t Dementia, CVA, general weakness. Goal: Resident #1 will maintain current level of function in ADL's through the next review date. Interventions: Resident #1 requires Supervision and cueing X 1 staff with bathing/showering three times weekly and PRN; Bed Mobility: Resident #1 requires Supervision and cueing X 1 staff with turning and repositioning; requires Supervision and cueing X 1 staff for dressing; requires Supervision and cueing X 1 staff for toileting/incontinent care and transfers. Record review of Resident #1's Transfer Form not dated revealed Resident #1 was discharged from the facility to the local Behavioral Health Hospital. Record review revealed no discharge summary documentation in Resident #1's clinical record. In an interview on 4/13/2023 at 12:15 pm with the Administrator she said the facility did not have discharge papers and a discharge summary for Resident #1. She said she could not explain why said documents were not in Resident #1's clinical record. In an interview on 4/13/2023 at 3:20 pm with the Administrator, she said the discharge summary showed where a resident was being discharged to, medications reconciliation, and to ensure the Interdisciplinary Team were all on the same page. She said if the facility did not provide a discharge 676116 Page 4 of 5 676116 04/13/2023 Focused Care at Westwood 8702 Course Drive Houston, TX 77099

F 0661 Level of Harm - Minimal harm or potential for actual harm summary to residents, family members or resident representatives, the resident could have a lag in their continuum of care. Policy for discharge summary was requested on 4/13/23 at 1:30 pm; and 3:30 pm from the DON and Administrator; the facility did not provide the discharge summary prior to exit. Residents Affected - Few 676116 Page 5 of 5