Health inspection·June 23, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 a resident who was unable to carry out activities of daily living (ADLs) received the necessary services to maintain grooming and personal hygiene for 1 of 4 residents (Resident #1) reviewed for ADLs. Residents Affected - Few -The facility failed to provide showers to Resident #1 in compliance with her shower schedule and as she requested. This deficient practice could place residents at risk of a decline in their sense of well-being, level of satisfaction with life, and at risk for skin breakdown. Findings include: Record review of Resident #1's, undated, face sheet revealed a [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included schizoaffective disorder (a mental health problem where you experience psychosis as well as mood symptoms), hypertension (A condition in which the force of the blood against the artery walls is too high) and depression (is a common and serious medical illness that negatively affects how you feel, the way you think and how you act). Record review of Resident #1's Comprehensive MDS, dated [DATE], revealed a BIMS score was 15 out of 15, which indicated the resident was cognitively intact. Resident #1 required limited assistance from one person assist from staff with bed mobility, dressing, toilet use and personal hygiene. Record review of Resident #1's Care plan initiated on 12/20/22 revealed the following: Focus: I, (Resident#1) have an ADL self-care performance deficit r/t schizoaffective/bipolar disorder. Goal: I, (Resident#1) will maintain current level of function in ADL's through the review date. Interventions: Bathing/showering: I, (Resident#1) require extensive assist by 1 staff with bathing/showing three times weekly and as necessary. Record review of Resident#1's nurses notes for the month of June 2023 revealed there was no documentation of the resident's refusal for showers/bad bath. Record review of Resident#1's ADLs Task for the month of June 2023 revealed CNA Z's initialed with time stamp 13:59 (1: 59 pm) for Monday (6/19/23) and Wednesday (6/21/23) under ADL-Bathing (MWF Page 1 of 3 676116 676116 06/23/2023 Focused Care at Westwood 8702 Course Drive Houston, TX 77099

F 0677 6-2). Level of Harm - Minimal harm or potential for actual harm In a telephone interview on 06/22/23 at 3:23 p.m., the complainant said Resident #1 had not been offered a shower during the week of June 19, 2023. Resident #1's assigned shower days were Monday, Wednesday, and Friday. Residents Affected - Few In an interview on 06/23/23 at 10:05 a.m., Resident #1 said she loved taking her showers. She said her shower days were Monday's, Wednesday's, and Friday's. She said this week she had not received a shower. She said Monday (6/19/23) no one offered her a shower. She said on Wednesday (6/21/23) CNA Z came early in the morning around 7:00 am and asked if she wanted to take a shower. Resident #1 said she did not feel good so she asked CNA Z if she could take a shower later in the afternoon. CNA Z agreed. Resident#1 said she pressed her call light sometime after lunch requesting a shower. CNA Z told her she was in the middle of something and could not give a shower at that time. Resident #1 said she waited but CNA Z never came back. She said, Today is my shower day. I felt dirty and requested CNA this morning to give me a shower. I got my shower and i feel much better now. In a telephone interview on 06/23/23 at 11:10 a.m., with CNA Z, she said she worked with Resident#1 on Monday (06/19/23) and Wednesday (6/21/23) of this week. She said the resident got her shower on Monday (06/19/23). On Wednesday (6/21/23) around 7:00 am she went to ask Resident#1 if she would like to take a shower the resident refused saying that she was not feeling well. She said she notified a male nurse that was on duty that day of the resident's refusal. She said toward the end of her shift Resident#1 said she wanted to shower but it was time for CNA Z to go home. CNA Z said she forgot to notify the oncoming shift CNA of the resident's shower request. In an interview on 6/23/23 at 11:49 a.m., with LVN AA, he said he worked with Resident#1 on Wednesday (06/21/23). He said he did not recall CNA Z telling him of Resident #1 refused a shower. He said the process was if the resident refused to shower the nurse would talk to the resident to inquire the reason for refusal. Ask if a resident wanted to take a shower later in the day, or on a different shift. If the resident continued to refuse then educate the resident on the importance of showering, and then document in the nurses note. Record review and interview on 6/23/23 at 1:04 p.m., the Surveyor reviewed Resident #1's bathing tasks and the nurses notes with the DON. The DON said she did not see any specific note for the refusal of the shower for Resident #1 on Monday (06/19/23) and Wednesday (6/21/23) of this week. She said Resident #1 was an easy shower, you just have to monitor her. The DON said on the ADLs documentation CNA Z documented at 1359 (1:59 pm) on Monday (06/19/23) and Wednesday (6/21/23) which was the time she sat down to do her charting towards the end of her shift. She said the CNA should be charting after every resident before going to the next resident. She said her expectations were that the aides showered the residents according to their shower schedules and as needed. She said if a resident refused a shower, the aides should notify the nurse. A negative outcome of not receiving showers regularly could be foul hygiene, fungal infections, not assessing skin, and unidentified wounds. She said the nurses were responsible for ensuring residents were getting showers on their assigned days. At this time a policy on ADLs was requested. The DON said the facility did not have a policy on ADLs. Record review of facility's Charting and Documentation policy (Revised July 2017) revealed read in part: .All services provided to the resident, progress toward the care plan goals, or any changes in the resident's medical, physical, functional or psychosocial condition, shall be documented in the resident's medical record. The medical record should facilitate communication between the interdisciplinary team regarding the resident's condition and response to care. 3. Documentation in the 676116 Page 2 of 3 676116 06/23/2023 Focused Care at Westwood 8702 Course Drive Houston, TX 77099

F 0677 medical record will be objective (not opinionated or speculative), complete, and accurate Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 676116 Page 3 of 3