Health inspection·April 27, 2023

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 interviews, and record review, the facility failed to review and revise the person-centered comprehensive care plan to reflect the resident's current condition for 1 of 6 residents (Resident #2) reviewed for care plans, in that. The facility failed to update Resident #2's care plan to reflect the resident having an indwelling urinary catheter in place. This deficient practice could place the resident at risk for not receiving appropriate care and intervention to meet their current needs. The findings were: Record review of Resident #2's face sheet, undated, revealed the resident was initially admitted on [DATE], readmitted [DATE] and 4/23/2023. Resident #1 diagnoses included Parkinson's Disease, unspecified intellectual disabilities, atherosclerotic heart disease of native coronary artery without angina pectoris (arteries that deliver blood to the heart can cause chest pain), hyperlipidemia(a condition that incorporates various genetic and acquired disorders that describe elevated lipid levels within the human body.), gastro-esophageal reflux disease without esophagitis(occurs when stomach acid repeatedly flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus.), unspecified dementia,(a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with your daily life. )dehydration, protein-calorie malnutrition, cerebral palsy(group of disorders that affect movement and muscle tone or posture.). Record review of Resident #2's quarterly MDS, dated [DATE], revealed a BIMS score of 0 (cognitively impaired-unable to process thoughts). The functional status indicated the resident required total dependence for bed mobility, transfers, dressing, eating, toilet use, and personal care. Bed mobility, transfers, dressing, eating, and toilet use required two or more persons physical assistance and personal hygiene required one person assist. Resident #2's bladder and bowel indicated had always urinary and bowel incontinent . All needs to be anticipated by staff. The MDS did not indicate Resident #2 had an indwelling urinary catheter. Record review of Resident #2's Care Plan, date initiated 4/4/2022 with revision scheduled 5/30/2022, The resident had bladder incontinence r/t cerebral hypoxia (a form of hypoxia (reduced supply of oxygen), specifically involving the brain. The goal reflected: The resident would remain free from skin breakdown due to incontinence and brief use through the review date, date initiated 4/28/2022, Page 1 of 7 676133 676133 04/27/2023 Maverick Nursing and Rehabilitation Center 3106 Bob Rogers Dr Eagle Pass, TX 78852

F 0656 Level of Harm - Minimal harm or potential for actual harm revision date: 3/23/2023, target date 6/6/2023. The interventions included brief use: change every 2 hours and as needed. No indication of an indwelling catheter in place . During an observation on 4/26/2023 at 11:20 a.m. of Resident #2 observed she had an indwelling urinary catheter in place. Residents Affected - Few Interview on 04/27/23 at 10:15 a.m. ADON 2 confirmed Resident #2 did not have a care plan for an indwelling urinary catheter. She revealed a care plan should have been added to her electronic medical record care plan when she returned from the hospital on 4/23/2023. During an interview on 4/27/2023 at 2:30 p.m. the Administrator stated, We do not have a specific policy. When a care plan policy was requested. 676133 Page 2 of 7 676133 04/27/2023 Maverick Nursing and Rehabilitation Center 3106 Bob Rogers Dr Eagle Pass, TX 78852

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, interview and record review the facility failed to ensure that a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections, based on the resident's comprehensive assessment for 1 of 6 residents (Resident #2) whose records were reviewed. Nursing staff failed to properly place Resident #2's indwelling urinary catheter bag off of the floor while she was in bed. This deficient practice could affect any resident with an indwelling catheter and could result in avoidable UTI's(urinary tract infection) and trauma to the urethra. The findings were: Record review of Resident #2's face sheet, undated, revealed the resident was initially admitted on [DATE] readmitted [DATE] and 4/23/2023. Resident #1 diagnoses included Parkinson's Disease, unspecified intellectual disabilities, atherosclerotic heart disease of native coronary artery without angina pectoris (arteries that deliver blood to the heart can cause chest pain), hyperlipidemia(a condition that incorporates various genetic and acquired disorders that describe elevated lipid levels within the human body.), gastro-esophageal reflux disease without esophagitis(occurs when stomach acid repeatedly flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus.), unspecified dementia,(a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with your daily life. )dehydration, protein-calorie malnutrition, cerebral palsy(group of disorders that affect movement and muscle tone or posture.). Record review of Resident #2's quarterly MDS, dated [DATE], revealed a BIMS score of 0 (unable to determine (cognitively impaired-unable to process thoughts). The Functional status indicated the resident required total dependence for bed mobility, transfers, dressing, eating, toilet use, and personal care. Bed mobility, transfers, dressing, eating, and toilet use required two or more persons physical assistance and with personal hygiene required one person assist. Resident #2's bladder and bowel indicated had always urinary and bowel incontinent . All needs to be anticipated by staff. The MDS did not indicate Resident #2 had an indwelling urinary catheter. Record review of Resident #2's Care Plan, date initiated 4/4/2022 with revision scheduled 5/30/2022, The resident had bladder incontinence r/t cerebral hypoxia (a form of hypoxia (reduced supply of oxygen), specifically involving the brain. The goal reflected: The resident will would remain free from skin breakdown due to incontinence and brief use through the review date,. date initiated 4/28/2022, revision date: 3/23/2023, target date 6/6/2023. The interventions included brief use: change every 2 hours and as needed. No indication of an indwelling catheter in place. Observation on 4/27/2023 at 9:50 a.m., revealed Resident #2 was lying in bed. Resident #2 non interviewable. Observation of Residents #2 's indwelling urinary catheter bag revealed it was lying on floor under the bed, along with tubing on floor. During an observation and interview on 4/27/2023 at 11:45 a.m. revealed ADON 1 confirmed Resident #2's indwelling urinary catheter bag was lying on floor under the bed, along with the tubing on the 676133 Page 3 of 7 676133 04/27/2023 Maverick Nursing and Rehabilitation Center 3106 Bob Rogers Dr Eagle Pass, TX 78852

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few floor. ADON 1 stated the staff should not allow the resident's indwelling urinary catheter bag or tubing to be on the floor. She stated, That is not clean practice, and the resident could get an infection. A request for a policy for indwelling urinary catheters was made on 4/27/2023 at 2:30 p.m. to the Administrator prior to exit from the facility, resulted in the Administrator informing the surveyor that there was not a policy. She stated, We should be following infection control practices. 676133 Page 4 of 7 676133 04/27/2023 Maverick Nursing and Rehabilitation Center 3106 Bob Rogers Dr Eagle Pass, TX 78852

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record review, the facility failed to ensure that a resident needs respiratory care, is provided such care, consistent with professional standards of practice for 2 of 6 residents (Resident #2 and Resident #5) reviewed for respiratory care in that: Residents Affected - Few Resident #2 and Resident #5's oxygen concentrator bottle's and nasal canula's were not dated. This deficient practice could affect residents who receive oxygen and result in infection and respiratory compromise. The findings were: Record review of Resident #2's face sheet, undated, revealed the resident was initially admitted on [DATE] readmitted [DATE] and 4/23/2023. Resident #1 diagnoses included Parkinson's Disease, unspecified intellectual disabilities, atherosclerotic heart disease of native coronary artery without angina pectoris (arteries that deliver blood to the heart can cause chest pain), hyperlipidemia(a condition that incorporates various genetic and acquired disorders that describe elevated lipid levels within the human body.), gastro-esophageal reflux disease without esophagitis(occurs when stomach acid repeatedly flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus.), unspecified dementia, (a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with your daily life. ) dehydration, protein-calorie malnutrition, cerebral palsy(group of disorders that affect movement and muscle tone or posture.). Record review of Resident #2's quarterly MDS, dated [DATE], revealed a BIMS score of 0(cognitively impaired-unable to process thoughts). The functional status indicated the resident required total dependence for bed mobility, transfers, dressing, eating, toilet use, and personal care. Bed mobility, transfers, dressing, eating, and toilet use required two or more persons physical assistance and personal hygiene required one person assist. Resident #2's bladder and bowel indicated had urinary and bowel incontinent. All needs to be anticipated by staff. The MDS did not indicate Resident #2 had an indwelling urinary catheter. Oxygen use. Record review of Resident #2's quarterly MDS, dated [DATE], revealed a BIMS score of 0 (unable to determine). Functional status indicated resident required total dependence for bed mobility, transfer, dressing, eating, toilet use, and personal care. Bed mobility, transfers, dressing, eating, and toilet use required two or more persons physical assistance with personal hygiene required one person assist. Bladder and bowel indicated always urinary and bowel incontinent. All needs to be anticipated by staff. No documentation for oxygen use. Record review of Resident #2's physician's orders dated 4/26/2023 revealed O2 @ 2L/Min via NC (nasal canula) for shortness of breath related to hypoxia. (loss of oxygen to brain) Record review of Resident #2's Care Plan, date initiated 4/27/2023 did not have oxygen usage on the current care plan. Observation on 4/27/2023 at 9:50 a.m., revealed Resident #2 was lying in bed. The resident was non interviewable. Resident #2 had a nasal canula with oxygen at 2 lpm on. Resident #2's oxygen 676133 Page 5 of 7 676133 04/27/2023 Maverick Nursing and Rehabilitation Center 3106 Bob Rogers Dr Eagle Pass, TX 78852

F 0695 concentrator water bottle and nasal canula were not dated. Level of Harm - Minimal harm or potential for actual harm During an interview on 4/27/2023 at 12:00 p.m. ADON 1 confirmed Resident #2's oxygen concentrator water bottle and nasal canula did not have a date on it, indicating when it had been opened or placed. ADON 1 stated the oxygen bottles and nasal cannulas should have a date written on them to indicate when they were opened. ADON 1 further revealed night shift change the oxygen bottles and nasal cannulas weekly on Sundays or when they are empty or dirty, and the date is to be written on the bottles and nasal cannulas. ADON 1 further revealed this is to prevent infection or bacteria build up. Residents Affected - Few Record review of Resident #5's face sheet computer dated 4/27/2023 with an original admission date of 11/16/2018 and an updated admission date of 3/19/2023 with diagnoses to include epilepsy, anoxic brain damage (damage to the brain caused by lack of oxygen), acute and chronic respiratory failure with hypoxia, and tracheostomy (a small surgical opening that is made through the front of the neck into the windpipe, or trachea). Record review of Resident #5's care plan date initiated 4/6/2021 updated 3/30/2023 Problem The resident has a tracheostomy of risk for hypoxia. Goal the resident will have clear and equal breath sounds bilaterally through the review date. The resident will have no signs and symptoms of infection through the review date. Interventions: Apply oxygen at 2 liters per minute for oxygen saturations below 90%. Use universal precautions as indicated. Record review of Resident #5's Quarterly MDS dated [DATE], revealed Resident #5's BIMS score was 00 indicating severe cognitive impairment. Further record review of Quarterly MDS section O, documentation of oxygen use. Observation on 4/27/23 11:25 a.m. revealed Resident #5 was lying in bed. Oxygen tubing was connected to a nebulizer device with no date on it, to indicate when it had been changed. During an interview and observation on 4/27/2023 at 10:20 a.m. revealed ADON 1 confirmed Resident #5's oxygen tubing was connected to a nebulizer device with no date on it, to indicate when it had been changed. ADON 1 stated the oxygen tubing should have a date written on it to indicate when it was opened. ADON 1 further revealed night shift changes the oxygen tubing weekly. During an interview on 4/27/2023 at 2:40 p.m. with Administrator stated, We do not have a policy for changing or dating the oxygen bottles or nasal cannulas. 676133 Page 6 of 7 676133 04/27/2023 Maverick Nursing and Rehabilitation Center 3106 Bob Rogers Dr Eagle Pass, TX 78852

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. Based on observation and interview, the facility failed to ensure in accordance with State and Federal laws, to store all drugs and biological's in locked compartments when not in attendance by staff for 1 of 1 medication rooms observed, in that: The medication storage room at the central nursing station was left unlocked and the door was open and not in attendance by staff. This deficient practice could allow residents access to the main medication room and place them at risk for a drug diversion, mishandling of medication, and or injury to residents. The findings were: During an observation on 4/26/23 at 11:13 a.m. revealed the medication storage room door, located at the central nurse's station, was open, left unlocked and unattended by a staff member. Further observation revealed there were no visible staff at the nurse's station. Further observation revealed the main medication room contained a variety of accessible prescriptions medications, insulin, and stock medications. During an observation and interview on 4/26/2023 at 11:15 a.m. LVN A stated the medication room door should always be locked and the door closed whenever there were no staff present. She stated she did not know why the medication room door was left unlocked and opened. When asked what type of medications were kept in the medication room that could be accessible to residents, LVN A stated, there are multiple medications like stock medications such as aspirin, vitamins, different stomach medications. During an interview with ADON 1 on/4/26/2023 at 12:00 p.m. ADON 1 confirmed the main medication room door had been left unlocked with no staff in attendance. ADON 1 stated she did not know why the door the medication room was left open as it had a lock on the door with a keypad, that when closed should automatically lock. She stated the nurses were the ones who should enter the medication room. She further revealed it was her expectation to have the medication room door closed and locked when a staff member nurse is not in the medication room as residents could go into the medication room and potentially take medication by mouth causing injury. She further revealed the medication room mainly is stocked with vitamins, Tylenol, eye drops, stomach medications like Maalox or medicines for indigestion. A request to the Administrator on 4/27/2023 at 2:30 p.m. for a policy for locking or securing doors resulted in Administrator saying We do not have a policy for locking or securing doors. 676133 Page 7 of 7