Health inspection·January 11, 2024

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop a comprehensive care plan within 7 days after completion of the comprehensive assessment, and include to the extent practicable, the participation of the resident and the resident's representative(s) for 2 of 4 residents (Resident #'s 45 and 80) whose records were reviewed for assessments and care plans. Resident #45 did not have a comprehensive care plan meeting or an updated care plan after the Significant Change MDS dated [DATE]. Resident # 80 did not have a comprehensive care plan meeting or an updated care plan after the SignigficantSignificant Change MDS dated [DATE] This failure placed the residents at risk for not having individual needs identified and care and services provided to meet their needs, promote quality of care, feelings of well-being and quality of life. The findings included: Review of Resident #45's face sheet, dated 01/11/24, revealed a [AGE] year-old female, with a current admission date of 07/24/23. Diagnosis included: hypertension (high blood pressure), seizures, major depressive disorder. Review Resident #45's MDS assessment history revealed a quarterly assessment dated [DATE] and a significant change assessment dated [DATE]. Review of Resident #45's comprehensive care plan revealed it was last Reviewed/Revised on 11/20/23. There was no documented evidence that a care plan meeting was conducted for this care plan. In an interview on 01/09/24 at 01:26 PM Resident #45 said she had never been invited to a care plan meeting to discuss her care with facility staff. Review of Resident #80's face sheet, dated 01/11/24, revealed a [AGE] year-old female, with a current admission date of 01/23/21. Diagnosis included: Hypertension (high blood pressure), seizure disorder, chronic lung disease, and malignant neoplasm of the lung (cancerous tumor) Review Resident #80's MDS assessment history revealed a significant change assessment dated [DATE]. Page 1 of 5 676144 676144 01/11/2024 Senior Care Health & Rehabilitation Center - Wichi 910 Midwestern Pkwy Wichita Falls, TX 76302

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of Resident #80's comprehensive care plan revealed it was last Reviewed/Revised on 10/24/23. There was no documented evidence that a care plan meeting was conducted for this care plan. Record review of Resident #80's EMR revealed an IDT Care plan conference was last held on 7/25/23. In an interview on 01/09/24 at 02:49 PM, Resident # 80 stated she had never been invited to a care plan meeting about her care with facility staff. Interview with the Social Worker on 01/11/24 at 1:16 PM revealed the following: She stated that she was responsible for scheduling care plan meetings and sending invitations to the resident and resident representatives. She stated a care plan meeting should have occurred for resident #45 after the significant change assessment dated [DATE], and a care plan meeting should have occurred for Resident #80 after the significant change MDS dated 10/26.23. She said care plan meetings were missed because the facility had a new system, and it was supposed to send a notice the care plan meeting was due, but it did not, and the care plan was missed. She stated corporate was aware of the system failure and was working to correct it. Interview with the DON on 01/11/24 at 1:32 PM revealed that she did not do the care plans or schedule the care plan meetings. She said that the Social Worker was responsible for that. She stated she expected care plan meetings to be held quarterly and she did expect all required members to attend and the resident or their representative be included. Review of the facility's policy and procedure for Care Plans - Comprehensive, (not dated), revealed the following [in part]: Purpose: 1. To identify resident real and potential needs. 2. To set achievable short- and long-term outcome goals. 3. To document interdisciplinary interventions to achieve stated goals. 4. To evaluate, review, and revise goals and approaches. Procedure: 1. M.D.S./C.P. nurse and Care Plan Team members will utilize the R.A.P. Summary to identify triggered problems, real and potential. 4. Approaches/Interventions will state specific items the interdisciplinary team will do assist the resident in meeting goals and ensure care needs are met. 5. Care plans will be updated to reflect changes in resident needs. 6. Care plan goals and approaches will be reviewed and revised at least every 90 days. 676144 Page 2 of 5 676144 01/11/2024 Senior Care Health & Rehabilitation Center - Wichi 910 Midwestern Pkwy Wichita Falls, TX 76302

F 0657 New admissions will have a comprehensive care plan in place by day 21. A new care Level of Harm - Minimal harm or potential for actual harm plan will be written annually. Residents Affected - Some 676144 Page 3 of 5 676144 01/11/2024 Senior Care Health & Rehabilitation Center - Wichi 910 Midwestern Pkwy Wichita Falls, TX 76302

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety, for residents who received their meals in the Rehab Dining Area and Rehab Kitchen area on Hallway 100, by failing to ensure: A. Countertops were clean. B. Floors were clean. C. Cabinet drawers were clean. This failure could affect residents by placing them at risk for food-borne illness and food contamination. The findings included: In an observation on 01/08/24 at 12:34 PM, of the Rehab Dining Area on Hallway 100, revealed the following: - 4 cabinet drawers out of 6 observed that was used for storage of coffee, condiments, and miscellaneous items were soiled with dirt, dried colored water spots, hair and food crumbs. - The Rehab Kitchen door connected to the Rehab Dining Area was opened during lunch. Inside the Rehab Kitchen, the floor was sticky and soiled with dirt and food crumbs. The exterior countertop and shelves were soiled with dust, food crumbs and dried white-water spots. In an interview and observation on 01/11/24 beginning at 11:11 AM with the Corporate Dietary Manager and the Dietary Manager, the 4 cabinet drawers in the Rehab Dining area were observed which were soiled with dirt, dried colored water spots, hair and food crumbs, the Corporate Dietary Manager said he could not refute that. The Rehab Kitchen area was observed, the floor was sticky and soiled with dirt and food crumbs. The exterior countertop and shelves were soiled with dust, food crumbs and dried white-water spots. The Corporate Dietary Manager said the area was no longer used for food prep and used for storage. He said the area was dirty. The Corporate Dietary Manager said this failure had the potential to attract bugs and roaches and make an unsanitary area for the residents. In an interview on 01/10/24 at 4:32 PM, the Administrator said his expectation was for the Rehab Dining area and Rehab Kitchen area to be clean . He said the area is going to remolded and the cabinet drawers were going to be taken out. Record review of the facility policy Cleaning Cabinets and Drawer, dated as revised on 01/01/10 revealed the following [in part]: Policy: Cabinets and drawers will be clean and organized. Procedure: Weekly: 3. Be sure to clean inside and outside of doors and drawers. 676144 Page 4 of 5 676144 01/11/2024 Senior Care Health & Rehabilitation Center - Wichi 910 Midwestern Pkwy Wichita Falls, TX 76302

F 0812 Level of Harm - Minimal harm or potential for actual harm Record review of the facility policy Cleaning the Floor, dated as revised on 01/01/10 revealed the following [in part]: Policy: The floor will be kept in a clean and sanitary condition. The floor to be mopped includes storerooms, office space, dish room, janitor closet and rest room. Residents Affected - Some 676144 Page 5 of 5