Health inspection·March 5, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to promote care for residents in a manner and in an environment that maintained or enhanced each resident's dignity and respect in full recognition of his or her individuality for 1 of 5 residents reviewed for- residents rights. (Resident #5) The facility failed to ensure Resident #5 was provided privacy when she used a bedside commode in her room. This failure placed residents at risk for diminished quality of life, loss of dignity and decrease in comfort. Findings include: Record review of Resident #5's face sheet dated 03/05/24 indicated Resident #5 was a [AGE] year-old female and admitted on [DATE] with diagnoses including screening for malignant neoplasm of colon (is a cancer, or malignant tumor, of the large intestine, which may affect the colon or rectum), need for assistance with personal care, chronic superficial gastritis with bleeding (a persistent, but low grade, inflammation and damage to the stomach lining), noninfective gastroenteritis and colitis (a disorder characterized by inflammation of the colon), and constipation. Record review of Resident #5's quarterly MDS assessment dated [DATE] indicated Resident #5 was understood and understood others. The MDS assessment indicated Resident # 5 had a brief interview for mental status score of 15, which indicated her cognition was intact. The MDS assessment indicated Resident # 5 required limited assistance with activities of daily living. Resident #5 had partial assistance with toilet hygiene, supervised with personal hygiene and independent with toilet transfer. Record review of Resident #5's care plan dated 12/20/2023 indicated Resident #5 has a risk for constipation related to medication usage, low level of physical activity, pain in bottom area (history of hemorrhoidectomy (is a surgical procedure to remove hemorrhoids. Hemorrhoids are enlarged blood vessels in your anus that can sometimes cause uncomfortable symptoms, like anal pain and bleeding)). Intervention included monitored for signs and symptoms of constipation such as lethargy, decreased bowel sounds, abdominal distention, tenderness, change in level of consciousness. Record review of Resident #5's care plan dated 02/09/23 indicated Resident #5 had an infatuation her with anal area. Intervention included education on the need to leave area alone to allow area to not be irritated. Page 1 of 3 676154 676154 03/05/2024 Capstone Healthcare of Hughes Springs 215 Fm 161 Business South Hughes Springs, TX 75656

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of Resident #5's care plan dated 03/04/24 indicated Resident #5 compulsively put multiple wipes and toilet tissue in commode in bathroom which has caused several plumbing issues. Bedside commode placed in room. Intervention included maintain dignity while bedside commode in room. During an observation and interview on 03/04/24 at 10:04 a.m., Resident #5 said her bathroom had not worked since January 2024. She said the facility had given her a bedside commode to use instead. She said she did not have privacy and it made her uncomfortable when she used the bedside commode. She said when people entered her room when she was on the bedside commode, they could see her. She said it would make her very happy if the facility fixed her bathroom toilet. Resident #5's bedside commode was in her room against the bathroom door. No privacy curtain noted in room or by bedside commode. There was a sign on the bathroom door that said, Sorry Out of Order. During an interview on 03/05/24 at 12:31 p.m., CNA A said had been a couple weeks since Resident #5's bathroom toilet had been out of order. She said it would have made her feel uncomfortable if she had to use a bedside commode with no privacy curtain. CNA A said housekeeping were responsible for residents' privacy curtain. During interview on 03/04/2024 at 1:29 PM, the Maintenance Man said the facility had some plumbing issues. The Maintenance man said staff took Resident #5 to shower room to use bathroom but Resident #5 took too long in the restroom and tied up the shower room from the other residents. The Maintenance Man said the lines were clogged. The Maintenance Man said the plumbers came out to the facility twice in one week and said the toilet was clogged due to wipes flushed. The Maintenance Man said he does not have the exact date when the plumber came. During interview and observation on 03/04/2024 at 2:43 PM the Maintenance Man said Resident #5 toilet worked. The Maintenance said the plumber came out a couple weeks ago and fixed toilet. The Maintenance Man flushed the toilet and verified proper function. The Maintenance Man said the suction with the toilet was not the best. During interview on 03/05/2024 at 9:39 AM LVN A said Maintenance were responsible for privacy curtains. LVN A said she did not know Resident #5 had a bedside commode in her room. During interview on 03/05/2024 at 9:55 AM LVN B said she was aware Resident #5 had a bedside commode and Housekeeping was responsible privacy curtains. LVN B said she did not know why Resident #5 did not have privacy curtains. LVN B said she would not feel comfortable if people could walk in and see her on the pot. During observation on 03/05/2024 at 10:03 AM Resident #5 Bedside commode was in her room against the bathroom door. No privacy curtain noted in room or by bedside commode. There was a sign on bathroom door said, Sorry Out of Order. Resident #5 bedside commode had a brown substance on bedside commode and had a foul odor. During interview on 03/05/2024 at 10:05 AM CNA B said when she walked in Resident #5 could see her if she was on her bedside commode and she do not any privacy. CNA B said it would make her feel uncomfortable if she had to use a bedside commode with no privacy. During interview on 03/05/2024 at 10:10 AM LVN C said Resident #5 bathroom had not been used, due to plumbing issues. CNA C said Resident #5 had never complained to her about her bathroom not available. CNA C said Resident #5 stopped up the toilet with wipes when she used the bathroom. CNA C said 676154 Page 2 of 3 676154 03/05/2024 Capstone Healthcare of Hughes Springs 215 Fm 161 Business South Hughes Springs, TX 75656

F 0550 she would be embarrassed if she had no privacy when she used the bathroom. Level of Harm - Minimal harm or potential for actual harm During interview on 03/05/2024 at 10:30 AM the DON said he was aware Resident #5 has a bedside commode. DON said the facility has had plumbing issues with wipes. DON said Resident #5 had a fixation with her anal area. DON said Resident #5 had been advised not flush wipes down the toilet. DON said Resident #5 door to her room would secure her privacy and staff should knock prior to entrance. DON said Resident # 5 had not complained about privacy or use of bedside commode to him. Residents Affected - Few During interview on 03/05/2024 at 10:53 AM the Administrator said he was aware Resident #5 had a bedside commode. The Administrator said Resident # 5 had a documented history of putting things in the toilet. The Administrator said he had used signs to discourage Resident #5 for wipes placed in toilet. The Administrator said the facility had plumbers out two or three times a week, due to wipes placed in the toilet. The Administrator said Resident #5 did not have a roommate since she had her bedside commode. The Administrator said he knew Resident #5 would not be happy if someone just walked in while she used the bathroom. The Administrator said Resident #5 had not complained about the bedside commode to him. Record review of the facility's Rights of Nursing Facility Residents Policy revealed, .By law every Texas nursing facility resident has the right to be treated with dignity, respect, courtesy and consideration without regard to race, religion, national origin, sex, disability, marital status or source of payment .to privacy during visits and telephone calls and while attending to personal needs, unless providing would infringe on rights of others . 676154 Page 3 of 3