Health inspection·May 11, 2023

F 0656 isolation on the outside of it. An isolation caddy hung on the outside of the door during both observations. Level of Harm - Minimal harm or potential for actual harm In an interview with the DON on 5/11/23 at 4:00pm she revealed the resident was transferred to the hospital on 4/28/23 due to AMS and came back to the hospital on 5/2/23, with ESBL of the urine. The DON stated they (the facility) were behind on scanning the hospital records, so the chart was not updated, including the care plan. The DON went on to say, when a resident is transported back from the hospital, the transporter gives the medical packet to the nurse who is going to be receiving the resident. At that time, the nurse goes through the packet and enters all the orders into the computer. The DON said, then the ADON would get the packet of orders and go through them and compare them to the orders entered in the computer, to ensure they are correct. According to the DON, at that time the ADON would also call the MD and ask if he/she wanted to continue the orders the hospital ordered, or if he/she wanted to add anything. Per the DON, what should have happened in this instance, was whoever called the MD to confirm the orders, should have informed the MD that the resident was on Meropenem for ESBL and asked the MD if he/she wanted to put the resident on contact isolation. Then, the order should have been entered into the computer at that moment. The DON thought that someone received the order from the MD but did not put the order into the computer. Residents Affected - Few 2. Record review of Resident #6's face sheet indicates he's a [AGE] year-old male, admitted on [DATE], with diagnoses of metabolic encephalopathy (a chemical imbalance in the blood that causes changes in the brain), unspecified paraplegic (form of paralysis that affects the lower body), hypertensive chronic kidney disease (long term high blood pressure that reduces blood flow to the kidneys causing failure), end stage renal disease (kidney failure), Type 2 diabetes mellitus (body doesn't make enough insulin resulting in high blood sugar), pressure ulcer of sacral region (sore near the tailbone), dysphagia (trouble swallowing), urinary tract infection (bladder infection). Record review of Resident #6's progress notes from 5/11/23 revealed no record of contact isolation or candida auris. Record review of Resident #6's physician orders on 5/11/23, revealed no orders for contact isolation due to candida auris. Record review of Resident #6's most recent care plan printed on 5/11/23, with a revision date of 5/11/23, revealed no care plan documentation or interventions for contact isolation or candida auris. Observation on 5/11/23 at 9:54am and 2:48pm, revealed Resident #6's door had TBP for contact isolation on the outside of it. An isolation caddy hung on the outside of the door during both observations. In an interview and record review with the DON on 5/11/23 at 3:45pm, she stated Resident #6 had been on contact isolation for candida auris since he was admitted on [DATE]. The DON was not sure why there was not any documentation of the isolation or candida auris. The DON found the first progress note that documented contact isolation due to candida auris, on 4/18/22. The contact isolation was documented until September 2022, and then documentation stopped. The DON stated Resident #6 had to be on contact isolation the whole time he was there as a resident, so the isolation would continue indefinitely. She also was not sure how staff knew originally to put the resident on isolation, since there was not an order, but thought the MD must have given someone a verbal order, and they failed to put it into the computer. The DON said she did not use agency nurses, so they all knew the residents and knew Resident #6 was on isolation. She also said most of her staff knew Resident #6 was on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676155 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676155 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Courtyards at Pasadena 4048 Red Bluff Road Pasadena, TX 77503 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few isolation because he had been at the facility for so long, all the staff knew him. Per the DON, she did not know why there was not a care plan for the isolation because she remembered creating it. She said there should have been a care plan on him and did not know what happened to it. The DON remembered making a special care plan since it was for candida auris, and the corporate office made a big deal about it. In an interview with the DON on 5/11/23 at 4:00pm she revealed everyone (herself, the nurses, the Administrator) were responsible for the care plan being updated and correct. However, ultimately the DON was responsible for ensuring the care plans were updated and correct. Per the DON, if care plans were not updated, the facility was not following the treatment plan and the resident was not receiving appropriate services. Record review of facility's policies and procedures for person centered care plan process, dated 10/19/17, revealed: Policy: .a summary of the resident's medications and dietary instructions, and services and treatments to be administered by the facility and personnel acting on behalf of the facility . Procedures: Following RAI Guidelines develop and implement a comprehensive person-centered care plan .to meet a resident's medical, nursing, and mental and psychosocial needs . The Interdisciplinary Team will review for effectiveness and revise the care plan after each assessment . Thru ongoing assessment, the facility will initiate care plans when the resident's clinical status or change of condition dictates the need . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676155 If continuation sheet Page 3 of 3