Health inspection·March 22, 2024

F 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure residents have a right to personal privacy for 1 of 6 resident (Resident #42) reviewed for privacy, in that: Residents Affected - Few LVN A did not completely close Resident #42's privacy curtain while providing colostomy (an opening for the colon through the abdomen) care for the resident. This deficient practice could place residents at-risk of loss of dignity due to lack of privacy. The findings include: Record review of Resident #42's face sheet, dated 03/21/2024, revealed an admission date of 05/02/2019 and, a readmission date of 07/10/2021, with diagnoses which included: Hemiplegia (Paralysis of one side of the body), Dysphasia (language disorder), Congestive heart failure (impairment of the heart's blood pumping function), Alzheimer's disease (brain disorder that slowly destroys memory and thinking skills), Hyperlipidemia(Elevated level of any or all lipids(fat) in the blood), Mood disorder (any of a group of conditions of mental and behavioral disorder causing a disturbance in the person's mood), Colostomy (an opening for the colon through the abdomen) status. Record review of Resident #42's Significant change status MDS assessment, dated 02/05/2024, revealed the resident had a BIMS score of 12, indicating he was mildly impaired. Resident #42 had a ostomy and, was always incontinent of bladder. Observation on 03/21/24 at 09:41 a.m. revealed LVN A provided colostomy care for Resident #42, exposing the end of the resident's bed which could be seen from the door if someone had entered the room during care. Further observation revealed the curtain was either too short to cover the end of the bed or a curtain was missing at the end of the bed. During the care laundry staff knocked at the door and started to enter the room before being stopped by LVN A. During an interview with LVN A on 03/21/2024 at 10:00 a.m., LVN A confirmed the privacy curtain was not closed while they provided care for Resident #42 but it should have been. They confirmed the privacy curtain was too short to cover the end of the bed. During an interview with the ADON on 03/21/2024 at 10:10 a.m., the ADON confirmed privacy must be provided during nursing care and Resident #42's privacy curtains should have been closed completely. He revealed laundry services were in charge to change the curtain once a week and the curtain had been changed on Monday 3/18/2024. The ADON confirmed the resident would have been provided care, to include incontinent care, and therefore would have been been exposed without a full privacy curtain multiple times since Monday. Page 1 of 5 676181 676181 03/22/2024 The Heights of Atascosa 1855 W Goodwin Pleasanton, TX 78064

F 0583 Level of Harm - Minimal harm or potential for actual harm During an interview with the DON on 03/22/2024 at 11:30 a.m., the DON confirmed privacy must be provided during nursing care and Resident #42's privacy curtains should have been closed completely. She revealed the staff could write a note directly in the electronic records when they noticed something was wrong in a resident's room. She confirmed the privacy curtain missing in the resident's room should have been reported by staff. Residents Affected - Few Review of the facility's policy titled Statement of Resident Rights, dated January 2023, revealed, Personal privacy includes accommodations, medical treatment [ .] personal care, visits and meetings of family and resident groups, but this does not require the facility to provide a private room for each resident . 676181 Page 2 of 5 676181 03/22/2024 The Heights of Atascosa 1855 W Goodwin Pleasanton, TX 78064

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the assessment accurately reflected the resident's status for 1 of 18 residents (Resident #64) whose assessments were reviewed, in that: Residents Affected - Few Resident #64's admission MDS assessment incorrectly documented the resident as not receiving hospice services. This failure could place residents at-risk for inadequate care due to inaccurate assessments. The findings were: 1. Record review of Resident #64's physician orders, dated 03/21/2024, revealed an admission date of 02/27/2024, with diagnoses that included: Type 2 diabetes mellitus(high level of sugar in the blood), Depression (Mental state of low mood and aversion to activity), Alzheimer's disease (brain disorder that slowly destroys memory and thinking skills), Dementia (decline in cognitive abilities), Hyperlipidemia (Elevated level of any or all lipids(fat) in the blood). Further review of the physician orders revealed an order for Admit to [ .[ Hospice. No weights, no labs, Hospice nurse to pronounce [ .] with a start date of 2/27/2024. Record review of Resident #64's admission MDS, dated [DATE], revealed the assessment indicated Resident #64 was not receiving hospice services. During an interview with the MDS Coordinator B on 03/22/24 at 11:15 a.m., the MDS Coordinator confirmed she had completed the MDS. The MDS Coordinator confirmed Resident #64's admission MDS was coded as the resident having not received hospice services. The MDS Coordinator confirmed that Resident's 64 had orders for Hospice services. The MDS Coordinator revealed the RAI was used as reference for the MDS and she had access electronically to the RAI on her computer. During an interview with the DON on 03/22/2024 at 11:30 a.m., the DON confirmed Resident #64 was on hospice services and should have been coded for hospice services in the admission MDS assessment. The DON revealed the inaccuracy of the MDS assessment could negatively impact the care received Record review of, Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual, Version 1.18.11, October 2023, revealed, O0110K1, Hospice care. Code residents identified as being in a hospice program for terminally ill persons where an array of services is provided for the palliation and management of terminal illness and related conditions. The hospice must be licensed by the state as a hospice provider and/or certified under the Medicare program as a hospice provider. 676181 Page 3 of 5 676181 03/22/2024 The Heights of Atascosa 1855 W Goodwin Pleasanton, TX 78064

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infection for 1 of 6 residents (Resident #18) reviewed for infection control, in that: Residents Affected - Few CNA D failed to wash or sanitize her hands or change her gloves after touching the privacy curtain and the bed remote before starting incontinent care. This deficient practice could place residents at-risk for infection due to improper care practices. The findings included: Record review of Resident #18's face sheet, dated 03/21/2024, revealed an admission date of 02/11/2022 and, a readmission date of 03/22/2022 with diagnoses which included: Type 2 diabetes mellitus (high level of sugar in the blood), Atrial fibrillation (abnormal heart rhythm), Schizophrenia (mental disorder characterized by reoccurring episodes of psychosis), Metabolic encephalopathy (Brain function is disturbed due to different diseases or toxins in the body), Alzheimer's disease (brain disorder that slowly destroys memory and thinking skills), Hypertension (high blood pressure). Record review of Resident #18's Annual MDS assessment, dated 02/15/2024, revealed Resident #18 had a BIMS score of 9, indicating moderate cognitive impairment and, was always incontinent of bowel and bladder. Record review of Resident #18's care plan, dated 03/06/2024, revealed a problem of My skin is fragile and I am at risk for skin injury--new or worsening skin condition. chronic incontinent dermatitis to peri area, daily cream applied., with an intervention of Keep clean & dry and apply skin barrier cream as indicated. Observation on 03/21/24 at 10:10 a.m. revealed while providing incontinent care for Resident #18, CNA D washed her hands and put on gloves. CNA D touched the resident's privacy curtain and bed remote with her gloved hands, then without changing gloves or sanitizing her hands started assisting CNA C in providing care for the resident. CNA D touched the wet wipes, the resident skin and helped fasten the clean brief. During an interview on 03/21/2024 at 10:19 a.m. with CNA D, she confirmed the environment around the resident was considered dirty and she should have changed her gloves and sanitized her hands prior to providing care. She confirmed she received infection control training within the year. During an interview with the DON on 03/22/24 at 11:30 a.m., she confirmed the environment around the resident was considered dirty and the staff should change their gloves and wash. Staff should sanitize their hands after touching anything in the environment, before touching the resident and at the start of care. She confirmed the staff were in-serviced in infection control and incontinent care and skills were checked annually. She revealed the RN Supervisor would spot check the staff's skills over the weekends. Record review of the annual skills check for CNA D revealed CNA D passed competency for infection 676181 Page 4 of 5 676181 03/22/2024 The Heights of Atascosa 1855 W Goodwin Pleasanton, TX 78064

F 0880 control on 10/18/2023. Level of Harm - Minimal harm or potential for actual harm Record review of the facility policy, titled Hand washing/Hand hygiene, dated 01/2023, revealed Use an alcohol-based hand rub [ .] for situations such as: [ .] After handling used dressing, contaminated equipment, etc Residents Affected - Few 676181 Page 5 of 5