Health inspection·March 7, 2024

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure residents the right to be free from abuse for 1 of 19 residents reviewed for abuse (Resident # 10) in that: Residents Affected - Few On 8/11/23 CNA A slapped Resident #10 on the left forearm with a washcloth multiple times telling her to stop complaining while giving her a shower on 8/11/23. The non-compliance was identified as past non-compliance. The immediate jeopardy (IJ) began on 8/11/23 and ended on 8/16/23. The facility had corrected the noncompliance before the investigation began. This failure could place all residents in the facility at risk for physical harm, and pain which could prevent them from achieving their highest practicable physical, mental, and psychosocial well-being. Findings included: Resident #10: Record review of a facility face sheet dated 3/6/24 for Resident #10 indicated that she was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including: chronic multifocal osteomyelitis (a disease that causes pain and damage in bones due to inflammation), other spondylosis, lumbar region (age-related degeneration of the vertebrae and discs of the lower back), type 2 diabetes mellitus with diabetic neuropathy, unspecified (high blood sugar with nerve damage caused by high blood sugar), low back pain unspecified. Record review of the Quarterly MDS assessment for Resident #10 dated 2/2/24 revealed Resident #10's BIMS=15, which indicated Resident #10 was cognitively intact. Question GG0130 E, indicated Resident #10 needed supervision or touching assistance for showering. Record review of the comprehensive care plan revised on 7/21/23 for Resident #10 indicated resident had an ADL self-care performance deficit related to muscle weakness, unsteady gait, self-care deficit, lumbar spondylosis, confusion, and sciatica (pain, weakness, numbness, or tingling in the leg). Interventions: Staff to provide required assistance for ADL's. During an interview on 3/5/24 at 11:38 AM Resident #10 said CNA A gave her a shower after just having back surgery on 8/11/23. She said CNA A was scrubbing her back really hard with the washcloth Page 1 of 4 676190 676190 03/07/2024 Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few which made her cry and complain of pain. Resident #10 said CNA A then took the washcloth and twisted it up and began slapping her on the left forearm and said, stop complaining. Resident #10 said she told her family member what happened, and he talked to the Administrator. She said CNA A was terminated from the facility. She said that was the only incident that she had and everyone else had been nice to her. During an interview on 3/6/24 at 11:40 AM Resident #10's family member said Resident #10 told him on 8/14/23, while getting a shower on 8/11/23 that CNA A had twisted up the washcloth and began slapping her on the arm because she was complaining that CNA was scrubbing her back too hard. He said Resident #10 showed him a bruise on her left forearm that was very large and that he had 2 pictures of the bruise. He said he did not remember sending an email to the business office manager but could have. He said he talked with the Administrator and wanted the police called. He said the Administrator did call the police and filed a report. He said the facility did terminate CNA A. He said he was very angry and upset about what happened. He said he was satisfied with how the facility handled the incident. During an interview on 3/7/24 at 9:00 AM the ADON said that no resident had ever complained about CNA A being mean or hurting them in any kind of way. During an interview on 3/7/24 at 9:18 AM LVN B said Resident #10 used to be on her hall. She said Resident #10 had been very sick and confused when she admitted . She said she did remember Resident #10 having back problems and pain. She said she had never received any complaints that CNA A had been rough with care or had hurt anyone in any kind of way. During an interview on 3/7/24 at 9:59 AM CNA C said there is one shower room on each hall. She said one resident can be showered at a time. She said there is only one CNA in the shower room giving a shower at a time unless the resident required a 2 person assist with care. During an interview on 3/7/24 at 10:08 AM The DON said she had worked at the facility since October of 2019. The DON said Resident #10's family member sent an email to the business office manager stating he wanted to speak to the Administrator regarding an incident with Resident #10. She said she spoke with Resident #10, and she told her that CNA A hit her on her arm with a twisted-up washcloth while she was getting a shower causing a bruise to her left forearm on 8/11/23. She said Resident #10 was cognitively intact and was able to verbalize in detail the incident. She said CNA A was suspended immediately on 8/14/23 and later terminated on 8/16/23. The DON said her expectations from her staff is never to harm or abuse any resident and to never infringe upon their rights. She said the potential negative outcome for the residents that had been abused is depression, anxiety, PTSD, physical harm and or death. During an interview on 3/7/24 at 11:23 AM the Administrator said he had worked at the facility since May of 2023. He said the facility does everything possible to prevent resident abuse including screening potential employees before hire and following all regulations. He said he expects that abuse will not happen at the facility and that all alleged abuse is reported to him immediately. He said the potential negative outcome for resident abuse is physical harm and psychosocial stress. During a phone interview on 3/7/24 at 11:12 AM CNA A said she was giving Resident #10 a shower on 8/11/23 and Resident #10 had not had a recent back surgery because there was not any sutures or staples on Resident #10's back. She said Resident #10 already had a bruise to her left forearm before her shower. She said Resident #10 never complained that she was scrubbing her back too hard or of any 676190 Page 2 of 4 676190 03/07/2024 Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few pain during her shower. She said that she had never hit Resident #10 with a washcloth on the arm. She said after the shower the ADON came to her and told her Resident #10 had said that CNA A had told her to shut up. CNA A said the facility had suspended her pending investigation and then terminated her. Record review of facility incident report dated 8/14/23 at 3:00 PM revealed Resident #10 stated that a CNA slapped her left arm with a washcloth as she was told to stop complaining on 8/11/23. Police interviewed Resident #10 and stated, I do not think any harm was caused but I do feel like the person was not as nice as she could have been. Agencies/People notified were the DON, family member, ombudsman, police, and physician. Record review of 2 pictures sent to surveyor on 3/6/24 at 12:01pm by Resident #10's family member revealed a 6cmx4cm purple discoloration and a blue band aide next to the discoloration on the resident's left forearm. Record review of a personnel file for CNA A indicated that her hire date was 7/15/23. Criminal history check indicated that it had been performed on 7/12/23. Employee misconduct registry check indicated a date of 7/11/23. No unemployable actions on either were indicated. Record review of CNA A's education record revealed CNA A had been trained on abuse, neglect, and exploitation on 8/5/2023 prior to the date of the incident on 8/11/23. Record review of a witness statement undated signed by CNA A stated on Friday when Resident #10 was being moved I took her in the shower where I saw a bruise on her arm. I forgot to document. Resident #10 had the bruise before I got her up for the shower. I let Resident #10 wash what she could on her own. I washed her back and she dried herself and I dried her back. Record review of a witness statement undated signed by CNA D stated As I was giving Resident #10 a shower me and therapy noticed she had a blue band aide on her arm. When asked what happened she stated a short girl with glasses hit her while giving her a shower. When asked was it on purpose she stated she didn't know. But she was looking for me to tell me what happened. She also stated she was washing her back really hard and when she told her it was hurting the girl told her to stop crying. I notified the Administrator. Record review of police report dated 8/14/23 at 3:23 PM revealed police were notified of incident on 8/14/23 at 3:23 PM. Officer spoke with Resident #10 on 8/14/23 at 4:11 PM. The Officer closed the incident on 8/14/23 at 4:36 PM. Record review of QAPI notes dated 9/18/23 indicated that the meeting was attended by the following members: Administrator, DON, ADON, MDS nurse, Activity Director, Social Worker, Business Office Manager, Assistant Business Office Manager, Director of Admissions, Operations Manager, Human Resources Manager and Medical Director. The interventions and plan for correction included: 1. Policies reviewed this month: Abuse/Neglect. Record review of sign in sheets for in-service dated 8/14/23 indicated that 27 staff members had signed the sign in sheet for the in-service on Preventing/Reporting Abuse. 676190 Page 3 of 4 676190 03/07/2024 Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Record review of sign in sheets for in-service dated 8/14/23 indicated that 27 staff members had signed the sign in sheet for the in-service on Abuse Q & A, Types, When to Report, S/S. Record review of sign in sheets for in-service dated 8/14/23 indicated that 27 staff members had signed the sign in sheet for the in-service on Abuse Coordinator. Record review of sign in sheets for in-service dated 8/14/23 indicated that 27 staff members had signed the sign in sheet for the in-service on Resident Rights. Record review of sign in sheets for in-service dated 8/15/23 indicated that 9 staff members had signed the sign in sheet for the in-service on Abuse. Record Review of course completion history dated 3/6/24 revealed all 115 employees had been educated on abuse, neglect, exploitation, obligation to report abuse, and understanding abuse and neglect. During an interview with approximately 30 employees on 3/6/24, all employees were able to appropriately describe the types of abuse and how to report abuse. Record review of a termination form dated 8/16/23 for CNA A indicated that she was terminated on 8/16/23. Reason for termination: Involuntary-Code of conduct violation-Gross Misconduct. Employee handbook page 29 allegations from resident. Record review of the facility policy titled Abuse: Prevention of and Prohibition Against dated 11/2017 with revision date of 10/2022 indicated .The Facility will provide oversight and monitoring to ensure that its staff, who are agents of the Facility, deliver care and services in a way that promotes and respects the rights of the residents to be free from abuse, neglect, misappropriation of resident property, and exploitation . On 3/6/24 at 1:03 pm the Administrator, and DON were informed of IJ. The non-compliance was identified as past non-compliance. The IJ began on 8/11/23 and ended on 8/16/23. The facility had corrected the noncompliance before the investigation began. 676190 Page 4 of 4