Health inspection·June 2, 2023

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure that the medication error rate was not five percent or greater. The facility had a medication error rate of 5%, based on 2 errors out of 37 opportunities, which involved two of three residents (Resident #203 and Resident #205) and two of three staff (RN A and MA A) observed during medication administration, in that: Residents Affected - Few -RN A failed to administer Amantadine (antiviral that can also be used to treat Parkinson's) to Resident #203 during the medication administration pass. -MA A failed to administer Folic Acid (Vitamin used to treat anemia) to Resident #205 during the medication administration pass because it was unavailable. These failures placed residents at risk of inadequate therapeutic outcomes, increased negative side effects, and a decline in health. Findings Include: Resident #203 Record review of Resident #203's admission Record on 6/1/23 at 12:22 p.m., revealed he was a [AGE] year-old male, residing on hall 100 and admitted to the facility on [DATE] with the following diagnoses: epilepsy (neurological disorder marked by sudden recurrent episodes of sensory disturbances, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain), encephalopathy (disease in which the functioning of the brain is affected by some agent or condition), dementia (a condition characterized by progressive or persistent loss of intellectual functioning, especially impairment of memory and abstract thinking and often with personality changes), and Gastrostomy status (an opening into the stomach from the abdominal wall, made surgically). Record review on 6/1/23 at 9:06 a.m., Resident #203's Physician Order Summary Report dated 6/1/23 revealed an active order for: Amantadine HCI oral Solution 50 MG/ML Give 10 ml via G-Tube two times a day related .Communication Method .Prescriber Written . Order Status . Active .Order Date .05/29/2023 .Start Date .05/30/2023. Record review of Resident #203's Medication Administration Record (MAR) for 6/1/2023-6/30/2023 revealed the Amantadine HCI oral solution 50mg/5ML Give 10 ML via G-Tube two times a day was scheduled for 08:00 a.m. and 4:00 p.m. Page 1 of 5 676201 676201 06/02/2023 Tuscany Village 2750 Miller Ranch Rd Pearland, TX 77584

F 0759 Observation of medication pass on 6/1/23 at 8:23 a.m., RN A administered the following medications to Resident #203 via G-Tube: Level of Harm - Minimal harm or potential for actual harm ASA 81 mg 1 chewable Residents Affected - Few Ezetimibe 10 MG 1 tab Folic Acid 1 MG 1 tab Furosemide 40 MG 1 tab Lacosamide 200 MG 1 tab Levetiracetam 100MG/ML oral solution 15 cc/ml BID Valproic Acid solution 250 mg/5ml 10cc/ml BID Vitamin B-1 100 mg 1 tab- manufacturer's dosage 1 tab Lactulose 10GM/15ml -30 cc/ml Vitamin B-6 50 MG- 1 tab Metoprolol 25 mg give 0.5 tab =12.5mg HOLD for SBP<110 OR HR <60. HELD per parameters. In an interview with RN A on 6/1/23 at 9:52 a.m., she approached surveyor on a different hall (200), in the hallway, during a different medication administration pass, and said that she had forgotten to give Resident #203 his Amantadine oral solution 50 MG/ML during the medication administration pass observation earlier. She asked surveyor to come and observe her give the medication at this time. Surveyor advised RN A that they were in the middle of conducting a different medication administration and would not be able to observe the missed medication at that time. RN A left the hallway and said she going to give Resident #203 his missed medication. Record review of Resident #203's Medication Administration Record (MAR) for 6/1/2023-6/3/2023 revealed the Amantadine HCI oral solution 50mg/5ML Give 10 ML via G-Tube two times a day was scheduled for 08:00 am and 4:00 pm and that the 08:00 am dose was initialed and signed as being administered by RN A. Resident #205 Record review of Resident #205's admission Record revealed she was a [AGE] year-old female who admitted to the facility on [DATE] and readmitted to the facility on [DATE] with the following diagnoses: sepsis (a serious condition resulting in the presence of microorganisms in the blood or other tissues and the body's response to their presence, potentially leading to the malfunctioning of various organs, shock and death), depression (an illness characterized by persistent sadness and loss of interest in activities that a person may normally enjoy, accompanied by an inability to carry out daily activities), chronic obstructive pulmonary disease (condition involving constriction of the airways and difficulty or discomfort in breathing), hypertension(elevated blood pressure), and atrial fibrillation (an irregular, often rapid heart rate that commonly causes poor blood flow). 676201 Page 2 of 5 676201 06/02/2023 Tuscany Village 2750 Miller Ranch Rd Pearland, TX 77584

F 0759 Level of Harm - Minimal harm or potential for actual harm Record review on 6/1/23 at 10:23 a.m., Resident #205's Physician Order Summary Report dated 6/1/23 revealed an active order for: Folic Acid Oral Tablet (Folic Acid) Give 0.4 mg by mouth one time a day .Communication Method .Prescriber Written .Order Status .Active .Order Date .05/11/2023 .Start Date .05/12/2023. Residents Affected - Few Record review of Resident #205's Medication Administration Record (MAR) for 6/1/2023-6/30/2023 revealed the Folic Acid Oral Tablet Give 0.4 mg by mouth one time a day which was scheduled for 09:00 am. Observation during medication pass on 6/1/23 at 10:23 a.m., MA A completed medication Administration on Resident #205 that included the following medications: Tylenol 500 MG 2 tab -Resident refused- Charge Nurse notified Prednisone 10MG 1 tab PO ASA 81 MG Chewable PO 1 tab Brilinta/ticagrelor 90MG 1 tab Leflunomide 20 MG 1 tab Xeljanz XR 11 MG 1 tab Furosemide 40 mg 1 tab Gabapentin 300 mg 1 tab Isosorbide Mono 30 MG ER 1 tab, HOLD if SBP<110 Montelukast 10 MG 1 tab Potassium Chloride micro-ER 20 MG 1 tab Allopurinol 100 MG 1 Tab Carvedilol 3.125 MG 1 tab, HOLD if SBP less than 110 or HR <60 *37. Folic Acid 0.4mg 1 tab Omitted. In an interview and observation with MA A on 06/01/2023 at 10:23 a.m., Surveyor observed MA A pull an OTC bottle of Folic Acid out of the top drawer of the medication cart. She looked at the back of the bottle and then at her computer screen and returned the bottle of OTC Folic Acid to the top drawer and proceeded to Resident #205's bedside for the completion of the medication administration pass. After she had completed the pass, surveyor asked about the Folic Acid and MA A said she needed to check on it. MA A never returned to explain to surveyor what happened with Resident #205's Folic Acid 0.4 mg. 676201 Page 3 of 5 676201 06/02/2023 Tuscany Village 2750 Miller Ranch Rd Pearland, TX 77584

F 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of Resident #205's MAR dated 6/1/2023-6/30/2023, during medication reconciliation, it was revealed that MA A documented the number (9) and initialed in the 09:00 am space allocated for the administration of Folic Acid Oral Tablet (Folic Acid) Give 0.4 mg by mouth one time a day. Further record review at that time, of chart codes revealed the following: 9=Other/See Progress Notes. Record review of Resident #205's progress notes by MA A read as follows: Folic Acid Oral Tablet Give 0.4 mg by mouth one time a day .not available, nurse notified. Record review of the facility's policy titled; Administering Medications dated revised December 2012 revealed the following: .3. Medications must be administered in accordance with the orders, including any required time frame. .4. Medications must be administered within one (1) hour of their prescribed time . 676201 Page 4 of 5 676201 06/02/2023 Tuscany Village 2750 Miller Ranch Rd Pearland, TX 77584

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility did not maintain an infection prevention program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections for the facility. Residents Affected - Many -The facility failed to have measures to prevent the possible growth of Legionella bacteria (a bacteria which can cause a serious type of pneumonia (lung infection) called Legionnaires' disease) and other opportunistic waterborne pathogens in the building water system. This deficient practice could place residents at risk of infection from waterborne pathogens. Findings include: Interview on 6/1/2023 at 12:41 PM with the DON, she said she was the facility's IP. The DON said the facility reviewed the IPCP monthly during the QAPI meeting, and quarterly during the QA meeting. She said the Medical Director comes to the quarterly meetings and reviews the IPCP during those meeting. The DON said she was unsure if the facility had a water management program. Interview on 6/2/2023 at 11:47 AM with the Admin, he said he had been provided documentation related to water observation plan implementation approximately nine months earlier. The Admin said he was unsure if the City monitored their water for Legionella bacterium or other waterborne illnesses. He said he planned to implement a water observation plan for the facility, but it was not done. Record review of the facility's Legionella Water Management Program policy dated July 2017 read in part .facility is committed to the prevention, detection and control of water-borne contaminants . The policy further read in part .our facility has a water management program . The policy revealed the water management program would include an IDT, a description and diagram of the water system, identification of areas which could encourage growth and spread of waterborne bacteria, identification of situations which could lead to waterborne pathogen growth, specific measures to control the introduction and/or spread of waterborne pathogens, a system to monitor control limits and the effectiveness of the control measures, and a plan relating to if the control limits were not met. The policy documented the water management program would be reviewed at least annually and when the control limits were not consistently met, a major maintenance or water system change occurred, any disease associated with the water system was discovered, and/or if any changes to laws, regulations, standards, or guidelines occurred. 676201 Page 5 of 5