Health inspection·September 17, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 provide the necessary services for residents who are unable to carry out activities of daily living to maintain good grooming and personal hygiene for 2 (Resident #1, Resident #2) of 6 residents reviewed for ADLs. Residents Affected - Some The facility failed to ensure: 1Resident #1 had his fingernails trimmed and cleaned. 2Resident #2 had his fingernails trimmed and cleaned. This failure could place residents who were dependent on staff for ADL care at risk for loss of dignity, risk for infections, injuries to self or other residents, and a decreased quality of life. Findings include: 1Review of Resident #1's Comprehensive MDS assessment dated [DATE] reflected Resident #1 was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses included elevated blood pressure and schizoaffective disorder. Resident #1 had a BIMS of 5 which indicated Resident #1's cognition was severely impaired. He required extensive assistance of two-persons physical assistance with bed mobility and toilet use. He required extensive assistance of one-person physical assistance with personal hygiene. Review of Resident #1's Comprehensive Care Plan, revised 07/12/23, reflected the following: Problem: Resident may require staff assistance for ADL's related to decreased mobility at times. Goal: Resident will increase independence with ADLS. Interventions: Staff to assist with ADLs as needed. An observation on 09/17/23 at 2:22 PM revealed Resident #1 was walking in the hallway using the walker. The nails on both hands were approximately 0.4 cm in length extending from the tip of his fingers. The nails were discolored tan and the underside had dark brown colored residue. Resident #1 unable to answer questions. Page 1 of 2 676217 676217 09/17/2023 Royse City Medical Lodge 901 W Interstate 30 Royse City, TX 75189

F 0677 2- Level of Harm - Minimal harm or potential for actual harm Review of Resident #2's Comprehensive MDS assessment, dated 07/26/2023, reflected Resident #2 was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses included hemiplegia (paralysis that affects only one side of the body) following cerebral infarction (occurs as a result of disrupted blood flow to the brain due to problems with the blood vessels that supply it) affecting left side and type 2 diabetes mellitus. Resident #2 had a BIMS of 15 which indicated Resident #2's cognition was intact. Resident #2 required extensive assistance of two-persons physical assistance with bed mobility, transfers, and personal hygiene. Residents Affected - Some Review of Resident #2's Comprehensive Care Plan, revised 07/18/23, reflected the following: Problem: Resident may require staff assistance for ADL's related to hemiplegia with left sided weakness. Goal: Resident will increase independence with ADLS. Interventions: Staff to assist with ADLs as needed. Observation and interview on 09/17/23 at 2:44 PM revealed Resident #2 was laying in his bed. The nails on both hands were approximately 0.3cm in length extending from the tip of his fingers. The nails were discolored tan and the underside had dark brown colored residue. Resident #2 stated they told me they do nail trimming once a month . Resident#2 stated he did not like his nails long and dirty. Interview on 07/17/23 at 2:45 PM, CNA A stated CNAs were allowed to cut the residents' nails if they were not diabetic. CNA A stated she would check with the nurse, if both residents, Resident #1, and Resident #2 were not diabetic, she would clean and trim their nails. Interview on 07/17/23 at 2:50 PM, LVN B stated CNAs were responsible for cleaning and trimming residents' nails during the showers and as needed. LVN B stated only nurses cut residents' nails if they were diabetic. LVN B stated no one notified her Resident #1 and Resident #2's nails were long and dirty, and she had not noticed the nails herself. LVN B stated Resident #1 was not diabetic, but Resident#2 was diabetic, and she would clean and trim their nails. Interview on 09/17/23 3:52 PM, the DON stated nail care should be completed as needed and every time aides wash the residents' hands. The DON stated nails should be observed daily. The DON stated nurses were responsible for trimming the nails of residents who were diabetic, and CNAs could trim other residents' nails. The DON stated she expected CNAs to offer to cut and clean nails if they were long and dirty. The DON stated residents having long and dirty could be an infection control issue. DON stated she was responsible for routine rounds for monitoring. Record review of the facility's policy titled Care of Fingernails/Toenails, revised October 2010, reflected Purpose: The purposes of this procedure are to clean the nail bed, to keep nails trimmed, and to prevent infections. 1. Nail care includes daily cleaning and regular trimming . 676217 Page 2 of 2