Health inspection·May 13, 2024

F 0694 Record review of Resident #1's May 2024 TAR reflected the following orders were signed off by the ADON on 05/12/24: Level of Harm - Minimal harm or potential for actual harm - Residents Affected - Few Change needleless connector to each lumen one time a day every Sun for PICC patency at 8:00 AM Dressing change to PICC site one time a day every Sun at 8:00 AM Measure the circumference of the PICC line mid-upper arm QD and PRN every day shift at 6:00 AM Monitor PICC line site for redness, tenderness, edema, excessive bleeding at site, chest/neck/ear pain, numbness or tingling of affected arm/hand. Notify MD of abnormal findings every shift at 6:00 PM During an observation and interview on 05/13/24 at 10:57 AM, Resident #1 appeared clean, groomed, and dressed in a hospital gown. Resident #1 was observed in a semi-sitting position in bed. Resident #1 had a double lumen PICC line (two separate [purple; red] lumens [tubing] with ports) to the right upper arm covered by a transparent dressing dated 05/12/24 for IV antibiotics/fluids administration. The purple lumen did not have a needleless connector attached and the red lumen did not have a disinfectant cap placed over the end of the needleless connector to help prevent contamination. Resident #1 was Alert, attentive, and oriented to level of awareness of self, place, time, and situation. Resident #1 denied concerns about PICC line site or timeliness of care provided. During an observation and interview on 05/13/24 at 11:15 AM, LVN C said that each lumen had a needleless connector and disinfectant caps when she assessed Resident #1's PICC line site to the right upper arm. LVN C could not explain why the purple lumen was missing a needleless connector and the red lumen did not have a disinfectant cap. A sterile dressing change was observed to Resident #1's PICC line site at the right upper arm. There were no signs of redness, swelling, bleeding, or any other drainage around the catheter site was noted. One special disinfectant wipe was used to clean each lumen before placing a needleless connector to each lumen. Each port was flushed with 10 cc - 15 cc normal saline before a disinfectant cap was placed at the end of the connector. LVN C was observed appropriately connecting the scheduled IV antibiotic for administration. During an interview on 05/13/24 at 1:35 PM, the ADON indicated that she performed the task of changing Resident #1's PICC line dressing, applied new connectors to each lumen, and covered with disinfectant caps after each lumen was flushed on Sunday, 05/12/24. The ADON said that sterile dressings to PICC sites including the needleless connectors to the lumens should be changed every 7 days and PRN as reflected on the TAR. The ADON said that disinfectant caps should be placed over the end of the connector when the PICC line was not in use. During an interview on 05/13/24 at 1:42 PM, the DON indicated nurses were expected to change PICC/IV/CVC dressing changes every Sunday as scheduled/PRN and document. The DON stated the purpose of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676243 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 676243 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Remington Transitional Care of Richardson 1350 E Lookout Dr Richardson, TX 75082 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 0694 Level of Harm - Minimal harm or potential for actual harm changing PICC/IV/CVC dressings every 7 days and as needed if appeared soiled or pulled away from the skin, place residents at risk of infection associated with IV therapy. The DON was unable to locate IV management policies. The DON stated steps of procedure for PICC/IV/CVC dressing change was reviewed with the nursing staff and ensured staff understood. The DON stated surveillance was conducted throughout the day to monitor maintenance of PICC/IV/CVC to avoid complications. Residents Affected - Few During an interview on 05/13/24 at 2:00 PM, the NFA was not able to speak to the process of how central line dressings were changed and stated that the DON oversaw nursing clinical training and competency. The NFA could not produce related policies to IV Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676243 If continuation sheet Page 3 of 3