Health inspection·April 6, 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, it was determined the facility failed to provide the necessary services for residenst who are unable carry out activities of daily living receives the necessary services to maintain good personal hygiene for 1 of 5 residents reviewed for incontinent care (Resident #1) in that: Residents Affected - Few -The facility failed to ensure Resident #1's was provided incontinent care in a timely manner. This failure placed resident at risk for urinary tract infections, decrease in skin integrity, and unwanted hospitalization. Findings: Record review of Resident #1's face sheet revealed a 67year old admitted to facility initially on 10/17/2022 and again on 08/16/2022 with the following diagnosis that included: acute respiratory failure, cholecystitis (inflammation of the gallbladder (organ beneath the liver)), acute kidney failure, altered mental status, aphasia (difficulty in speaking) following cerebral infarction (stroke), and muscle weakness. Record review of Resident #1's MDS dated [DATE] revealed BIMS score of 0 (cognition severely impaired). Further record review revealed that resident required extensive to total assistance with ADL's and frequently incontinent of bowel and bladder. Record review of Resident #1's care planned date revised 09/10/2021 revealed that resident was being care planned for bowel and bladder incontinence with an intervention to use disposable briefs and change as required. Observation and interview on 04/06/2023 at 10:17 am for incontinent care of Resident #,1 who was resting in bed wearing a brief revealed Resident #1's brief was heavily soiled in urine. NA C said she made rounds on Resident #1 at 6:00 am. NA C said Resident #1 brief at that time was a little wet but did not provide incontinent care for Resident #1. NA C said she worked 6am- 2pm. NA C said that Resident #1 was a heavy wetter. NA C said she provided incontinent care for the residents every 2 hours and had not changed Resident #1's brief since she had been at work because she was busy with other residents. NA C said it was important to provide incontinent care at least every 2 hours and as need to prevent infections such as urinary tract infections. Interview on 04/06/2023 at 12:30pm the DON revealed the nursing staff should have been checking the residents every 2 hours and as need for incontinent care to prevent infections. Page 1 of 3 676251 676251 04/06/2023 Misty Willow Healthcare and Rehabilitation Center 12921 Misty Willow Dr Houston, TX 77070

F 0880 Provide and implement an infection prevention and control program. 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 maintain an infection control program to provide a safe, sanitary, and comfortable environment to help prevent the transmission of infection for 1 of 5 residents (Resident # 1) reviewed for infection control in that: Residents Affected - Few -During incontinent care for Resident #1, CNA B did not place soiled brief inside of plastic bag and instead placed soiled brief with urine on the floor. This failure placed residents at risk for infections with the potential for decline in health, quality of life, and hospitalization. Findings included: Record review of Resident #1's face sheet revealed a [AGE] year-old admitted to facility initially on 10/17/2022 and again on 08/16/2022 with the following diagnosis that included: acute respiratory failure, cholecystitis (inflammation of the gallbladder (organ beneath the liver)), acute kidney failure, altered mental status, aphasia (difficulty in speaking) following cerebral infarction (stroke), and muscle weakness. Record review of Resident #1's MDS assessment dated [DATE] revealed BIMS score of 0 (cognition severely impaired). Further record review revealed that resident required extensive to total assistance with ADL's and frequently incontinent of bowel and bladder. Record review of Resident #1's care planned date revised 09/10/2021 revealed that resident was being care planned for bowel and bladder incontinence with an intervention to use disposable briefs and change as required. Observation on 04/06/2023 at 10:17 am Resident #1 was resting in bed wearing a brief. CNA B with the assistance of NA C removed resident brief to provided incontinent care. Resident #1's brief was heavily soiled with urine. CNA B placed the soiled brief with urine on the floor at Resident #1's bedside. Interview on 04/06/2023 at 10:35 am with CNA B revealed she had been working at the NF for approximately 3 weeks. CNA B said she had not been in-serviced at the NF on infection control prevention. CNA B said she should not have place soiled materials on the floor but inside of a bag due to bacteria. CNA B said the reason she placed the materials on the floor was because she did not have a plastic bag. Observation on 04/06/2023 at 10:40 am revealed plastic bags were in the facility on housekeeping carts as well as resident rooms trash cans lined with plastic bags. Interview on 04/06/2023 at 12:30 pm the DON revealed she met with the new hires on a weekly basis to discuss what areas they needed further orientation in and to get feedback. The DON said the NF had just had training for the new hires on 03/28/2023. The DON said she learned on 04/04/2023, that CNA B did not attend but was at the NF. The DON said the staff recently received in-service on various topics including infection control prevention, handwashing, etc. Further interview with the DON revealed staff should have be placing soiled material inside of a plastic bag to prevent the spread of 676251 Page 2 of 3 676251 04/06/2023 Misty Willow Healthcare and Rehabilitation Center 12921 Misty Willow Dr Houston, TX 77070

F 0880 infections. Level of Harm - Minimal harm or potential for actual harm Record review of the NF In-service Training Report dated 03/17/2023 conducted by the DON revealed that in-service was done discussing infection control, customer service, documentation, etc. Further record review did not reveal that CNA B was in attendance. Residents Affected - Few Record review of the NF Policy on Infection Prevention and Control Program revised 10/2022 revealed in part: .The infection prevention and control program is a facility-wide effort involving all disciplines and individuals and is an integral part of the quality assurance and performance improvement program .Facility personnel will handle, store, process, and transport linens so as to prevent the spread of infection . On 04/06/2023 at 1:00pm the NF DON said she could not locate a policy on transporting soiled materials body fluids. 676251 Page 3 of 3