Health inspection·January 26, 2024

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review the facility failed to develop and implement a comprehensive person-centered care plan that includes measurable objectives and time frames to meet a resident's medical and nursing needs to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 of 8 residents, Resident #8, reviewed for care plans in that: -Resident #8's care plan was not revised quarterly. This failure could place residents in the facility at risk of not being provided with the necessary care or services and having personalized plans developed to address their specific needs. The findings included: Record review of Resident #8's Face Sheet reflected an [AGE] year-old female, with an original admission date of [DATE]. Diagnoses included Dementia (Decline in cognitive abilities that impacts a person's ability to perform everyday activities), Anxiety (An unpleasant state of inner turmoil and includes feelings of dread over anticipated events), Psychotic Disturbance (a collection of symptoms that affect the mind, where there has been some loss of contact with reality) and mood disturbance (mood is distorted or inconsistent with your circumstances and interferes with your ability to function). Record review of Resident #8's MDS quarterly assessment dated [DATE] reflected a BIMS score of 00 indicating severe cognitive impairment. Record review of Resident #8's care plan initiated [DATE] indicated the next review date was [DATE]. During an Interview on [DATE] at 3:00 PM with the DON she stated the MDS coordinator and the ADON handled most care plans. The DON stated Resident #8's care plan should have been updated. The DON said they missed it. The DON stated possible negative outcomes for Resident #8 could be anything not captured in the care plan. During an interview on [DATE] at 3:10 PM with the Director of Clinical Services, she said they were very overwhelmed at the time. She said they were in the middle of an outbreak. The Director of Clinical Services said the DON, the Director of Clinical Services, the Nurse manager and the ADON all check MDS coordinator's work. She said they do not have a double check system. Page 1 of 7 676266 676266 01/26/2024 Longhorn Village 12001 Longhorn Parkway Austin, TX 78732

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a telephone interview on [DATE] at 9:00 AM with the MDS coordinator she said Resident #8's care plan was expired. She said There was a lot going on when it was due. She said they were in the middle of a covid outbreak. She stated the dietician updated her part on [DATE] and the rest of the team should have updated their parts. She stated that the care plan should be reviewed to discuss medical changes, other changes, and status. She said they had the last meeting with the resident representative on [DATE]. She stated the reason to update the care plan was to ensure they talked about significant changes. She stated if it does not happen, they could miss something. She said they do not need to go by the schedule. She stated the care plan could be updated at any time if there was a significant change. She said it depends on the resident's status and the medical status. She stated the care plan was scheduled to be updated every quarter. She said if it they do not update the care plan, they could miss something. Record review of the Care Plans Policy (Revised [DATE]); Policy Statement: A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. 11.d The interdisciplinary team reviews and updates the care plan at least quarterly, in conjunction with the required quarterly MDS assessment. 676266 Page 2 of 7 676266 01/26/2024 Longhorn Village 12001 Longhorn Parkway Austin, TX 78732

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to accommodate residents' food preferences for 2 of 8 residents (Resident #3 and #16) reviewed for food preferences. 1.The facility failed to honor Resident #3's preferences for no condiments. 2.The facility failed to honor Resident #16's preference for her dislike of mustard. This failure could result in a decrease in resident choices, diminished interest in meals, and weight loss. Findings included: 1. Record review of Resident #3's face sheet dated 01/23/24 revealed an [AGE] year-old female with diagnoses including dementia, senile degeneration of brain (reflects a long history of not understanding), abnormal weight loss, protein-calorie malnutrition, dysphagia (difficulty swallowing), and adult failure to thrive (a syndrome of global decline). Record review of Resident #3's MDS assessment dated [DATE] indicated she was rarely understood and sometimes understood simple, direct communication. Resident #3 had a BIMS score of 0 with memory problems and was cognitively severely impaired. Resident #3 had a feeding tube as well as a regular diet and required assistance with all ADL tasks. Resident #3 was on Hospice. Record Review of Resident #3's Care Plan dated 01/24/23 indicated Resident #3 required tube feeding related to her inability to meet nutrition/hydration needs through oral intake-date initiated 02/01/23 and revised 05/07/23. Resident #3's care plan also included Resident #3 had a nutritional/hydrational problem related to mental disorders, dementia, poor consumption of meals and received tube feedings daily. Resident #3 was able to feed herself in her room. She liked: hamburger plain, ice cream, cheesecake, cookies, mac and cheese, grilled cheese, and lemon-lime sodas. Record Review of Resident #3's physician orders dated 01/25/23 documented a regular diet with cut meats and (thin) regular consistency. Physician orders dated 03/03/23 documented tube feed 1 can once a day for supplement, on 02/03/23-flush g-tube with 300ml of water 3 times a day for hydration. Record review of Resident #3's family request sheet dated 02/05/23 had no condiments-plain for hotdogs and hamburger-plain-no condiments, lettuce, tomato, pickle, or anything. Record review of Resident #3's undated electronic food preferences revealed Likes: . plain hot dog, plain hamburger . Record review or Resident #3's daily menus dated 01/23/24, 01/24/24, and 01/25/24 did not indicate any preferences, likes or dislikes, nor any preferences, likes or dislikes on the Every Day menus. Observation and interview with Resident #3 on 01/23/24 at 1:49 pm revealed a hot dog with mustard & ketchup and Resident #3 stated she hated condiments and did not want the hot dog. 676266 Page 3 of 7 676266 01/26/2024 Longhorn Village 12001 Longhorn Parkway Austin, TX 78732

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2.Record review of Resident #16's face sheet had an initial admission of 07/15/22 and most recent admission dated 08/28/23 revealed a [AGE] year-old female with diagnoses including heart failure, protein-calorie malnutrition, stage 3 kidney disease, cognitive communication deficit, high cholesterol, a-fib (a type of arrhythmia, or abnormal heartbeat), dementia, unsteadiness on her feet, and anxiety. Record review of Resident #16's MDS assessment dated [DATE] indicated she had no communication deficits, and her BIMS score was 14, indicating no cognitive impairment. Resident #16 required 1-2-person assistance for mobility and transfers. Resident #16 was in a wheelchair. Resident #16 was in hospice. Record Review of Resident #16's Care Plan dated 08/28/23 indicated Resident #16 Loves milk to drink, date initiated 10/13/23, moderate protein-calorie malnutrition date initiated 09/09/23, with interventions such as able to make food and fluid needs known to staff, date initiated 01/25/24, usually eats off every-day menu, date initiated 01/25/24, regular diet with cut meats and thin liquids, date initiated 09/12/23, staff helps Resident #16 fill out menus. Resident #16 usually changes her mind for lunch and dinner once food is delivered in dining room and will order off Every-Day Menu. Or if eating in room CNA will come to kitchen asking for alternate meal if she changes her mind once delivered in her room. Staff honors food preferences. Sometimes just sits in dining room not touching meal for extended time and then will eat. Sometimes just picks at food or eats very slowly. Not a big eater. Will drink Ensure at times if eats poorly. Drinking supplements date initiated 01/25/24. Record Review of Resident #16's physician orders dated 10/07/23 documented a daily supplement drink, on 09/06/23 a different supplement drink three times a day, on 08/28/23 regular diet with cut meats and (thin) regular consistency. Record review of Resident #16's undated electronic food preferences revealed mustard in her dislikes. Record review or Resident #16's daily menus dated 01/23/24, 01/24/24, and 01/25/24 did not indicate any preferences, likes or dislikes, nor any preferences, likes or dislikes on the Every-Day menus. Observation and interview on 01/23/24 at 2:28 pm, Resident #16 was observed with an uneaten hamburger on her tray in her room. She stated it had mustard all over it and she was not going to eat it because she has requested only light mayonnaise. Resident #16 stated she was quite upset because this happened all the time. Interviews with CNAs A and B on 01/24/24 at 10:40 am revealed they sometimes helped residents with their menus daily. They stated they did not refer to the resident's preference sheets nor knew where to locate them. They stated the daily menus were generic, and they circled what the resident chose from the list, or circled the always menu, that was printed on the back of the daily menus. Interview with the DM on 01/25/24 at 8:54 am provided preference cards and a diet information sheet dated 02/05/23 from the family of Resident #3. The DM stated Resident #3 had a favorite of Asian food, and when they present it, she told them she didn't want it. If they give her time, she will eat it 100%. The DM stated they address this (preferences) in the care plan. She stated she documented new admits likes and dislikes in the electronic record and the diet roster. The DM stated she did not know if the staff referred to the preference sheets in the electronic record. The DM stated she was responsible for making sure the staff and the residents were honoring the resident's preferences. 676266 Page 4 of 7 676266 01/26/2024 Longhorn Village 12001 Longhorn Parkway Austin, TX 78732

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The DM stated the nursing staff helped with the menus daily and the kitchen staff just goes by what was on the daily menu without comparing it to the resident's preference sheets. The DM stated she believed the nursing staff was filling in condiments and such without actually asking the residents what they preferred. Interview with the DCS on 01/25/2024 at 3:26 pm stated residents had choices of dining in their room or in the dining room and they got snacks throughout the day. The DCS stated residents had options and staff documented what they (the resident's) want, and the residents can get whatever they want. She stated, it (food preferences) was a very liberal plan here, not rigid at all. They DCS stated she did not have a clue as to how residents were getting condiments or any food they did not want. The DCS stated this was a problem. The DCS stated nutritional issues could arise with residents not eating the food they did not like. The DCS stated the resident's had a right to choose what they want and do not want to eat. Record review of the Every Day menu revealed All beef hot dog (mustard/mayo/ketchup/relish). Hamburger w fries (lettuce/tomato/onion/mustard/mayo/ketchup A facility policy on resident food preferences was requested, but not provided. 676266 Page 5 of 7 676266 01/26/2024 Longhorn Village 12001 Longhorn Parkway Austin, TX 78732

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews, and record review, the facility failed to store, prepare, distribute, and serve food by professional standards for food service safety for 1 of 1 kitchen reviewed. Residents Affected - Some There were unsealed bags containing dairy products in the refrigerator. 3 of 3 steam table wells had a whitish yellow substance in them. There was a heavily dented large metal colander. There were containers of spices open to air. This failure could place residents at serious risk for complications from food contamination. The findings were: Observation during the initial tour of the kitchen on 01/23/24 at 10:00 am revealed, 2 unsealed gallon bags in the refrigerator and open to air; one contained butter, the other cheese. The steam table wells had a whitish yellow substance caked on their bottoms, and 2 had a whitish yellow substance caked inches up the sides of 3 of 3 wells. The well in the center had what appeared to be bits of food floating in murky water. There was a heavily dented large metal colander that was being used for service according to the COOK. 10 of 29, 28oz containers of spices were open to air. Interview with the COOK on 01/23/24 at 10:15 am revealed one of the unsealed bags in the refrigerator contained a large amount of butter and the other one, a large amount of shredded cheese. The COOK stated the bags should be sealed to keep the food fresh and to keep the food from possibly becoming cross contaminated. The COOK stated the residents could get sick from cross contamination. The COOK stated the heavily dented large metal colander was being used for service. The COOK stated the dented colander, or any other heavily dented pans, should not be used for service because the dents could collect bacteria in them and make the residents sick. The COOK stated the spices should not be open to air because they could clump or go bad. Return observation visit to the kitchen on 01/25/24 at 11:45 am revealed 1 of 3 steam table wells remained crusted on the bottom and sides with a whitish substance and bits of what appeared to be food floating in murky water. There were 2 of 29, 28oz containers of spices open to air. Interview with the DM on 01/25/24 at 11:45 am stated the cleaning lists showed the steam table wells were cleaned daily. The DM stated the steam table wells did not look clean. The DM stated residents could potentially get sick. The DM stated the spices and anything in the refrigerators should not be open to air. References: Food equipment standards, Food Equipment, Certification and Classification convey that equipment certified for conformance to a recognized American National Standard by an American National Standards Institute (ANSI) accredited certification program is deemed to comply with the equipment sanitation provisions contained in Food Code Chapter 4, Parts 4-1 of the Food Code, Section 4-205.10. 4-202.11 Food-Contact Surfaces. (A) Multiuse FOOD-CONTACT SURFACES shall be: (1) Smooth; (2) Free of breaks, open seams, cracks, chips, inclusions, pits, and similar imperfections (3) Free of 676266 Page 6 of 7 676266 01/26/2024 Longhorn Village 12001 Longhorn Parkway Austin, TX 78732

F 0812 sharp internal angles, corners, and crevices (4) Finished to have smooth welds and joints Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 676266 Page 7 of 7