Health inspection·February 15, 2024

F 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to assure that residents received a therapeutic diet as prescribed by the physician for 1 of 5 residents (Resident #4) reviewed in that: Resident #4 was on a regular diet with no fried or high fat foods and was given fried okra during meal service which did not meet his dietary needs. This failure could affect residents who are prescribed a no fried or high fat foods diet and could result in heart disease or stroke. The findings include: Record review of Resident #4's face sheet dated 2/15/2024 revealed Resident #4 was a [AGE] year-old male admitted to the facility on [DATE] and had diagnoses that included colostomy status (an opening into the colon from the outside of the body, providing a new path for waste material to leave the body after bowel surgery or injury), vascular dementia (a form of dementia caused by an impaired supply of blood to the brain), bipolar disorder with psychotic features (a mental disorder that causes unusual shifts in mood, energy, activity level and concentration with delusions, hallucinations or both), pure hypercholesterolemia (a genetic disorder associated with high cholesterol), and major depressive disorder (characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life). Record review of Resident #4's physician orders revealed the resident had a diet order, with a start date 7/24/2019, which specified, NAS, no fried or high fat foods diet, mechanical soft texture, thin/regular consistency. Record review of Resident #4's Dietary Profile dated 2/5/2024 revealed NAS, no fried or high fat foods, texture mechanical soft, with regular fluid consistency and regular portions. The profile also noted the resident had no chewing or swallowing problems, required total assistance with meals, and had a good appetite. Further review of Resident #4's Dietary Profile revealed the resident's hearing and eyesight were good, however, the resident exhibited confusion. Record review of Resident #4's tray ticket dated 2/15/2024 reflected the resident was on a mechanical soft diet, NAS, no fried or high fats foods. Observation on 2/15/2024 at 12:10 p.m. revealed Resident #4 was being fed by MA B. Observation of Resident #4's meal tray revealed there was fried okra on his tray. Page 1 of 3 676274 676274 02/15/2024 River Bend Healthcare 1339 Eastwood Dr Seguin, TX 78155

F 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview on 2/15/2024 at 12:10 p.m. with MA B, she stated she did not notice that Resident #4's meal ticket indicated he had an order for no fried or high fat foods and there was fried okra on the meal tray. Interview on 2/15/2024 at 12:31 p.m. with LVN A revealed she checked each tray that came out of the kitchen and assured the meal ticket matched what was on the tray before the food was served to the resident. The LVN stated she did not catch that Resident #4's meal ticket indicated no fried foods and he was served fried okra. Interview on 2/15/2024 at 12:20 p.m. with the FSS revealed she had a new cook in the kitchen serving the noon meal service. The FSS reported the resident would not get proper nutrition and could have difficulty swallowing their meal if a resident was served the wrong diet. Record review of the facility policy, revised December 2008, titled Resident Nutrition Services revealed 2. Nursing personnel will ensure that residents are served the correct food tray, 3. Prior to serving the food tray, the nurse aide/feeding assistant must check the tray card to assure that the correct food tray is being served. If there is doubt, the Nurse Supervisor will check the written physician's order, and 4. If an incorrect meal has been delivered, nursing staff will report it to the Food Service Manager so that a new food tray can be issued. 676274 Page 2 of 3 676274 02/15/2024 River Bend Healthcare 1339 Eastwood Dr Seguin, TX 78155

F 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. 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 special eating equipment for 1 of 5 residents (Resident #1) reviewed for assistive devices in that: Residents Affected - Few Resident #1 was not provided with a plate guard (helps prevent food from accidently being pushed off the plate while eating) during meal service to minimize food spillage and help the resident remain as independent as possible. This deficient practice could affect residents who required assistive devices for meals and could result in poor nutritional intake. The findings were: Record review of Resident #1's face sheet, dated 2/15/2024 revealed she was a [AGE] year old female admitted on to the facility on 8/29/2023 and had diagnoses that included hemiplegia and hemiparesis (hemiplegia is defined as paralysis of partial or total body function on one side of the body, whereas hemiparesis is characterized by one-sided weakness, but without complete paralysis) following cerebral infarction (occurs due to disrupted blood flow to the brain due to problems with blood vessels that supply it), type 2 diabetes mellitus (when the pancreas does not make enough insulin), bipolar disorder ((a mental disorder that causes unusual shifts in mood, energy, activity level and concentration), heart disease, and mild intellectual disabilities. Record review of Resident #1's February 2024 Consolidated Physician Orders revealed the resident's diet orders initiated 8/29/2023, noted the resident was on a low concentrated sweets diet, mechanical soft texture, thin/regular consistency, and plate guard for diet. Observation on 2/15/2024 at 12:26 p.m. revealed Resident #1 was in the dining room feeding herself her lunch. Record review of Resident #1's tray ticket placed next to her plate, dated 2/15/2024, revealed the resident was on a low concentrated sweets diet, mechanical soft texture, thin/regular consistency, and plate guard for diet. Observation of Resident #1's lunch tray revealed there was not a plate guard on the resident's plate as ordered. Interview on 2/15/2024 at 12:31 p.m. with LVN A revealed she checked each tray that came out of the kitchen and assured the meal ticket matched what was on the tray before the food was served to the resident. The LVN stated she did not catch that Resident #1's meal ticket indicated the resident's plate required a plate guard to assist the resident with her meals. Interview on 2/15/2024 at 12:20 p.m. with the FSS revealed she had a new cook in the kitchen serving the noon meal service. The FSS reported if a resident did not have a plate guard according to the resident's physician orders the resident would not get proper nutrition and could result in weight loss. Record review of the facility policy, revised December 2008, titled Resident Nutrition Services, revealed, 6. Assistive devices will be made available to residents who need them. 676274 Page 3 of 3