Health inspection·January 4, 2024

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents who were incontinent of bladder or had a urinary catheter received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 1 of 3 Residents (Resident #1) reviewed for incontinent care, in that: 1. CNA B failed to properly clean the groin area and right and left buttock area while providing perineal care for Resident #1., leaving urine on the skin of Resident #1. This failure could affect residents by placing them at increased risk of exposure to communicable diseases, spread of infections, and skin breakdown. Findings include: Resident #1 Record review of face sheet for Resident #1, dated 01/03/24, revealed a [AGE] year-old male admitted to the facility on [DATE] with the following diagnoses: cerebral palsy (disorders that affect a person's ability to move and maintain balance and posture), depression (mental illness), and seizure disorder. Review of Resident #1's comprehensive MDS, dated [DATE] revealed Resident #1 had a BIMS of 00 which indicated the resident's cognition was severely impaired. He required total dependence with one person assist with personal hygiene and toilet use. Record review of Resident #1's Comprehensive Care Plan dated 12/05/23 revealed the resident required assistance with toileting and personal hygiene. The interventions included assistance of one to be able to complete personal hygiene, and assistance of 1 person for toileting. Resident #1 was incontinent of bowel with intervention to provide peri care after each episode of bowel incontinence. Resident #1 was at risk for pressures ulcers related to bowel and bladder incontinence. The interventions included check resident as needed for incontinence and provide peri care after incontinent episodes. During an observation on 01/03/2024 at 2:07 PM CNA B was providing incontinent care for Resident #1, with CNA C assisting CNA B with turning Resident #1. During peri care for Resident #1, CNA B did not provide the correct technique needed to clean Resident #1. Observed Resident #1 brief wet with urine. Observed CNA B using a clean wipe and repetitively wiping all over the groin area in a circular Page 1 of 9 676279 676279 01/04/2024 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few motion with the same wipe. CNA B and CNA C turned Resident #1 over to the right side to clean the buttock area. CNA B used one wipe to wipe upward in the center going from the anus up toward the back. CNA B disposed of that wipe, then grabbed another clean wipe and repeated cleaning the center of the buttocks area, wiping from the anus up toward the back in the center. CNA B disposed of that wipe. CNA B and CNA C proceeded in putting a clean brief on Resident #1. CNA B did not wipe the left or the right side of the buttocks. During an interview on 1/03/2024 at 2:21 PM with CNA B and CNA C, she stated that she has had training in peri care. CNA B stated that the training that she had received was verbally with the DON and she has had skills checks once a month with the DON. CNA B stated that the negative potential outcome for not using the correct peri care technique was the spread of infection. CNA B stated that she was uncertain what the policy stated on peri care techniques. CNA B and CNA C stated that she understood why it was deficient practice. During an interview on 01/04/2024 at 9:20 AM with the DON, she stated that she expects staff to clean all of the skin to complete peri care in order to keep the skin clean and dry and not leave acidic residue on the skin. The DON stated that if the skin was not cleaned correctly or properly that it could cause skin to break down or cause skin to become macerated (soften or become softened by soaking in a liquid). The DON stated that staff was trained through in-services as often as needed and if there are issues that need to be addressed. The DON stated that the staff do also attend a skills fair that was held once a year and the staff was able to perform return demonstration in these fairs. The DON stated that each staff was also given a competency check annually and upon hire. During an interview on 01/04/2024 at 9:20 AM with the Administrator, she stated that she expects staff to do a great job with all peri care and to keep all the acidity and bacteria from causing skin breakdown. The Administrator stated that the negative potential outcome was that the urine could cause skin breakdown by not cleaning the skin properly. Administrator stated that the training that was provided to the staff was in the form of in-services when there was an issue or the yearly skills fair. Administrator stated that in-services were completed as needed. Record Review of facility provided policy, labeled, Perineal Care, date Revised in October 2022, revealed: The purposes of this procedure are to provide cleanliness and comfort to the resident, to prevent infections and skin irritation, and to observe the resident's skin condition. Steps in procedure: 9. For a male resident: a). Wipe the perineal area starting with urethra and working outward. 1). Retract the foreskin of the uncircumcised male. 2). Wipe urethral area using a circular motion. 3). Continue to wipe the perineal area including the penis, scrotum, and inner thighs with wipe. Do not reuse the same wipe to clean the urethra. B). Reposition foreskin of uncircumcised male. C). Instruct or assist the resident to turn on his side with his upper leg slightly bent, if able. D). Wipe the rectal area thoroughly, including the area under the scrotum, the anus, and the buttocks with wipe. 676279 Page 2 of 9 676279 01/04/2024 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 ensure that residents who need respiratory care were provided such care consistent with professional standards of practice for 4 of 16 residents (Resident #21, #49, #56, and #349) reviewed for Respiratory Care. Residents Affected - Some The facility failed to follow MD orders for initial and dating oxygen supplies for Resident #21, #49, #56, and #349. This deficient practice has the potential to affect residents by placing them at an increased risk of respiratory compromise, infections, pneumonia, respiratory distress, and sepsis. Findings include: Resident #21 Record Review of Resident #21's face sheet dated 1/3/24 revealed an [AGE] year-old male with an admission date of 6/19/14 with the following diagnosis: Parkinson's (disease of the nervous system), chronic obstructive pyelonephritis (inflammation and scarring induced), hypothyroidism (low thyroid), shortness of breath, muscle weakness, and depression. Record review of Resident #21's annual MDS dated [DATE] Section O - Special Treatments, Procedures and Programs revealed Resident #21 used oxygen therapy while a resident. Record Review of Resident #21's Care Plan, initiate date 11/19/21, reveals resident requires Oxygen therapy interventions included applying oxygen as ordered, monitoring lung sounds, respirations, presence of cough. Assess for symptoms of poor oxygenation, report to MD/NP . Change/clean/date equipment per facility policy. Keep oxygen tubing off floor. Record Review of Resident #21's current Physician Orders dated 11/17/21 revealed an order dated 11/17/21 to change nasal cannula and tubing every week on Sundays. Initial and date tubing. every night shift, every Sunday. Resident #49 Record review of Resident #49's face sheet dated 1/03/24 revealed a [AGE] year-old female with an admission date of 01/31/22 with the following diagnoses: chronic obstructive pulmonary disease (airflow blockage and breathing-related problems), weakness (state of lacking strength), acute diastolic congestive heart failure (heart condition), osteoarthritis (degenerative joint disease), hypothyroidism (thyroid condition), and hypertension (high blood pressure). Record review of Resident #49 quarterly MDS dated [DATE] Section O - Special Treatments, Procedures and Programs revealed Resident #49 used oxygen therapy while a resident. Record Review of Resident #49 Care Plan, dated 02/02/22, revealed Resident #49 used oxygen related to Chronic Obstructive Pulmonary Disease (COPD). Interventions included to apply oxygen as ordered, change, clean, and date equipment per facility policy. 676279 Page 3 of 9 676279 01/04/2024 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record Review of Resident #49's current Physician Orders dated 01/03/24 revealed an order dated 02/02/22 to change oxygen equipment and clean filters weekly. Initial and date all tubing when changed. (Every night shift, every Sunday). Physician Orders further revealed an order for Oxygen: May have oxygen at 2-3L via nasal cannula by concentrator dated 02/02/22. Record Review of Resident #49 Treatment Administration Record dated 1/3/24 revealed oxygen was administered 12/1/23 through 1/3/24 and that oxygen tubing was last changed on 12/31/23. Resident #56 Record review of Resident #56's face sheet dated 1/02/24 revealed a [AGE] year-old-male with an admission date of 09/29/21 with the following diagnoses: post-traumatic stress disorder (PTSD) (mental illness), chronic pain (long-standing pain), and hypertension (high blood pressure). Record review of Resident #56's annual MDS dated [DATE] Section O - Special Treatments, Procedures and Programs revealed Resident #56 used oxygen therapy while a resident. Record Review of Resident #56's Care Plan, dated 12/05/22, revealed Resident #56 used oxygen related to shortness of breath. Interventions included to apply oxygen as ordered, change, clean, and date equipment per facility policy. Record Review of Resident #56's current Physician Orders dated 01/02/24 revealed an order dated 12/04/22 to change oxygen equipment and clean filters weekly. Initial and date all tubing when changed. (Every night shift, every Sunday). Physician Orders further revealed an order for Oxygen: May have oxygen PRN at 2-3L via nasal cannula by concentrator as needed for shortness of breath dated 12/05/22. Record Review of Resident #56's Treatment Administration Record dated 1/03/24 revealed oxygen tubing was last changed on 12/31/23. Resident #349 Record review of Resident #349's face sheet dated 1/3/24 revealed a [AGE] year-old female with an admission date of 12/24/23 with the following diagnoses : chronic obstructive pulmonary disease (diseases that cause airflow blockage and breathing-related problems), depression, metabolic encephalopathy (chemical imbalance in the blood), hypertension (high blood pressure), chronic respiratory failure, and chronic pain. Record Review of Resident #349's initial care plan dated 12/24/23 indicates resident requires oxygen therapy. Interventions include Apply oxygen as ordered. Monitor lung sounds, respirations, presence of cough, assess for symptoms of poor oxygenation, report to MD/NP, change/clean/date equipment per facility policy. Record review of Resident #349's physician orders dated 12/24/23 revealed an order dated 12/24/23 to change nasal cannula and tubing every week on Sundays. Initial and date tubing. During observation on 1/2/24 at approximately 10:00 AM Resident #349 had no date or initials on nasal cannula tubing. 676279 Page 4 of 9 676279 01/04/2024 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0695 Level of Harm - Minimal harm or potential for actual harm During an observation on 1/2/24 at 10:38 AM Resident #56 had no date or initials on tubing or humidification bottle. During an observation on 1/2/24 at 10:55 AM Resident #49 had no date or initials on tubing or humidification bottle. Residents Affected - Some During and observation on 01/03/24 at 09:49 AM Resident #349 resident had no date or initials on nasal canula tubing. During an observation on 1/3/23 at 10:02 AM Resident #49 had a label on the oxygen tubing dated 1/1/24. During an observation on 1/3/24 at 10:03 AM Resident #56 had no date or initials on tubing or humidification bottle. During an observation on 01/03/24 at 10:24 AM of Resident #21 resident had no date or initials on nasal cannula tubing. During an interview on 01/03/24 at approximately 10:45 AM with the DON, she said they do not have a policy that states anything about labeling the tubing, but they usually follow the physician orders on when to change it. During an interview on 1/3/24 at 11:36 AM, LVN A said she was the Charge Nurse today. LVN A said the Sunday night nursing staff were responsible to ensure that all oxygen tubing was changed, dated, and initialed. She said all other nursing staff were responsible for spot checking the oxygen tubing to ensure it was all dated and labeled on all other days and shifts during the week. She said she had staff spot check, change, date, and label Resident #56's and Resident #49's oxygen tubing this morning when she was made aware that it was not done this past Sunday. She said there were physician's orders requiring the tubing to be labeled and dated. She said staff were trained to label and date oxygen tubing at the same time it was being changed. She said potential negative outcomes of the tubing not being labeled or dated were that the tubing could get plugged up, which would prevent the oxygen from flowing properly, and that it could cause an infection. During an interview on 01/03/24 at 11:38 AM with LVN B, she confirmed resident's tubing was dated 12/25/23 and it should have been changed out last Sunday 12/31/23. During an observation on 1/3/23 of Resident #349 at 11:40 AM, nasal cannula tubing labeled 1/3/23, no initials were observed. During an observation on 1/3/23 at 12:50 PM Resident #56 had a label on the oxygen tubing dated 1/1/24. During an interview on 1/3/24 at 12:51 PM, CNA A said she has worked at the facility for three months. She said she was instructed by LVN A this morning to change, date, and initial the oxygen tubing on Resident #56 and Resident #49's oxygen tubing. CNA A said she does not usually change or date the oxygen tubing as the Sunday night staff were responsible for completing this task. CNA A said she was told by LVN A this morning to change the oxygen tubing and write the date 1/1/24 on the tubing, because that was the date the tubing was originally supposed to be changed, so she did what she was told to do. She said she was trained that oxygen tubing was supposed to be dated and labeled at the 676279 Page 5 of 9 676279 01/04/2024 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some time it was being done by the staff who was doing it. CNA A said she was trained properly, and she knew she should have written today's date on the tubing and that it was wrong for her to back date the date on the tubing. She said a potential negative outcome was that old tubing could get clogged, grow bacteria, and cause the residents to get sick. During an interview on 1/3/24 at 1:27 PM with LVN B, she said the negative effects of not changing tubing as ordered can be the tube getting dirty, clogged, nor working the way it should be working. LVN B said night shift usually changes the tubing during the weekend but overall, it was everyone's responsibility to change the tubing if its outdated. LVN B said the physician orders do state to change the tubing every Sunday and to label with date and time as well. She said they were trained yearly and as needed on respiratory care. During an interview on 1/3/24 at 1:29 PM with LVN C, she said tubing not labeled with date and time can increase risk of infection if it was left on for too long. She said nurses and aides were responsible for checking the tubing and making sure they were up to date. She said physician orders state to change tubing every Sunday at night. She said they have training annually and as needed. During an interview on 01/03/24 at 2:55 PM with ADON, she said negative effects of outdated tubing would be risk of bacteria buildup, and mucus build up. She said the goal was to minimize infection. She stated the expectation of her staff was If the cannula needs to be changed whoever puts it on needs to date it. She said oxygen tubing was changed every week by night shift. She said the facility has a template order that was initiated on admission and the oxygen orders were included. She said the physician orders do state the day the oxygen tubing needs to be changed as well as to be dated and timed. She said training was done annually with nurse competencies. During an interview on 1/03/24 at 3:20 PM with DON and ADM, the DON said it was the facility policy and the responsibility of all staff to ensure physician's orders were followed. She said the physician's orders state oxygen tubing was to be changed, dated, and initialed on Sunday nights. She said Sunday night nursing staff were responsible to change, date, and initial oxygen tubing. She said she was not aware the tubing was not being dated and initialed by nursing staff as she assumed it was being done as per the orders. She said all ADON's were responsible to complete spot checks during the week and provide education to staff when they identify a situation of physician orders not being followed, and they will also address the issues with staff if residents bring it to their attention. She said herself, ADM, all ADON's, and charge staff were all responsible for training staff to follow physician's orders, changing, dating, and initialing oxygen tubing. She said she believes staff were trained to follow physician orders and how to properly change oxygen tubing during their onboarding training as well as during their annual respiratory care training. She said it was important for tubing to be dated and initialed, so staff were aware of the last time it was changed to ensure the orders were being followed. She said a potential negative outcome of not dating and labeling the tubing was that they cannot verify if it was being done weekly per the orders. She said not dating and initialing the oxygen tubing would not prevent the resident from receiving the oxygen as ordered. She said she would have to evaluate each resident on a case-by-case basis to determine the risk of how not following physician's orders would negatively affect the resident. She said another negative potential outcome was that the tubing could not be clean and condensation buildup. The DON said staff were expected to change, initial, and date oxygen tubing with the correct date and time on it as per physician orders if they discover unlabeled tubing. ADM said staff were expected to change, date, and initial the tubing at the time they were doing it by the staff member that was doing it. The ADM said herself, DON, and ADON's were responsible for training staff. The ADM said staff were trained annually on these competencies. The ADM said it was incorrect for a staff to backdate when dating the 676279 Page 6 of 9 676279 01/04/2024 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0695 Level of Harm - Minimal harm or potential for actual harm oxygen tubing. The ADM said staff should mark the current date on the tubing. The ADM said she agrees with the negative outcomes that DON said. She said the physician orders do include the days tubing should be changed and the tubing should be dated and initialed when placed on a resident. The ADM said she expected staff to follow physician's orders. Residents Affected - Some Record review facility policy titled Oxygen Administration, dated 10/2010 revealed the following: Preparation: . .1) Verify that there is a physician's order for this procedure. Review the physician's orders of facility protocol . 676279 Page 7 of 9 676279 01/04/2024 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored in locked compartments for 1 of 4 medication carts (med cart on Diamond Hall for rooms 414-429), The facility failed to ensure that medication carts were secured when unattended. This failure could place residents at risk of having access to unauthorized medications and/or lead to possible harm, drug overdose, or drug diversions. The findings include: On 1/4/24 at 9:48 AM, an observation of medication pass for Diamond Hall (rooms 414-429) was conducted with CMA A. During the medication pass for room [ROOM NUMBER], CMA A was observed leaving the medication cart unlocked and unattended in the hallway, while entering a resident room to administer medications. Resident had questions regarding a medication, requiring CMA A to have an extended interaction with the resident while medication cart was left unlocked and unsupervised in hallway. On 1/4/24 at 10:02 AM, an observation of medication pass for Diamond Hall (rooms 414-429) was conducted with CMA A. During the medication pass for room [ROOM NUMBER], CMA A was observed leaving the medication cart unlocked and unattended in hallway, while entering a resident room to administer medications. Record review of the facility provided in-services, labeled Oral Medication Administration Skills Checklist revealed CMA A signed and met criteria for the skills check. On 1/4/24 at 10:18 AM, an interview was conducted with CMA A. During the interview, CMA A stated she did leave her medication cart unlocked and unattended, but thought it was ok if the cart was in the hallway and facing the doorway. CMA A stated she did not have visualization of the cart while interacting with the resident in the room, as her back was to the hallway. CMA A stated she had been trained but she did not remember what the facility's policy was for locking medication carts. On 1/4/24 at 10:57 AM, an interview was conducted with the DON who stated the facility's policy was that medications would be secured on carts at all times. The DON stated it was her expectation of staff to follow facility policy 100% of the time. The DON stated a potential negative outcome of unlocked medication carts/unsecured medications would be that it could allow residents or other individuals access to medications on the cart. On 1/4/24 at 10:59 AM, an interview was conducted with the ADM who stated it was her expectation that the medication cart is locked at all times when unattended. The ADM stated a potential negative outcome of unlocked medication carts/unsecured medications would be that it could potentially allow unwanted access to medications by other individuals. Record review on 1/4/24 of facility provided policy labeled, Medication Labeling and Storage, date revised in February 2023, revealed: 676279 Page 8 of 9 676279 01/04/2024 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0761 Policy heading: Level of Harm - Minimal harm or potential for actual harm The facility stores all medications and biologicals in locked compartments under proper temperature, humidity, and light controls. Only authorized personnel have access to keys. Residents Affected - Few Policy Interpretation and Implementation: Medication Storage: 4. Compartments (including, but not limited to, drawers, cabinets, rooms, refrigerators, carts, and boxes) containing medications and biologicals are locked when not in use, and trays or carts used to transport such items are not left unattended if open or otherwise potentially available to others. 676279 Page 9 of 9