Health inspection·September 23, 2022

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Potential for minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure each resident's assessment accurately reflected the status for 1 of 3 resident closed records (Resident #71) reviewed for assessments in that: Residents Affected - Some Resident #71's discharge MDS did not accurately reflect the residents discharge status. This deficient practice could affect residents by placing them at risk of not receiving proper care to meet their needs. The findings were: Record review of Resident #71's face sheet, dated 9/23/22 revealed a [AGE] year old female admitted on [DATE] and discharged on 6/22/22 with diagnoses that included encephalopathy (brain disease that alters brain function ad structure), dysphagia (difficulty swallowing), communication deficit and hypertension (high blood pressure). Record review of Resident #71's care plan, dated 5/2/22 revealed the resident wished to be discharged to the community when appropriate, with interventions that included to evaluate and discuss with the resident/family/caregivers the prognosis for independent or assisted living. Record review of Resident #71's Discharge to Home Instructions, dated 6/22/22 revealed the resident was discharged to an assisted living. Record review of Resident #71's discharge MDS assessment, dated 6/22/22 was inaccurately coded the resident was discharged to an acute care hospital. During an interview on 9/23/22 at 2:40 p.m., the MDS Coordinator stated, Resident #71's discharge MDS assessment was incorrectly coded the resident discharged to an acute care hospital instead of an assisted living facility. The MDS Coordinator stated she believed the Regional Reimbursement Nurse was responsible for doing audits on the MDS's quarterly. The MDS Coordinator stated Resident #71's discharge MDS was completed by the former MDS Coordinator. During an interview on 9/23/22 at 2:54 p.m., the DON stated the facility was aware of the issue they had with MDS inaccuracies and had developed a plan during their QAPI meetings to resolve the issue. Record review of the facility policy and procedure, titled Resident Assessment, undated, revealed in part, .A comprehensive assessment will be completed .The facility will utilize the Resident Page 1 of 4 676297 676297 09/23/2022 The Rio at Mission Trails 6211 S New Braunfels Ave San Antonio, TX 78223

F 0641 Assessment Instrument (RAI) .The assessment will include at least the following .h. Discharge potential .Results must be recorded to assure continued accuracy of the assessment . Level of Harm - Potential for minimal harm Residents Affected - Some 676297 Page 2 of 4 676297 09/23/2022 The Rio at Mission Trails 6211 S New Braunfels Ave San Antonio, TX 78223

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident, for 1 of 5 residents (Resident #12) reviewed for drug administration, in that: Medication Aide A had an expired medication in the medication cart prescribed to Resident #12. This deficient practice could place residents who received medications dispensed by the facility and place them at risk for not receiving a therapeutic effect. The findings were: Record review of Resident #12's face sheet, dated 9/23/22, revealed a [AGE] year old female admitted on [DATE], and re-admitted on [DATE] and 11/4/20 with diagnoses that included acute and chronic respiratory failure with hypoxia (lack of oxygen supply in the blood with levels of carbon dioxide close to normal), mild cognitive impairment, protein-calorie malnutrition, muscle wasting and atrophy (wasting [thinning] or loss of muscle tissue), muscle weakness, diabetes and anemia (lack of red blood cells that leads to reduced oxygen flow in the body's organs). Record review of Resident #12's most recent quarterly MDS assessment, dated 7/19/22 revealed a BIMS score of 14 which indicated the resident was cognitively intact for daily decision-making skills and was diagnosed with anemia and malnutrition. Record review of Resident #12's care plan, revision date 9/30/21 revealed the resident had a potential risk for malnutrition and at risk for complications related to anemia with interventions that included to administer medications as ordered. Record review of Resident #12's order summary report, dated 9/23/22 revealed an order for Prostat 30 milliliter two times daily(a prescribed medication used to increase protein needs in low volume related to muscle loss and protein-energy malnutrition) for low protein levels, with order dated 7/1/21 and no end date. Record review of Resident #12's medication administration record for September 2022 revealed the resident had been administered Prostat 30 milliliters two times daily for low protein levels from 9/1/22 through 9/22/22. During an observation and interview on 9/22/22 at 7:21 a.m., during the medication pass revealed Medication Aide A dispensed 30 milliliters of Prostat in a medication cup intended for Resident #12. Medication Aide A stated she was ready to give Resident #12 the dose of Prostat but was stopped by the surveyor. Medication Aide A was asked to read the expiration date on the half empty bottle of Prostat and she stated the medication had expired on 7/23/22. Medication Aide A stated it was the responsibility of the person dispensing medications from the medication cart to check for expired medications every two weeks. Medication Aide A stated the residents were not supposed to receive expired medications because it could cause the resident to become ill. 676297 Page 3 of 4 676297 09/23/2022 The Rio at Mission Trails 6211 S New Braunfels Ave San Antonio, TX 78223

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 9/23/22 at 9:59 a.m., the DON stated, the staff dispensing medications from the medication cart should have been checking the expiration dates for all medications prior to administering the medication to the resident. The DON stated, if the resident had been given an expired medication, it would have been considered a medication error and a medication error report would have been completed and the staff would have had to notify the physician and the resident's family. The DON stated she was unsure if giving a resident an expired medication would have caused any harm. The DON stated she and the ADON were responsible for training staff on medication administration. Record review of Medication Aide A's Medication Administration Observation/Competency Tool, dated 8/15/22 revealed she had satisfied the requirements for administering medications, including dispensing medications within date (not expired). Record review of the facility policy and procedure titled, Storage of Medications, revision date November 2020 revealed in part, .The facility stores all drugs and biologicals in a safe, secure, and orderly manner .Discontinued, outdated, or deteriorated drugs or biologicals are returned to the dispensing pharmacy or destroyed . 676297 Page 4 of 4