Health inspection·June 6, 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 that residents received appropriate treatment and services to prevent urinary tract infections for 1 of 6 residents (Resident #1) who were reviewed for incontinent care, in that: CNA A did not spread and clean Resident #1's labia and clean around the resident's bottom during incontinent care. These failures could affect residents who received incontinent care performed by facility staff and could result in urinary tract infections. Findings Included: Resident #1 Record review of Resident #1's admission face sheet revealed she was admitted to the facility on [DATE]. Her diagnoses included cerebral infarction due to thrombosis (when blood clots blocks blood flow to the brain), hypertension (high blood pressure), chronic pain (pain that last for a long time), diabetes (high blood sugar), bacteria pneumonia (infection of the lungs cause by bacteria), seborrheic dermatitis( itchy scaley patches), rash (temporary break out red, bumpy or scaly patches on the skin), and cellulitis of the abdominal wall (skin infection). Record review of Resident #1's MDS dated [DATE] for cognition revealed the resident was severely impaired for cognition. For ADL, the resident was dependent on staff for care and was always incontinent of bowel and bladder. Record review of Resident #1's care plan dated 11/09/20 revealed the resident was always incontinent of bowel and bladder: Goal - ensure that there was no evidence of skin break down over the next 90 days. Intervention: Apply moisture barrier to buttocks. Check skin for areas of redness and report changes to the nurse. Observation on 6/6/24 at 10:33 AM, revealed incontinent care for Resident #1 was done by CNA A and assisted by CNA B. CNA A washed her hands and donned clean gloves, she undo Resident#1's brief that was soiled with urine. Using the wet wipes CNA A, cleaned the groin area but did not open the labia to clean it. She repositioned the resident to her right side and clean between the resident's buttocks but did not clean around the buttocks. She changed her gloves and without washing her hands or using hand sanitizer she applied antiseptic ointment on Resident #1's buttocks and placed a clean Page 1 of 4 676310 676310 06/06/2024 Solera at West Houston 2101 Greenhouse Road Houston, TX 77084

F 0690 brief on her. Level of Harm - Minimal harm or potential for actual harm In an interview with CNA B on 6/6/24 at 10:53 AM, regarding the incontinent care performed by CNA A, she said CNA A did not open Resident #1's labia to clean it, she changed gloves without washing her hands and applied ointment to the resident's buttocks. She said had been in-services on incontinent care monthly. Residents Affected - Few In an interview with CNA A on 6/6/24 at 11:00 AM, regarding the incontinent care, she performed, she said I missed a step by not washing my hands after changing gloves. She was then asked by the surveyor about not opening Resident #1's labia to clean it and cleaning around the buttocks, CNA A said she forgot. CNA A said, not performing proper incontinent care could cause infection. Further interview with CNA A revealed she was hired 5 months ago, and a nurse monitored her and had skilled care checks done. Interview with the filled-in DON on 6/6/24 at 5:45 PM she said staffs should perform incontinent care without the potential for residents to acquire infection. She said they should open the labia and clean it. She said she was going to do one and one in-service with CNA A and observed her perform incontinent care. Record review of CNA A's personnel file revealed that the date of hire was 12/21/2023 and the skilled check for perineal care skills checklist was checked as completed on 3/14/2024. Record review of the perineal care skills checklist revised: January 2015 . read in part . 4. Using gentle downward one stroke method, clean from front to back of the perineum. Use a separate cleaning wipe for each of the outer skin folds and the labia area. 676310 Page 2 of 4 676310 06/06/2024 Solera at West Houston 2101 Greenhouse Road Houston, TX 77084

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 establish and maintain an infection control program designed to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of communicable diseases and infections for 1 of 6 residents (Resident #1) reviewed for infection control as evidence by: Residents Affected - Few CNA A did not wash hands or use hand sanitizer after changing gloves and then applied antiseptic ointment to Resident #1's buttocks. These failures could affect residents who received incontinent care performed by facility staff and could result in urinary tract infections. Findings Included: Resident #1 Record review of Resident #1's admission face sheet revealed she was admitted to the facility on [DATE]. Her diagnoses included cerebral infarction due to thrombosis (when blood clots blocks blood flow to the brain), hypertension (high blood pressure), chronic pain (pain that last for a long time), diabetes (high blood sugar), bacteria pneumonia (infection of the lungs cause by bacteria), seborrheic dermatitis( itchy scaley patches), rash (temporary break out red, bumpy or scaly patches on the skin), and cellulitis of the abdominal wall (skin infection). Record review of Resident #1's MDS dated [DATE] for cognition revealed the resident was severely impaired for cognition. For ADL, the resident was dependent on staff for care and was always incontinent of bowel and bladder. Record review of Resident #1's care plan dated 11/09/20 revealed the resident was always incontinent of bowel and bladder: Goal - ensure that there was no evidence of skin break down over the next 90 days. Intervention: Apply moisture barrier to buttocks. Check skin for areas of redness and report changes to the nurse. Observation on 6/6/24 at 10:33 AM, revealed incontinent care for Resident #1 done by CNA A and assisted by CNA B. CNA A washed her hands and donned clean gloves, she undo Resident#1's brief that was soiled with urine. Using the wet wipes CNA A, cleaned the groin area but did not open the labia to clean it. She repositioned the resident to her right side and clean between the resident's buttocks but did not clean around the buttocks. She changed her gloves and without washing her hands or using hand sanitizer she applied antiseptic ointment on Resident #1's buttocks and placed a clean brief on her. In an interview with CNA B on 6/6/24 at 10:53 AM, regarding the incontinent care performed by CNA A. She said CNA A changed her gloves but did not washed her hand and applied ointment to the resident's buttocks. She said had been in-services on incontinent care monthly. In an interview with CNA A on 6/6/24 at 11:00 AM, regarding the incontinent care, she performed, she said I missed a step by not washing my hands after changing gloves. She was then asked by the surveyor about not opening Resident #1's labia to clean it and not cleaning around the buttocks, CNA A 676310 Page 3 of 4 676310 06/06/2024 Solera at West Houston 2101 Greenhouse Road Houston, TX 77084

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few said she forgot. CNA A said, not performing proper incontinent care could cause infection. Further interview with CNA A revealed she was hired 5 months ago, and a nurse monitored her and had skilled care checks done. Interview with the filled-in DON on 6/6/24 at 5:45 PM she said staffs should perform incontinent care without the potential for residents to acquire infection. She said they should open the labia and clean it and should change gloves or use hand sanitizer or wash hands when a task was completed She said she was going to do one and one in-service with CNA A and observed her perform incontinent care. Record review of the Patient Care Management 8 Infection Controldated November 2017 did not address hand washing. 676310 Page 4 of 4