Health inspection·November 21, 2025

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 observations, interviews, and record review, the facility failed to ensure that residents who needed respiratory care were provided with such care, consistent with professional standards of practice, for 5 of 7 residents (Resident #1, Resident #2, Resident #3, Resident #4, and Resident #5) reviewed for quality of care.The facility failed to ensure Resident #1, Resident #2 , Resident #3, Resident #4, Resident #5's nebulizing masks and/or oxygen canulas were bagged for sanitation when not in use on 11/06/25.This failure could place residents at risk for respiratory infections. The findings included:Record review of Resident #1's face sheet, dated 11/06/25, revealed a [AGE] year-old male, admitted on [DATE]. His diagnoses were multiple fractures of ribs, pulmonary embolism (block by blood clot in lung's artery), Parkinson's disease (kind of neurological disorder), acute respiratory failure with hypoxia (less oxygen), abnormalities of gait and mobility and muscle wasting and atrophy. Resident #1 was sent out to the hospital on [DATE] and returned to the facility on [DATE].Record review of Resident #1's initial MDS assessment, dated 11/03/25, revealed a BIMS score of 10 indicating his cognition was moderately impaired. Record review of Resident #1's care plan, dated 10/23/25, reflected Resident #1 had altered respiratory status/difficulty breathing r/t acute respiratory failure due to PE. The relevant intervention was administering medication/puffers as ordered and monitoring for effectiveness and side effects. Record review of Resident #1's physician's order reflected: Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% 3 milliliters: Inhale orally via nebulizer every 6 hours as needed for wheezing. -Start Date- 11/01/2025. During an observation and interview on 11/06/25 at 10:45 a.m., Resident #1 was in his room. It was observed the mask of his nebulizer was on the side table beside the nebulizing machine. It was exposed to the air and was not in a protective bag. Resident #1 stated he used the nebulizer as needed but not often. Record review of Resident #2's face sheet, dated 11/06/25, revealed an [AGE] year-old female, admitted [DATE]. Her diagnoses were dementia, type 2 diabetes, chronic respiratory failure (Lungs cannot get enough oxugen and remove carbon dioxide) , chronic obstructive pulmonary disease ( breathing difficulty) , muscle weakness, hypertension and chronic cough. Record review of Resident #2's quarterly MDS assessment, dated 09/01/25, revealed a BIMS score of 15 indicating her cognition was intact. Record review of Resident #2's care plan, dated 05/22/25, reflected Resident #2 had emphysema/COPD (lung disease that causes breathing difficulties). The relevant intervention was giving aerosol or bronchodilators as ordered and monitoring /documenting any side effects and effectiveness. Record review of Resident #2's physician's order reflected: Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML 3 ml: Inhale orally via nebulizer every 4 hours as needed for SOB or wheezing related to chronic obstructive pulmonary disease, unspecified. -Start Date- 07/20/2025. During an observation and interview on 11/06/25 at 11:20 a.m., Resident #2 was in her room relaxing in her wheelchair. The nebulizer and its mask were on her bed among the pillows and blanket. Resident #2 stated she was able to self-administer medication via nebulizer; however, staff also helped her with Residents Affected - Some Page 1 of 3 676345 676345 11/21/2025 Bel Air at Teravista 4105 Teravista Club Drive Round Rock, TX 78665

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some it. She stated no one instructed her to put the mask in a protective bag. An observation at that time revealed there was no protective bag available in her room. She stated she did not get any education on storing the mask. Record review of Resident #3's face sheet, dated 11/06/25, revealed a [AGE] year-old female, admitted [DATE]. Her diagnoses were acute respiratory failure, heart failure, shortness of breath, obstructive sleep apnea, type 2 diabetes, hemiplegia and hemiparesis ( one side paralysis) , muscle weakness, cognitive communication deficit, and anxiety disorder. Record review of Resident #3's initial MDS assessment, dated 05/06/25, revealed a BIMS score of 12 indicating her cognition was moderately impaired. Record review of Resident #3's care plan, dated 06/10/25, reflected Resident #3 had oxygen therapy r/t respiratory failure with hypoxia (low oxygen level in blood), acute on CHF. The relevant intervention was providing oxygen as ordered and medications as ordered by physician and monitoring/ documenting side effects and effectiveness.Record review of Resident #3's physician's order reflected: Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% 3 milliliter: Inhale orally via nebulizer every 4 hours as needed for Shortness of breath/wheezing. -Start Date- 07/20/2025. During an observation and interview on 11/06/25 at 1:35 p.m., Resident #3 was in her room lying in her bed awake. She stated she received medication via nebulizer for shortness of breath on an as needed basis. It was observed that her nebulizer with its mask was on the side table. There was no protective bag available for the mask and it was exposed to the air. Record review of Resident #4's face sheet, dated 11/06/25, revealed a [AGE] year-old female, admitted [DATE]. Her diagnoses were acute and chronic respiratory failure, dementia, chronic obstructive pulmonary disease, muscle weakness, cognitive communication deficit, type 2 diabetes mellitus and cough. Record review of Resident #4's initial MDS assessment, dated 07/29/25, revealed a BIMS score of 13 indicating her cognition was intact. Record review of Resident #4's care plan, dated 04/28/25, reflected she had altered respiratory status/difficulty breathing r/t acute respiratory failure, COPD, CHF and, OSA. The relevant intervention was administering medication/puffers as ordered and monitoring for effectiveness and side effects. Record review of Resident #4's physician's order reflected: Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML 1 vial: Inhale orally vianebulizer two times a day for SOB/wheezing for 3 Days -Start Date- 11/06/2025. During an observation and interview on 11/06/25 at 1:10 p.m., Resident #4 was in her room sleeping. Her nebulizer was on the side table and the mask was on the floor. Resident #4 stated she was not sure how long it was on the floor . Record review of Resident #5's face sheet, dated 11/06/25, revealed a [AGE] year-old male, admitted [DATE]. His diagnoses were sepsis due to Escherichia coli, urinary tract infection, acute congestive heart failure, acute kidney failure, type 2 diabetes mellitus, chronic obstructive pulmonary disease, muscle wasting, muscle weakness, cognitive communication deficit and, pain. Record review of Resident #5's initial MDS assessment, dated 10/29/25, revealed a BIMS score of 11 indicating his cognition was moderately impaired. Record review of Resident #5's care plan, dated 10/22/25, reflected Resident #5 had oxygen therapy r/t COPD and the relevant intervention was providing oxygen as ordered. Record review of Resident #5's physician's order reflected: Oxygen: Oxygen at 2L/M per NC cannula every shift. -Start Date-10/23/2025. During an observation on 11/06/25 at 11:00 Resident #5 was not in his room. There was an oxygen concentrator, and the cannula of the concentrator was folded and hung on the machine. There was no protective bag in the room. During an observation and interview on 11/06/25 at 2:25 p.m., the nasal cannula and tubing of Resident #5 were in a plastic bag hung on the concentrator. RN C stated she kept it in the protective bag when observed in the afternoon that it was hanging on the oxygen concentrator without a bag. She stated Resident #5 used oxygen therapy every shift and was in the process of weaning off from it. RN C stated she knew protective bag helped to minimize contamination and thus 676345 Page 2 of 3 676345 11/21/2025 Bel Air at Teravista 4105 Teravista Club Drive Round Rock, TX 78665

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some respiratory infection. During an interview on 11/06/25 at 1:45pm, LVN A stated she was the charge nurse for Resident #1, Resident #3, and Resident #4. LVN A stated she was responsible for ensuring the nebulizer masks were in the protective bag. She stated it was her mistake and she did not ensure the masks were protected from contamination. She stated it was essential to minimize the risk of infection, especially respiratory infection. She stated she did not remember attending any in-service on this subject, however, was aware of the importance of it from her professional knowledge. During an interview on 11/06/25 at 1:50 p.m., LVN B stated she worked with Resident #2 this day. She stated Resident #2 handled the nebulizer independently and had the habit of keeping it anywhere. LVN B stated she did not know if Resident #2 was supervised at any time to make sure she stored the mask safely or was educated on the importance of storing in a protective cover . LVN B stated the necessity of storing it in protective cover was to protect the mask from contamination and it was the responsibility of the nurse to make sure it was done appropriately. She stated she did not remember if she received any in service in this regard at the facility. During an interview on 11/06/25 at 2:40 p.m., the DON stated it was a common practice that the residents used nebulizers by themselves and left them anywhere. When the investigator informed him that there were no protective bags available in any of the residents' rooms, he stated that was because the usual practice at the facility was storing them in a drawer. The DON stated one of the practices at the facility to reduce infection was minimizing contamination. He stated technically the nebulizer masks were to be cleaned and safely stored in the protective bags provided, however, in reality, this rarely happened. The DON stated there was no system in place to ensure the nurses were doing this properly and wanted to make sure the staff were diligent in this practice in the future. Record review of the facility's policy, titled Oxygen Administration, dated October 2010, had not reflected the necessity for storing oxygen/nebulizer tubing, cannulas, and facemasks in protective bags when not in use.Record review of web site https://www.nhlbi.nih.gov/sites/default/files/publications/How-to-Use-a-Nebulizer-21-HL-8163.pdf reviewed on 11/10/25 reflected: . Between uses: Store nebulizer parts in a dry, clean plastic storage bag. If the nebulizer is used by more than one person, keep each person's medicine cup, mouthpiece or mask, and tubing in a separate, labeled bag to prevent the spread of germs. Wipe the surface with a clean, damp cloth as needed. Cover nebulizer machine with a clean, dry cloth and store as stated in the instructions. Replace medicine cup, mouthpiece, mask, tubing, filter, and other parts as stated in the instructions or when they appear worn or damaged 676345 Page 3 of 3