Health inspection·May 8, 2025

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 drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principles, and included the appropriate professional principles, and included the appropriate accessory and cautionary instructions, and the expiration date when applicable for 1 of 6 medication carts (100 hall nursing cart) and 1 of 15 resident rooms (Resident #2)reviewed for drug labeling and storage. 1- The facility failed on 05/07/2025 to ensure prescribed medication, not belonging to Resident#2 be left bedside tray, unattended. 2. The facility failed to ensure on 05/07/2025 the following was not left on top of the 100 Hall Nursing Cart unattended: 1 unused lancet (small plastic cylinders containing a sterile steel needle), 1 unopen insulin pen needle and 5 alcohol prep pads (1 torn open with pad exposed and 4 unopen). These failures could place residents at risk of adverse medication reactions and drug diversions. Findings included: 1.Record Review of Resident #2's face sheet revealed a [AGE] year-old female admitted to the facility on , 09/01/2021. The diagnoses included dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, other lack of coordination, paraplegia, unspecified, other cerebral infraction, cellulitis of left finger, type 2 diabetes, Alzheimer's disease with early onset. There were no diagnoses revealed that would relate to the usage of the prescribed medication found on Resident #2's bedside tray. Record Review of Resident #2 quarterly Minimum Date Set dated on, 03/31/2025 revealed a Brief Interview for Mental Status (BIMS) score of 15 out of 15 to indicate they were cognitively impaired. Resident #2 is dependent on staff for, oral hygiene, toileting hygiene, shower/bathe, and upper body dressing as they are unable to complete the activity on their own. Record Review of Resident #2 Medication Administration Record revealed no prescribed medication by the name of, Ketoconazole Shampoo 2% to be used on skin during bathing or showering. Record Review of Resident #2 Care Plan revealed no skin issues, concerns, or focus that would relate to the prescribed medication found on Resident #2 bedside tray. The care plan did reveal Resident #2 focus is having fragile skin and is at risk for skin injury, treatment is applied when ordered, Page 1 of 8 676356 676356 05/08/2025 The Heights of North Houston 303 Hollow Tree Lane Houston, TX 77090

F 0761 with a last update of 01/13/2025. Level of Harm - Minimal harm or potential for actual harm Observation on 05/07/2025 at 8:23am of the Resident #2 surrounding areas on their side of the room, it was noticed there was food on the floor and Resident #2 bedside tray. It was discovered Resident #2 has a prescribed medication that was a bright orange red substance oozing out of the bottle. The labeling of who the prescribed medication belonged to was torn off. The only legible writings on the prescribed bottle, Ketoconazole Shampoo 2% . Residents Affected - Few In an interview with Resident #2 on 05/07/2025 @ 8:23am, the resident was observed to be awake and awaiting for breakfast to be served. Resident #2 was asked if they were aware of the prescribed medication bottle on their bedside tray and they stated, yes. Resident #2 stated they were unsure of who the medication belongs to but was used on skin before. Resident #2 could not remember how long ago or the staff who used the prescribed medication. In an interview with LVN B on 05/07/2025 @ 9:17am. LVN B was preparing to give medication to resident when they were asked about prescribed medication left on Resident #2 bedside tray. LVN B stated they were unsure how the prescribed medication got on the bedside tray, and they never seen it before. LVN B stated that he has not used the prescribed medication on the resident and was unsure who or why it would have been left on the resident bedside tray. LVN B confirmed that he did not know who the prescribed medication belonged to, as it was illegible. LVN B stated that because he doesn't know why the medication was there, he would need to speak with the DON, where he proceeded to take the prescribed medication off Resident #2 bedside tray and inform the DON of the findings. In an interview with DON on 05/07/2025 @ 9:55am stated they were conducting an in-service now (at this time) regarding medications, labeling, and storage. DON stated the medication was not prescribed to the resident but did make contact the doctor and expressed the resident could benefit from the medication and received an order for the prescribed medication, specifically for the resident because she does have dermatitis. The DON was unsure of who the medication belongs to. The DON stated they have never seen the prescribed medication in the resident room or on the bedside tray. The DON stated there was no one residing at the facility who is was currently prescribed to take the medication. The DON also stated they are unsure if the medication was used on the resident or how long the prescribed medication has been on the resident bedside tray. The DON stated the risk of a resident using another resident medication or a medication that was not prescribed to them can have side effects, which could harm the resident. In an interview with CNA L on 05/08/2025 @ 10:51am stated they were assigned to Resident #2 today and is normally assigned to the 400 hall. CNA L stated when bathing Resident #2 there is not a specific lotion or skin soap that used. CNA L stated that there was a time a red-like substance was used on Resident #2 during bathing but could not remember when or if it was prescribed medication. CNA L stated the soap and lotions are given to the CNAs before bathing/showering residents, and they do not see where the soap or lotions come from because it is already placed in a clear container. 2. During an observation on 05/07/25 at 1:07 PM revealed the 100-hall nursing cart unattended for approximately 2-3 minutes positioned halfway down the hall with the following on top: LVN A was talking to unknown person at the beginning of the hall, with her back to the cart. One unknown resident was self-propelling himself down the hall in the direction of the cart. Unattended Nursing Cart: 676356 Page 2 of 8 676356 05/08/2025 The Heights of North Houston 303 Hollow Tree Lane Houston, TX 77090

F 0761 o Level of Harm - Minimal harm or potential for actual harm 1 unused lancet (small plastic cylinders containing a sterile steel needle). o Residents Affected - Few 1 unopen insulin pen needle. o 5 alcohol prep pads (1 torn open with pad exposed and 4 unopen pads). In an interview on 5/7/2025 at 1:15 PM LVN A said she left the cart to retrieve batteries for the glucometer (instrument for measuring the concentration of glucose (sugar) in the blood. She said she should have placed the supplies (lancet, insulin pen needle and alcohol prep pads) inside of the cart. She said it was her responsibility to ensure the cart was locked and supplies were secure. She said she was trained to keep medical supplies secured and locked in carts to prevent misuse. She said the residents were at risk for injury if they tried to use the needles or misused the alcohol pads. In an interview on 5/8/2025 at 8:25 AM, the DON said the nursing cart supplies should be kept inside of the secured nursing carts until they are ready to be used by the nurses. The DON said the nurses should have unsecured alcohol pads, lancets and insulin pen needles presented a risk to the residents, and they could injury themselves. She said LVN A should have kept the nursing cart in line of site if supplies were on top and not secured. Record review of the facility's policy titled, Medication cart use & storage and Biologicals dated 3/13/19 (revised January 2023) revealed, .Responsible Disciplines -Licensed nurses . 1. Security - The medication cart and its storage bins should be kept closed, secured and/or in the line of sight when not in use . avoid placing medications on top of the cart unless pulling medications from the cart. The only exception would be if the cart and medications are within the direct line of sight of the authorized personnel. Note: Best practice is to avoid leaving medication on top of the cart . 676356 Page 3 of 8 676356 05/08/2025 The Heights of North Houston 303 Hollow Tree Lane Houston, TX 77090

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen observed for kitchen sanitation. The facility failed to ensure the kitchen vents above the steam table was free from dripping condensation on 05/07/2025. This failure could have the potential to affect residents who ate food from the facility's kitchen placing them at risk of foodborne illness. Findings included: Observation on 5/7/2025 at 11:35 AM - 12:03 PM of the kitchen vents, revealed 4 vents positioned above the steam table with condensation droplets. During the observation a cart with small bowls was placed near the steam table (used for plating side dishes). Condensation from the vents fell onto the cart with the small bowls. The plate warmer was placed under a vent that had condensation droplets and condensation dropped on the plate warmer. The thermostat in the kitchen was set on 74 degrees Fahrenheit. Interview on 5/7/2025 at 12:00 PM, the Dietary Mgr . said the Maintenance Supervisor came in daily to inspect the sanitation of the kitchen. She said the kitchen was cleaned daily but had not noticed the vent condensation and the task was not a task to check off on the kitchen sanitation audit document. She said the condensation on the vents could drop into the food and cause cross-contamination. She said she told the Administrator about the condensation over six months ago. Interview on 5/7/2025 at 12:05 PM, the Dietician A said she had not looked up to see the condensation on the vents above the steam table. She said her monthly checks monitored for dust on the vents and she did not review the vents for condensation during meal service. She said the condensation could cause food-born illnesses and affect the resident if it dropped into the food. She said she would need to ask the administrator or maintenance about how to stop the condensation and who was responsible. Interview on 5/7/2025 at 12:42 PM, the Maintenance Supervisor said he checked and cleaned the vents above the steam table monthly. He said he was aware of the condensation but had advised the dietary staff not to put the air-condition thermostat under 72 degrees, because that will cause the condensation when the stove was on. Interview on 5/7/2025 at 2:55 PM, the Administrator said the condensation that formed on the vents above the stem table / prep station could have dropped into the food and put the residents at risk for a food born illness. He said he would close the vents to prevent the condensation from forming to prevent the cross-contamination of the droplets falling into the food. The Administrator further said there was no specific policy that addressed the vents in the kitchen. He said maintenance and the kitchen staff were responsible for ensuring the vents were free from condensation and debris. Record review of the undated pest control policy titled General Kitchen Sanitation revealed the following: 676356 Page 4 of 8 676356 05/08/2025 The Heights of North Houston 303 Hollow Tree Lane Houston, TX 77090

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Policy: The facility recognizes that foodborne illness has the potential to harm elderly and frail residents. All Nutrition & Foodservice employees will maintain clean, sanitary kitchen facilities in accordance with the state and US Food Codes in order to minimize the risk of infection and foodborne illness . Record review of facility QA Monitor Report dated 4/7/2025 and completed by Dietician A revealed the following: .General appearance of kitchen clean: floors, walls, ceilings, vents, . Answer - Yes. 676356 Page 5 of 8 676356 05/08/2025 The Heights of North Houston 303 Hollow Tree Lane Houston, TX 77090

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to establish and maintain an infection prevention and control program designed to help prevent the development and transmission of communicable diseases and infections for 1 of 1 facility reviewed for infection control. Residents Affected - Many The facility failed to provide documentation regarding regular or periodic testing and monitoring of environmental control limts, such as PH levels, temperature levels and disinfectant levels according to their policy and procedure regarding their water management plan. This failure could place residents at risk of exposure to Legionnaires' disease (a serious type of lung infection caused by Legionella bacteria which can live in standing water within facility water systems). Findings include: In an interview on 5/7/25 at 3:02 p.m. the Infection Preventionist said she was unsure who oversaw the water management program but would find out. In an interview on 5/8/25 at 10:41 a.m. the Administrator said Legionella could grow in hot water and the systems. He said if the facility had a drain line that had not been used in a while, he would pour bleach down the line or disinfect the drain. He said the facility did not test the water for Legionella and the CDC said there was no requirement to test it. He said if there was a confirmed case of Legionnaires disease the facility would be required to test the water daily. He said the corporate team would manage the testing. He said the facility did not have a process in place to measure outcomes. In an interview on 5/8/25 at 10:57 a.m. the DON said she did not have anything to do with the Legionella program. In an interview on 5/8/25 at 11:34 a.m. the Administrator said there was no documentation to provide regarding Legionella. In an interview on 5/8/25 at 11:52 a.m. the Administrator said the facility was not documenting information regarding Legionella but would start. Record review of the facility's Legionnaires' Disease: Detection, Response, Prevention policy dated March 2022 read in part, .The Community will utilize sound clinical and infection control practices to quickly identify and treat any potential Legionnaires' related illnesses. Sound engineering, preventative maintenance and housekeeping practices will be utilized to minimize the risk of exposing residents and team members to the legionella bacteria . Minimizing Growth of Legionella in the Domestic Water System: o Do not use shower rooms as permanent storage unless the unused piping has been removed. o 676356 Page 6 of 8 676356 05/08/2025 The Heights of North Houston 303 Hollow Tree Lane Houston, TX 77090

F 0880 Flush toilets and run faucets for a minimum of 30 seconds in all vacant resident rooms periodically. Level of Harm - Minimal harm or potential for actual harm o Residents Affected - Many For resident rooms, or other rooms with plumbing fixtures that are used for offices and/or storage, flush toilets and run faucets and showerheads for a minimum of 30 seconds periodically. o Visually inspect all cooling towers, as applicable, on a quarterly basis for debris or biofilm or slime build-up. If biofilm or slime is noted, drain the tower, clean and disinfect. Perform annual water quality testing for all cooling towers. o Visually inspect all decorative fountains, as applicable, on a quarterly basis for biofilm or slime build-up. Check PH to assure within acceptable range of 6.5 to 8.5 where disinfectants are most effective. Place chlorine tab dispenser in fountain. If biofilm or slime is noted, drain the fountain, clean and disinfect. o Perform annual water quality testing for all enclosed, air-cooled chiller systems, as applicable. o At the start of cooling season, inspect all HVAC units. Place chlorine tablets in condensate drain pans to prevent slime build-up. When checking filters periodically, inspect drain pans for slime build-up and place additional chlorine tablets as needed. o All visual inspections, cleaning, and water testing will be documented using the TELS preventive maintenance system. o Please note that neither CDC nor CMS guidelines require periodic testing of water for actual Legionella bacteria, unless there is a known Legionnaires case in the community. Regular or periodic testing and monitoring as related to this policy refers to environmental control limits, such as PH levels, temperature levels and disinfectant levels. If a Legionnaires case is identified, state agencies may require or request actual sampling for Legionella . 676356 Page 7 of 8 676356 05/08/2025 The Heights of North Houston 303 Hollow Tree Lane Houston, TX 77090

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record review the facility failed to maintain an effective pest control program to remain free of pests on 1 of 1 kitchen. Residents Affected - Some The facility failed on 05/08/2025 to ensure the dishwashing area was free from 1 roach observed. This failure could place residents at risk of food borne illnesses and unsanitary conditions in the kitchen which could result in a decline in health. Finding included: During an observation on 5/8/2025 at 9:51 AM revealed a medium size roach crawling on the automatic dishwasher's sanitation and detergent tubing while in use. In an interview on 5/8/2025 at 9:52 AM, the Dietary Aide A said she saw the roach crawling on the dishwasher. She said there were cleaning duties to keep the kitchen clean and sanitized. The interview was interrupted by the Dietary Manager. In an interview and observation on 5/8/2025 9:52 AM, the Dietary Manager said she saw the roach, and then she killed the roach that was crawling on the dishwasher. She said there is monthly pest control and is not sure how the roach was in the kitchen. She said the live roach placed residents at risk for contaminating clean dishes in the dishwasher area. She said she and the staff clean daily to prevent pest from being in the kitchen. She said all dietary staff were responsible for reporting pest to the maintenance so the pest control company could address it on the next visit. Record review of the facility pest control receipt dated 5/2/2025 revealed the pest control company was at the facility on 5/2/2025. The pest control treatment included the kitchen and the targeted pest included roaches. Record review of the undated pest control policy titled General Kitchen Sanitation revealed the following: Policy: The facility recognizes that foodborne illness has the potential to harm elderly and frail residents. All Nutrition & Foodservice employees will maintain clean, sanitary kitchen facilities in accordance with the state and US Food Codes in order to minimize the risk of infection and foodborne illness . 13. Have a professional pest-control program in place . Record review of facility policy titled Physical Environment date 2/2017 (revised 1/2023) revealed the following: Pest control - The community maintains an effective pest control program so that the community is free of pests and rodents. An effective pest control program is defined as measures to eradicate and contain common household pest (e.g., roaches .) 676356 Page 8 of 8