Health inspection·April 28, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record reviews the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents and the public for 1 of 1 facility reviewed for environment. The facility failed to ensure staff dogs were leashed at all times and failed to prevent staff dogs from being in the dining room and resident rooms during meal service and during resident incontinent care. These failures could affect residents placing them at risk of living in an unsafe, uncomfortable environment, infection and disease, and decreased quality of life due to exposure to animals during incontinent and meal service in the facility. Findings includes: During an interview on 4/27/23 at 1:30 p.m. with the Administrator; stated there was one facility staff who had their dog in the facility right now, the BOM. The ADM stated the BOM was allowed to bring her dog into the building and the dog stayed in the BOM office unless it went outside to use the restroom. The ADM stated the BOM had provided proof that the dog was vaccinated. The ADM stated staff are permitted to bring their dog to work if they present a vaccination record, keep the dog on a leash and ask permission first. During an interview on 4/27/23 at 1:57 p.m. with the Activity Director, stated there are 2 dogs are typically in the facility owned by CNA A and the BOM. The Activity Director stated the BOM keeps her dog in her office and CNA A takes her dog around the facility to resident rooms on a leash. The Activity Director stated that CNA A had her dog in the dining room during mealtimes on at least one occasion. The Activity Director stated only one resident has complained about the dog, but she cannot remember the specifics about the complaint. During an interview and observation on 4/27/23 at 2:39 p.m. with the BOM and a small Australian shepherd puppy in the BOM office; BOM stated her dog has had all vaccines based on his age of 2.5 months old. The puppy was observed moving around the office unleashed with the office door opened. The BOM stated she has a copy of the vaccinations in her office and has provided it to the facility. The BOM stated she does not keep the dog on a leash in her office or when she takes him outside to use the restroom. The BOM stated the puppy moves freely around her office and stands in the office doorway when it wants to go outside and then it walks off leash outside the doors where the smoking area is. The BOM stated she is not sure what the pet policy is for staff. The BOM stated she had not thought the puppy could pose a safety or fall hazard to residents if the puppy got between a resident's Page 1 of 9 676389 676389 04/28/2023 Matador Health and Rehabilitation Center 805 Harrison St Matador, TX 79244

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some legs or in front of a resident walking. The BOM stated she did get permission from the facility to bring her dog to work. Stated she does not bring the puppy into the dining room. The BOM stated there is a CNA (CNA A) who brings her dog to work but it is not at the facility the entire shift. The BOM stated CNA A keeps her dog on a leash and the dog goes with her around the facility. During an interview on 4/27/23 at 2:45 p.m. with Resident # 1 , stated that CNA A brings her dog to work a lot and so does the BOM. Resident #1 stated that CNA A lets the dog run around in the dining room during mealtime and the dog runs by his feet. Stated that he is worried that a resident will fall when the dog runs around and does not want the dog in the dining room at all. Stated that the dog should always be on a leash and CNA A should hold the leash but does not always hold it and lets the dog drag it. Resident #1 stated that the BOM brings her dog to work and keeps it inside her office unless it goes outside. Resident #1 stated the BOM's dog is not leashed when it goes from her office to the outside and the dog barks a lot, and he does not think residents should have to listen to a dog barking in the facility. During an interview on 4/27/23 2:50 p.m. with CNA B; stated that there are 2 dogs that staff bring to the facility. CNA B stated the BOM has a puppy that she keeps in her office unless the BOM is taking the dog outside. Stated the BOM puppy is not on a leash when it goes from the BOM office to the outside area to use the restroom. CNA B stated that CNA A brings her dog, and her dog is on a leash most of the time. Stated that the CNA A does bring her dog into resident rooms and into the dining room. During an interview on 4/27/23 at 2:58 p.m. with Resident # 2 , stated that the BOM has a puppy in her office, and she did not mind the puppy because it stays in the office unless it goes outside. Resident #2 stated that CNA A brings her dog every time she works usually in the afternoon. Resident # 2 stated that CNA A's dog is on a leash but is in the dining room during meals and she does not like it. Resident # 2 feels that the dog in the dining room during mealtimes is not sanitary and should not be allowed. During an interview on 4/27/23 at 3:02 p.m. with a visiting community member; stated that she visits the facility often because many of the residents she has known for years. The community member stated that she has observed the dogs in the facility and has an issue with the dogs being here. The community member stated she also hears the BOM's barking in her office when she is visiting friends. The community member stated that the dogs run around wild and not always on a leash. The community member stated that she has observed CNA A's dog in the dining room during mealtime and think that it is disgusting, and the dog could be spreading germs. During a phone interview on 4/27/23 at 4:06 p.m. with CNA A; stated that she has a male [NAME] mixed dog that weighs approximately 7 pounds and is 1.5 years old. CNA A stated that her dog is fully vaccinated but she does not have a copy of the vaccinations and has not provided them to the facility. CNA A stated that the activity director requested the vaccination records, but no other staff had. CNA A stated that she started bringing her dog to work when he had escaped from home, and she found him on her way to work. Stated she did not ask permission and she would bring her dog in the afternoon to the facility. CNA A stated that the dog is always on a leash and always with her, or with someone at the nurses station. CNA A admitted that she does not always have control of the leash or have it attached to her body. CNA A stated the dog goes into resident rooms but stated she had never asked a resident permission before bringing the dog into their room. Stated that the dog only comes in the evening hours. CNA A stated that the dog has been in the dining room during meal service. CNA A stated the dog has accompanied her to residents who eat in their rooms. CNA A stated that when she 676389 Page 2 of 9 676389 04/28/2023 Matador Health and Rehabilitation Center 805 Harrison St Matador, TX 79244

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some delivered meals to resident rooms, she would set the dog leash on the ground outside the resident room, pick up the food tray and deliver it into the resident room. CNA A stated she would then exit the room, pick up the dog leash and move to the next room where she would set down the dog leash and grab the next food tray. CNA A stated she did not sanitize her hands after touching the dog leash off the floor or before grabbing the resident food tray. CNA A stated her dog is at the facility several times a week when she worked, and she did not ask permission. CNA A stated that she has brought her dog into a resident room when she performed incontinence care and the dog laid on the floor during resident care. CNA A stated that she did not know the rules about bringing her dog into the facility and stated she thought it was okay because no one had ever told her not to. During an interview on 4/27/23 at 4:26 p.m. with the ADM; stated that all dogs must be with their owner or a designated staff member at all times. The ADM provided the HHSC Investigator a policy regarding dogs and stated this is what the facility is following regarding facility staff and resident dogs. The ADM stated that dogs should not be in resident rooms or in the dining room during meal service. The ADM stated staff must ask resident permission before bringing a dog into a resident room. The ADM stated that she is aware of the Food Code by the Food and Drug Administration that prohibits dogs in the dining room. The ADM stated that dietary staff have Food Handler certificates and would know that dogs are prohibited from the dining room. The ADM stated that if dietary observed a dog in the dining room, they should have had the dog removed and notified her that a dog had been permitted in the dining room. The ADM stated that all staff had a responsibility to notify her that CNA A had allowed her dog in the dining room, and during meal service. The ADM stated that she was not aware that CNA A brought her dog into resident rooms during incontinence care and that it is not permitted. The ADM stated that I am in the dark and did not know this was going on. The ADM stated that had staff notified her that CNA A's dog was in the dining room, in resident rooms during incontinence care or off leash, she would have addressed it. The ADM stated that she was not aware that the BOM and CNA A took their dogs outside without a leash or let the dogs roam in the resident smoking areas off leash. During an interview on 4/27/23 at 5:14 p.m. with Dietary Supervisor; stated that she has previously informed the ADM that the CNA had her dog in the dining room during dinner meal service on more than one occasion. The Dietary Supervisor stated that she is certified in food handling but does not know the rules pertaining to dogs in the dining food. The Dietary Supervisor stated that she believes that having a dog in the dining room during meal service is unsanitary and should not happen. During an interview on 4/27/23 at 5:45 p.m. with the ADM; stated that the dietary supervisor never informed her that CNA A brought her dog into the dining room during resident meal service. The ADM stated she had found on a policy that the facility is following regarding dogs in the facility. The ADM stated that all dogs must be vaccinated, on a leash at all times and prohibited in the dining room or around food service. The ADM stated that CNA A never provided her with her dog's vaccination records and the BOM has her puppy's vaccination record in her office. During an interview on 4/27/23 at 6:13 p.m. with the Dietary aide; stated that he has seen CNA A's dog roam in and out of the dining room and has seen the dog in the dining room during meal service at least once. The Dietary aide stated that he has told staff to get the dog out of the dining room but had not informed the Administrator about the dog. The Dietary aide stated that Food safety training instructs them that dogs are not allowed in the dining room. The Dietary aide stated that he believes that by the dog being in the dining room it could be an infection control issue and if the dog has fleas or ticks it could cause health concerns. The Dietary aide stated that dogs carry germs, and it is unsanitary for dogs to be in the dining room, regardless of if it is mealtime or not. 676389 Page 3 of 9 676389 04/28/2023 Matador Health and Rehabilitation Center 805 Harrison St Matador, TX 79244

F 0584 Level of Harm - Minimal harm or potential for actual harm During an interview on 4/27/23 at 6:38 p.m. with Resident # 3; stated that there are two dogs that staff bring to the facility. Resident #3 stated that the BOM has a cute mini aussie that she keeps in her office and CNA A has a mixed breed dog. Stated that the dogs go outside in the smoking area and are not on a leash when the dogs use the restroom outside on the grass in the smoking area. Resident #3 stated he is concerned that someone will fall from the dogs running around the facility. Residents Affected - Some During an interview on 4/27/23 at 6:42 p.m. with Resident #4; stated that CNA brings her dog to work, and she has brought the dog into her room. Resident #4 stated that the CNA does not always ask before bringing the dog into her room. Resident #4 stated that the dog has a retractable leash that the CNA A puts the handle into her pocket but stated that sometimes the dog's leash handle is on the ground following on the floor behind the dog. Resident # 4 stated that sometimes the dog is in the dining room and begs for food from the residents. During an interview on 4/27/23 at 6:46 p.m. with Resident #5; stated that there are two staff owned dogs that come into the facility. Resident #5 stated that the BOM's dog is a small puppy, and it stays in the BOM's office unless the BOM takes it outside. Resident #5 stated that he is concerned of the dogs getting under foot and causing a fall. Resident # 5 stated that CNA A brings her dog into his room, and he does not mind that because the dog is smaller and not aggressive. Resident # 5 stated he does have a problem with mealtimes in the dining room because CNA A has brought her dog into the dining room during meal service on at least two occasions. Resident #5 stated that the dog will come under their feet and beg for food and some resident's do feed the dog during meal service. During an interview on 4/27/23 at 6:55 p.m. with Resident # 6 ; stated that CNA A has brought her dog into her room once and the dog came and jumped on her bed. Stated CNA A has brought the dog into the dining room at least once during mealtime. During an interview on 4/28/23 at 10:44 a.m. with LVN C; stated that she has observed CNA A bring her dog to work several times during the week. LVN C stated that CNA A keeps her dog on a leash and tries to keep the dog out of the dining room. LVN C stated that she has observed CNA A's dog in the dining room a few times during dinner meal service. LVN C stated she has not told the ADM about the dog being in the dining room. LVN C stated that CNA A's dog follows her around the facility on a leash. During an interview on 4/28/23 at 11:07 a.m. with CNA D; stated that she has seen the BOM and CNA A's dog in the facility and has only seen CNA A's dog in the dining room during mealtime with residents. CNA D stated she never told the ADM that CNA A permitted her dog in the dining room. Review of the undated, provided facility policy on Pets-Allowed indicated that: -Procedure: We recognize that pets can be beneficial to the psychosocial well-being of our residents, therefore: Pets are permitted at this facility with prior approval of the Administrator. Pets must be kept on a leash when outside the room and their owners must clean up after them. Pets are not permitted in the common areas. Noisy pets are not acceptable. Must present documentation of pet immunizations. 676389 Page 4 of 9 676389 04/28/2023 Matador Health and Rehabilitation Center 805 Harrison St Matador, TX 79244

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 2017; revealed that: -Section: 6-501.115 Prohibiting Animals. (A) Except as specified in (B) and (C) of this section, live animals may not be allowed on the premises of a food establishment. (B) Live animals may be allowed in the following situations if the contamination of food; clean equipment, utensils, and linens; and unwrapped single-service and single use articles cannot result: (4) Pets in the common dining areas of institutional care facilities such as nursing homes, assisted living facilities, group homes, or residential care facilities at times other than during meals if: (a) Effective partitioning and self-closing doors separate the common dining areas from food storage or food preparation areas, (b) Condiments, equipment, and utensils are stored in enclosed cabinets or removed from the common dining areas when pets are present, and (c) Dining areas including tables, countertops, and similar surfaces are effectively cleaned before the next meal service. -Salmonella lives in the intestines of animals or humans. It can be found in water, food, soil, or surfaces that have been contaminated with the feces of infected animals or humans. People can become infected with Salmonella by: o Contacting farm animals or pets (including reptiles, amphibians, chicks, and ducklings), animal feces, or animal environments. o Touching contaminated surfaces or objects and then touching ones mouth or putting a contaminated object into ones mouth. 676389 Page 5 of 9 676389 04/28/2023 Matador Health and Rehabilitation Center 805 Harrison St Matador, TX 79244

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. Based on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored in locked compartments for 1 of 2 carts (medication cart 1) reviewed for storage: The facility failed to ensure medication cart 1 was locked when unattended. This failure could place residents at risk of having access to unauthorized medications and/or lead to possible harm or drug diversions. Findings included: During an observation and interview on 4/28/23 at 10:44 a.m. revealed an unsupervised medication cart 1against the wall and observed the lock not pushed in. LVN C stated LVN E was assigned to the unlocked medication cart, and she does not see her in the area. LVN C walked to the medication cart and pushed in the lock on the unsupervised medication cart. LVN C stated that the cart should have been locked and residents could get into the unlocked medication cart and get medications and take them. LVN C stated that there is a risk of residents taking medications that are not theirs and it could cause them to have potential side effects to the medications and cause them to become sick and require hospitalization. The LVN C stated that an unlocked medication cart can also lead to missing medications and medication errors. LVN C stated that all nurses are trained to keep medication carts locked at all times when they are not standing in front of them. LVN C stated that LVN E walked out of the area and was taking medications to a resident. During an observation and interview on 4/28/23 at 10:55 a.m. with LVN E who was walking out of the dining room towards the nursing station with empty medication dispensing cups in her hand. LVN E stated that she is assigned to the medication cart and did not realize that she left it unlocked. LVN E stated there was no issue with the locking mechanism and there was no excuse for leaving her cart unlocked. The LVN E stated that she has worked at the facility for 2 years and was trained to keep the medication cart locked. The LVN E stated that a resident could be at harm if they took medications that were not theirs or took too many of their own medications. The LVN E stated that the risk of residents having access to an unlocked and unsupervised medication cart and taking medications would be the resident overdosing, ingesting chemicals, medication side effects and death. The LVN E stated that she knew better and was in the dining room giving a resident medication and failed to lock the medication cart when she left the area. During an interview on 4/28/23 at 11:35 a.m. with the ADON/MDS; stated that she was notified by LVN E that LVN E left her assigned medication cart unlocked. The ADON/MDS stated that the medication cart should be locked at all times and the nurse should lock it after getting into the cart. The ADON/MDS stated that the LVN E assigned to the cart was responsible for keeping the cart secure. The ADON/MDS stated that the LVN E has been trained on drug diversion and keeping the medication cart secured and the LVN E had been an ADON before and knows the risks of leaving a cart unlocked. The ADON/MDS stated that the risk of a medication cart being unlocked would be multiple residents getting into the cart and medications. The ADON/MDS stated that a resident could take a medication. When asked by the HHSC Investigator the risk associated with a resident taking medications from an unlocked cart the ADON/MDS replied, I know where you are going with this, so I don't want to say. It should have 676389 Page 6 of 9 676389 04/28/2023 Matador Health and Rehabilitation Center 805 Harrison St Matador, TX 79244

F 0761 been locked. Level of Harm - Minimal harm or potential for actual harm Review of the facility provided, undated policy titled Pharmacy Services reflected the following: Policy statement: Residents Affected - Few The facility will provide routine and emergency drugs and biologicals to our residents. Storage of Drugs and Biological: -In accordance with state and federals laws, the facility will store all drugs and biologicals in locked compartments under proper temperature controls and permit only authorized personnel to have access to keys. Drug Security: -When not in use, a medication cart will be secured in a designated area. 676389 Page 7 of 9 676389 04/28/2023 Matador Health and Rehabilitation Center 805 Harrison St Matador, TX 79244

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to store food in accordance with professional standards for food safety for the facility's refrigerator used by the activity department and residents. The facility failed to ensure that food items were dated and labeled in the dining room refrigerator/freezer. These failures could place residents at risk for foodborne illness. Findings include: During an interview on 4/27/23 at 4:26 p.m. with the ADM; stated that dietary was in charge of the resident refrigerator/freezer in the dining room, and it is their job to ensure items are labeled with the resident name and date. The ADM stated the date on the item was the date the item was placed in the refrigerator. The ADM stated that any staff could have monitored the refrigerator including herself, dietary, activities or nursing to make sure the refrigerator was cleaned, and old items were tossed. During an observation and interview on 4/27/23 at 4:44 p.m. with the Dietary Supervisor of the refrigerator and freezer located in the dining room; stated that she did not know that she was in charge of making sure that this refrigerator/freezer contained labeled and dated food items. The Dietary Supervisor stated that she did not know who was in charge of this refrigerator/freezer. The Dietary Supervisor stated that she has been trained on food storage and knows that all items should be labeled and dated to ensure that food items are safe to eat. -The Dietary Supervisor pulled the following items undated items from the dining room refrigerator: 2 Styrofoam cups with a whipped cream fruit salad; 7 chocolate, 2 orange juice, 7 strawberry banana and 1 strawberry shake cartons from a metal serving bowl; 1 chocolate and 1 vanilla four pack of pudding; Open chocolate shake; 1 sandwich wrapped in plastic wrap; Plastic container of pineapple chunks; clear plastic container of pimento cheese; container of sour cream containing peanut butter; 2 20 oz opened Dr. Pepper sodas; opened [NAME] Honey BBQ sauce; Lemonade bottle ½ full; Pace Taco Sauce; Sweet Relish; Yellow Mustard; Tostitos Chunky salsa; 44 oz container of ½ full Heinz ketchup. The Dietary Supervisor pulled the following undated items from the dining room freezer: Frozen cups of green, red, orange substance; Breyers opened vanilla ice cream; Cow Bell opened vanilla ice cream; cup of yellow residue; medical glove filled with frozen liquid; Frozen water bottle; [NAME] Dean Delights Bowl; One gallon of opened rainbow sherbet; One-gallon vanilla ice cream ¾ full; Clear plastic container of plastic reusable ice cubes. During an observation and interview on 4/27/23 at 4:46 p.m. with the ADM; stated that all items in the dining room refrigerator/freezer should be dated with names on the items. The ADM stated that this refridgerator/freezer is used by the Activity department and residents also use it. The ADM stood next to HHSC Investigator, and the Dietary Supervisor as the Dietary Supervisor removed items from the freezer and refrigerator. The ADM took items and threw all of the undated items into the trash can and advised the Dietary Supervisor that it was her responsibility to ensure only dated/labeled 676389 Page 8 of 9 676389 04/28/2023 Matador Health and Rehabilitation Center 805 Harrison St Matador, TX 79244

F 0812 items were stored in the refrigerator/freezer. Level of Harm - Minimal harm or potential for actual harm Record review of the facility provided, undated, Storage of Food in Refrigeration policy, indicated All containers must be labeled with the contents and date food item was placed in storage. Residents Affected - Few 676389 Page 9 of 9