Health inspection·October 4, 2023

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents receive adequate supervision and assistance devices to prevent accidents for one (Resident #1) of three residents observed during a transfer. CNA A failed to use a gait belt when transferring Resident #1 from wheelchair to toilet back to wheelchair. This failure could place residents at risk for discomfort, pain and or injury. Findings included: Record review of Resident #1's Quarterly MDS assessment, dated 08/07/23, reflected an [AGE] year-old-female admitted to the facility on [DATE]. Resident #1's diagnoses included Alzheimer's, high blood pressure, and dementia. Her BIMs score was 03 revealing the resident was not cognitively intact. Her functional status reflected substantial assistance for toileting hygiene, bed mobility, and transfers. Record review of Resident #1's comprehensive plan of care dated 06/10/22 reflected, Focus: Resident#1 requires assist with ADLs .provide level of support to complete dressing, toilet use, personal hygiene . Observation on 10/04/2023 at 11:05 AM, CNA A was observed as she assisted Resident#1 to the toilet. CNA A rolled Resident #1 in wheelchair into restroom next to the toilet. CNA A locked the wheelchair on both sides. CNA A lightly grabbed jean waist, Resident #1 used rail next to toilet to help pull herself up, CNA A used both her hands to guide Resident #1 to standing. No gait belt was used. CNA A helped to turn and sit Resident #1 on the toilet. After cleaning Resident #1, CNA A helped Resident #1 stand up, Resident #1 pulled on side rail while CNA A placed hand on Resident #1's buttock to help her stand. No gait belt used. CNA A stated, Oops I am sorry and stated she was supposed to use the gait belt anytime she transferred a resident. CNA A stated she has been trained by therapy regarding using gait belts during transfer. CNA A stated that she was not thinking and when she saw Resident #1 soaking wet, she instantly thought she needed to change her. Interview on 10/04/23 at 11:51 AM, the DON stated that nursing staff are to use a gait belt for any resident that require more than limited assistance. The DON stated that using gait belts helped prevent injury and promotes safety. Page 1 of 3 676390 676390 10/04/2023 Lexington Medical Lodge 2000 West Audie Murphy Pkway Farmersville, TX 75442

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A record review of In-Service Training Report - Topic: Gait belt and hoyer pads, dated 7/3/23, revealed, All aides must have a gait belt on them at all times .CNA A . A record review of the facility's policy Transfer of Patient, no date, reflected . to safely move resident from one place to another . staff will use gait belt to assist in getting resident to stand and guiding resident to pivot . 676390 Page 2 of 3 676390 10/04/2023 Lexington Medical Lodge 2000 West Audie Murphy Pkway Farmersville, TX 75442

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 a resident with or without an indwelling catheter, receives the appropriate care and services to prevent urinary tract infection to the extent possible for one (Resident#1) of five residents reviewed for incontinent care. The facility failed to ensure Resident #1 was assisted with incontinence care and toileting in a timely manner. This failure could place residents at risk of a diminished quality of life by not receiving care and services to meet their toileting needs. Findings included: Record review of Resident #1's Quarterly MDS assessment, dated 08/07/23, reflected an [AGE] year-old-female admitted to the facility on [DATE]. Resident #1's diagnoses included Alzheimer's, high blood pressure, and dementia. Her BIMs score was 03 revealing that resident was not cognitively intact. Her functional status reflected extensive assistance for personal hygiene. She was frequently incontinent of bowel and bladder and requires extensive assistance for toilet use. Record review of Resident #1's comprehensive plan of care dated 06/10/22 reflected, Focus: Resident#1 requires assist with ADLs .has been identified at risk for pressure ulcer development or skin breakdown .check for incontinence frequently and PRN. Provide incontinent care after each episode . Observation on 10/04/2023 at 10:47 AM revealed Resident #1 in wheelchair. Resident #1's jeans were wet from her hips, down her left side to about the middle of her left thigh. Liquid appeared to fall down Resident #1's leg to the puddle. There was a puddle under her leg and foot. The puddle was approximately 2ft by 2ft. Surveyor attempted to interview Resident # 1, but she was unable to answer questions. Observation on 10/04/2023 at 11:05 AM, CNA A assisted Resident#1 to the toilet. CNA A stood the resident up, there was a puddle of liquid where Resident #1 was sitting, removed Resident #1's wet jeans and put into a trash bag. The resident was wearing an incontinent brief which was swollen large with yellow liquid. When asked if the resident had been changed, CNA A stated that hospice bathed her around 06:30 am this morning. CNA A stated that they are to check on residents and change if needed every two hours. The surveyor observed the resident's skin, and no breakdown or redness was noted . Interview on 10/04/23 at 11:51 AM, the DON stated nursing staff are to check residents every 2 hours and change them if they are wet. The DON stated the risk of incontinent care not being provided on time would be skin break down and infection. A record review of the facility's policy Operational/Resident Care Policies, undated, reflected . Incontinence .receives appropriate treatment and services to prevent urinary tract infections . 676390 Page 3 of 3