Health inspection·March 12, 2025

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 provide the necessary services for residents who are unable to carry out activities of daily living to maintain good grooming and personal hygiene for 2 (Resident #1, Resident#3) of 3 residents reviewed for ADL's. Residents Affected - Few The facility failed to ensure. 1-Resident #1 had her facial hair shaved. 2- Resident#3 had her fingernails trimmed and cleaned. These failures could place residents who were dependent on staff for ADL care at risk for loss of dignity, risk for infections and a decreased quality of life. Findings include: Record review of Resident #1's Quarterly MDS assessment dated [DATE] reflected Resident #1 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including cerebrovascular accident (result of disrupted blood flow to the brain due to problems with blood vessels that supply it), dementia (diseases that affect memory, thinking, and the ability to perform daily activities), and hypertension (High blood pressure). She had a BIMS score of 06/15 indicating severe cognitive impairment. She was totally dependent with personal ADLs. Record review of Resident #1's Comprehensive Care Plan last revised 12/19/24 reflected the following Focus. Resident #1 requires assist with ADLs. Goal. The resident#1 is able to perform self-care to optimal level and maintains strength and endurance x90 days. Intervention. Provide level of support to complete dressing . personal hygiene and bathing needs Observation/interview on 03/12/25 at 09:38 AM revealed Resident#1 was lying in bed. Resident#1's chin had long scattered white hair, and there were white hairs on both sides of Resident#1 upper lips corners. Resident#1 stated she would like the hair in her face removed and she used to pull it out but could no longer do for herself. Interview on 03/12/25 at 11:23 AM with CNA A, she looked at Resident#1's face and stated she was in the process of preparing to give Resident#1 a bed bath. CNA A stated she will remove the resident facial hair, after the bed bath. CNA A stated it was the responsibility of the CNAs to make sure residents were groomed, and to remove the facial hair for female resident if the resident agreed. CNA A stated the risk to the resident was loss of dignity. Page 1 of 5 676390 676390 03/12/2025 Lexington Medical Lodge 2000 West Audie Murphy Pkway Farmersville, TX 75442

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 03/12/25 at 11:26 AM with LVN D, she stated the CNAs were supposed to remove female residents' facial hair. LVN D stated it was the responsibility of the charge nurse for the Hall to make sure the residents were cleaned and groomed. She stated the risk to the resident was that she could be embarrassed. LVN D further stated, she would be embarrassed if she was left with her face like that. 2-Record review of Resident #3's Quarterly MDS assessment dated [DATE] reflected Resident #3 was a [AGE] year-old female initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including cerebral palsy (a group of disorders that affect movement, muscle tone, and posture), seizure disorder (a neurological condition characterized by recurrent uncontrolled jerking, loss of consciousness, blank stares caused ny abnormal electrical activity in the brain), and anxiety. She had a BIMS score of 02/15 indicating severe cognitive impairment. She required substantial/maximal assistance with personal hygiene. Record review of Resident #3's Comprehensive Care Plan last revised 01/01/25 reflected the following Focus. Resident #3 requires assist with ADLs. Goal. The resident#3 is able to perform self-care to optimal level and maintains strength and endurance x90 days. Intervention. Provide level of support to complete dressing . personal hygiene Observation/Interview on 03/12/25 at 10:08 AM revealed Resident#3 was up in her wheelchair in the Hall 100 common area. Resident#3 had long fingernail approximately 0.7 cm on both hands, with clear brown matter underneath. Resident#3 was unable to answer questions. Interview on 03/12/25 at 10:10 AM with CNA B, she looked at Resident#3's fingernail and stated they were long and some of them were dirty underneath. CNA B stated Resident#3's fingernails needed to be cleaned and trimmed. She further stated the risk to the residents were that they could scratch them self and develop infection. Interview on 03/12/25 at 10:48 AM with RN C, she stated both CNAs and charge nurses in the Halls were responsible for residents' nail care. She stated if a resident had diabetes, only nurses were allowed to trim resident's nails. She stated the risk for not performing nailcare was increased risk of infection and skin break down. Interview on 03/12/25 at 2:25 PM with the DON, she stated her expectation was that nail care should be provided every shower day and as needed. She stated that both CNAs and charge nurses were responsible for doing nail care on all residents; except Nurses were responsible for nailcare if resident had diagnosis of diabetes. The DON stated residents who had dirty fingernails could be an infection control issue. Record Review of the facility undated policy titled Nail Care-Fingernails and Toenails reflected, Purpose: 1. To promote cleanliness 2. To prevent injury 3. To prevent infection The purposes of this procedure are to clean the nail bed, to keep nails trimmed, and to prevent infections. Record Review of the facility undated policy titled Bath, Shaving the Resident reflected, Purpose: 1. Personal Hygiene 2. Dignity. 676390 Page 2 of 5 676390 03/12/2025 Lexington Medical Lodge 2000 West Audie Murphy Pkway Farmersville, TX 75442

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, and record review the facility failed to provide pharmaceutical services, including procedures that assured the accurate acquiring, receiving, dispensing, administering of drugs and biologicals, to meet the needs of each resident for 1 of 1 medication carts (nurses cart Hall 100) reviewed for pharmacy services. The Nurses Cart Hall 100 contained a blister pack for Resident #4 that was broken. This failure could place residents at risk of not having the medication available due to possible drug diversion, diminished effectiveness, and not receiving the therapeutic benefits of the medications. Findings Include: Observation and record review on 03/12/25 at 10:14 AM of nurses' cart Hall 100, with RN C revealed: - the blister pack for Resident #4's Tramadol 50 mg Hcl (controlled medication used for pain) had 1 blister seal broken, the pill was still inside the broken blister. Interview on 03/12/25 at 10:23 AM, RN C stated the count was done at shift change and the count was correct. She stated she did not check the blister packs during the count. She stated she was unaware when the blister pack seal was broken, and she was not aware of who might have damaged the blisters. She stated the risk to the residents would be a potential for drug diversion. She stated the nurses were responsible to check the medication blister packs for broken seals during the count of narcotics during the change of the shift. She stated when a broken seal was observed, she would report it to the DON. Interview on 03/12/25 at 02:25 PM, the DON stated she expected if a blister pack medication seal was broken the pill should be discarded. The DON stated the risk would be potential for drug diversion and infection control issue. She stated nurses were responsible for checking the medication blister packs for broken seals during the count on the change of shifts. The DON further stated the pharmacist do monthly audit of the medication carts for monitoring. Record review of the facility undated policy titled Narcotic count, revealed: The oncoming licensed nurse or certified medication aid will prepare to count narcotic medications with the off-going nurse or certified medication aide .a. any discrepancy will immediately be reported to the charge nurse and/or ADON, who will attempt to reconcile the discrepancy. b. The ADON will notify the DON if any discrepancy cannot be reconciled . 676390 Page 3 of 5 676390 03/12/2025 Lexington Medical Lodge 2000 West Audie Murphy Pkway Farmersville, TX 75442

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record reviews the facility failed to maintain medical records in accordance with accepted professional standards and practices for one (Resident #2) reviewed for documentation of wound care dressing changes. The facility failed to document wound care dressing changes on the Treatment Administration Record (TAR) for Resident # 2 on 02/09/25, 02/13/25, 03/01/25, 03/02/25 and 03/09/25. These failures placed residents at risk for missed treatments and care which could result in the wound deterioration, and development of infection. Findings included: Record review of Resident #2's quarterly MDS assessment, dated 02/26/25, reflected a [AGE] year-old female who was initially admitted to the facility on [DATE], and readmitted on [DATE]. She had a BIMS score of 06/15, which indicated her cognition was severely impaired. Resident #2 had diagnoses which included dementia (loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change, resulting from organic disease of the brain), wound infection, cellulitis of right lower limb, and acquired absence of toe. Further review revealed skin and Ulcer/injury treatment, surgical wound care application of nonsurgical dressings. Record review of Resident #2's care plan, with an onset date of 03/06/25, reflected focus. I have an amputation of right 1st toe. Goal. The resident's wound will heal and progress without complications through the review date. Intervention. Check and document on wound daily for s/sx of infection, drainage, any breakdown of skin and impaired circulation (edema or pain). Record review of Resident#2's Doctor orders revealed: 1Order started date: 01/10/25, end date 02/17/25: R foot-surgical site cleanse with betadine cover with dry dressing one time a day every other day. 2Order started date: 02/22/25 end date 03/05/2025: R foot-surgical site cleanse with ns, apply silver alginate and cover with dry dressing one time a day. 3Order started date: 03/05/25: R foot-surgical site cleanse with ns, apply Santyl ointment and cover with dry dressing one time a day. Review of Resident#2's TAR for the months of February 2025, and March 2025 revealed no documentation for wound dressing change on 02/09/25, 02/13/25, 03/01/25, 03/02/25 and 03/09/25. 676390 Page 4 of 5 676390 03/12/2025 Lexington Medical Lodge 2000 West Audie Murphy Pkway Farmersville, TX 75442

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An observation on 03/12/25 at 10:37 AM, revealed Resident #2 was sitting in her wheelchair in her room. LVN E entered the resident's room to change the wound dressing on Resident#2's right foot. LVN E removed the resident's right shoe, and sock. Resident#2's wound dressing was not dated, timed, or initialed. In an interview on 03/12/25 at 11:22 AM, LVN E (The wound care nurse) stated the facility did not have a policy for wound dressing dating, timing, and initialing. LVN E stated for her or any other staff to know when the dressing was last been changed, they had to check the TAR. She further stated if the wound care dressing change was not documented in the TAR the staff will not know the last time it had been done. She stated the risk to the resident could be missed treatment, and development of infection. In an interview on 03/12/25 at 11:26 AM, LVN D stated for the wound dressing care, she would put the date and initial on the dressing. LVN D stated the purpose of the date on the wound dressing was to know when it was changed. In an interview on 03/12/25 at 1:35 PM, ADON E stated when the wound care dressing was changed, personally, she would date the wound dressing. In an interview on 03/12/25 at 2:25 PM, the DON stated the facility did not have a policy for wound care change dressing dating, timing, and initialing. The DON stated there was no regulation indicating to date the wound dressing. The DON stated she trusted the staff documentation on the resident TAR, and to know when the last time the resident's wound dressing had been changed was by checking the TAR documentation. The DON stated the risk to the resident missed treatments, and wound deterioration. Record Review of the facility undated policy titled Wound Care reflected, Purpose: 1. Treat wounds with the appropriate products .Documentations: 1. Assessment of the wound 2. Treatment 4. Effectiveness of the treatment. 676390 Page 5 of 5