Health inspection·April 29, 2025

F 0558 Reasonably accommodate the needs and preferences of each resident. 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 the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences for 2 of 28 (Residents #85 and Resident #125) residents reviewed for reasonable accommodation of needs. Residents Affected - Few The facility failed to ensure the call light system in Resident #85 and Resident #125's rooms were in a position that was accessible to the residents on 04/27/2025. This failure could place the residents at risk of being unable to obtain assistance when needed and help in the event of an emergency. Findings included: Resident #85 Record review of Resident #85's Face Sheet, dated 04/28/2025, reflected the resident was an [AGE] year-old female who admitted to the facility on [DATE]. Resident #85's diagnoses included neurocognitive disorder with Lewy bodies (progressive brain disorder affecting cognition, behavior, movement, and sleep) and muscle wasting and atrophy (loss of muscle mass). Record review of Resident #85's Quarterly MDS (assessment used to determine functional capabilities and health needs) Assessment, dated 02/25/2025, reflected intact cognition with a BIMS (screening tool to assess cognition) score of 13. Section GG (functional abilities) indicated Resident #85 required moderate assistance with self-care and mobility. Record review of Resident #85's Comprehensive Care Plan, dated 03/20/2025, reflected a history of falling or other identified risk factors that result in increased risk of falling. One intervention was Be sure the resident's call light is within reach and encourage resident to use it for assistance as needed. During an observation and interview on 04/27/25 at 9:34 AM, Resident #85 was lying in bed awake. Her call light was on the floor near the head of the bed. Resident #85 was unable to participate in an interview due to her cognitive status. During an interview on 04/27/25 at 9:44 AM, CNA C stated Resident #85 was on hospice care and declining. CNA C stated it was important to ensure Resident #85's call light was in reach so she could notify staff if she needed anything. CNA C went to Resident #85's room and placed the call light on the bed near her. Page 1 of 5 676390 676390 04/29/2025 Lexington Medical Lodge 2000 West Audie Murphy Pkway Farmersville, TX 75442

F 0558 Resident #125 Level of Harm - Minimal harm or potential for actual harm Record review of Resident 125's Face Sheet, dated 04/28/2025, reflected the resident was an [AGE] year-old female who admitted to the facility on [DATE]. Resident #125 had diagnoses which included congestive heart failure (heart does not pump blood efficiently), COPD (chronic lung disease), and muscle weakness. Residents Affected - Few Record review of Resident #125's Quarterly MDS Assessment, dated 04/22/2025, reflected severe cognitive impairment with a BIMS score of 06. Section I (active diagnoses) reflected muscle weakness and Section O (special treatments, procedures, and programs) indicated Resident #125 received physical therapy services. Record review of Resident #125's Comprehensive Care Plan, dated 04/17/2025, reflected a history of falling or other identified risk factors that result in increased risk of falling. One intervention was Be sure the resident's call light is within reach and encourage resident to use it for assistance as needed. During an observation and interview on 04/27/25 at 10:20 AM, Resident #125 was sitting in her wheelchair next to her bed. Resident #125's bedside table was in front of her. Resident #125's call light was on the bed rail on the opposite side of the bed. Resident #125 stated she could not reach her call light. During an observation and interview on 04/27/25 at 10:22 AM, CNA E stated she transferred Resident #125 to her wheelchair and forgot to move the call light where the resident could reach it. CNA E went to Resident #125's room and handed the call light to the resident. She stated Resident #125 was not able to get up and get the call light on her own. CNA E stated it was important for the resident to have the call light in case she needed assistance or had a change of condition. During an interview on 04/28/2025 at 9:16 AM, ADON B stated residents should have their call lights within reach at all times. She stated call light placement was to be checked during rounds. ADON B stated all staff members were responsible for ensuring residents could reach the call light before leaving their rooms. During an interview on 04/28/2025 at 12:12 PM, the DON stated her expectation was that call lights were always in reach for the residents' safety. The DON stated if residents needed help and tried to get up, they could fall and get hurt. She stated she was in-servicing staff. During an interview on 04/29/2025 at 11:55 AM, LVN F stated it was important for residents to have their call light or they would not have a way to reach staff for assistance. She stated sometimes residents needed a drink, their television remote, or assistance to get up and go to the restroom. She stated staff had to be there to meet whatever needs the resident had. During an interview on 04/29/25 at 2:10 PM, the Administrator stated all staff members were responsible for ensuring residents' call lights were in reach before leaving the room. He stated administrative personnel had assigned residents they rounded on each day to ensure residents' needs were being met and that included ensuring the call light was accessible. He stated it was important for residents to be able to notify staff if they needed assistance with anything. Record review of the facility's policy Call Lights reflected The call light must always be within 676390 Page 2 of 5 676390 04/29/2025 Lexington Medical Lodge 2000 West Audie Murphy Pkway Farmersville, TX 75442

F 0558 resident's reach before you leave the room. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 676390 Page 3 of 5 676390 04/29/2025 Lexington Medical Lodge 2000 West Audie Murphy Pkway Farmersville, TX 75442

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 such care consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 2 of 11 (Resident #10 and Resident #77) residents reviewed for Respiratory Care. Residents Affected - Few The facility failed to ensure Resident #10's nasal cannula (flexible tube used to deliver oxygen to the nose through two prong) was stored in a bag when not in use on 04/27/2025. The facility failed to ensure Resident #77's nebulizer face mask was stored in a bag when not in use on 04/27/2025. These failures could place the residents at risk for respiratory infection and not having their respiratory needs met. Findings included: Resident # 10 Review of Resident #10's Face Sheet, dated 04/28/2025, reflected the resident was an [AGE] year-old female who admitted to the facility on [DATE]. Resident #10 was diagnosed with COPD (a chronic lung disease that limits airflow to the lungs). Review of Resident #10's Quarterly MDS Assessment, dated 04/09/2025, reflected moderate cognitive impairment with a BIMS score of 09. Section O (special treatments, procedures, and programs) indicated Resident #10 received intermittent oxygen therapy. Review of Resident #10's Comprehensive Care Plan, dated 04/08/2025, reflected the resident was administered oxygen therapy. Interventions included Apply oxygen as needed and Assess lung sounds PRN & document. Review of Resident #10's Physician's Orders, dated 04/03/2025, reflected an order to administer oxygen 2-4 LPM (oxygen flow rate) via nasal cannula as needed for shortness of breath. During an observation and interview on 04/27/25 at 9:25 AM, Resident #10 was sitting in a recliner in her room. Resident #10's oxygen tubing was connected to the oxygen concentrator next to the recliner. The oxygen tubing was on the floor between the recliner and the oxygen concentrator. Resident #10 stated someone would come and put the oxygen tubing in a bag. Resident #10 pulled the tubing from the floor and draped it over the oxygen concentrator. During an observation on 04/27/2025 at 9:45 AM, Resident #10's oxygen tubing was draped over the oxygen concentrator. It was not stored in a bag. During an interview on 04/27/25 at 9:49 AM, CNA C stated Resident #10's oxygen tubing should have been bagged so it did not get dirty. She stated if a resident used oxygen tubing that was dirty, it could cause them to get sick. She stated some residents already had a weakened immune system and it 676390 Page 4 of 5 676390 04/29/2025 Lexington Medical Lodge 2000 West Audie Murphy Pkway Farmersville, TX 75442

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few was important to ensure the oxygen tubing was stored in a bag. CNA C stated she would get new tubing and put it in a bag. Resident #77 Review of Resident #77's Face Sheet, dated 04/28/2025, reflected the resident was a [AGE] year-old female who admitted to the facility on [DATE]. Resident #77 was diagnosed with COPD and anxiety disorder (uncontrollable feelings of anxiety and fear). Review of Resident #77's Quarterly MDS Assessment, dated 02/06/2025, reflected moderate cognitive impairment with a BIMS score of 12. Section I (active diagnoses) indicated Resident #77 was treated for COPD. Review of Resident #77's Comprehensive Care Plan, dated 04/07/2025, reflected the resident had the potential for altered respiratory status and difficulty breathing related to COPD. One intervention was to administer medication as ordered and monitor for effectiveness and side effects. Review of Resident #77's Physician's Order, dated 06/08/2023, reflected administer Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML 1 dose inhale orally via nebulizer every 6 hours for SOB. During an observation and interview on 04/27/25 at 9:58 AM, Resident #77 was lying in bed watching television. Resident #77's nebulizer mask was on her nightstand and not bagged. Resident #77 stated it was not always stored in a bag. During an interview on 04/27/25 at 10:05 AM, CNA D stated Resident #77's nebulizer mask should have been bagged when she was not using it. CNA D stated dust could get on the mask and the resident had to put it on her face. She stated the resident could get sick if she got germs in her lungs. She stated it was really important for it to stay in a bag. She stated the nebulizer mask and tubing would be discarded and the new mask and tubing bagged. During an interview on 04/28/25 at 9:15 AM, ADON B stated it was important to keep all respiratory items bagged when the resident was not using them to help prevent infection. She stated it also prevented the residents from tripping on the tubing. During an interview on 04/28/25 at 9:22 AM, ADON A stated all respiratory items should be bagged when not in use. She stated she talked to the nurse to ensure this was done. She stated it was important to keep respiratory items as clean as possible to help prevent infection During an interview on 04/28/25 at 12:12 PM, the DON stated the nurses and aides were responsible for ensuring the respiratory items were bagged. She stated if a resident was cognitively aware, they can be told to place the item in the bag after use. She stated it was important to keep those items clean because the resident breathes through them. She stated all staff had been educated on following this infection control measure. During a telephone interview on 05/01/2025 at 2:12 PM, LVN G stated after completing a breathing treatment, it was important to assess the resident, remove the mask, sanitize it, and tie it up in a bag. He stated it was important to keep it sanitary and prevent infection. The facility did not provide a policy on how to store respiratory items when not in use. 676390 Page 5 of 5