Health inspection·June 22, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to develop and implement a person-centered care plan for each resident, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for 1 (Resident #1) of 5 residents reviewed for comprehensive care plans. Resident #1 was not care planned for tube feeding. This deficient practice could place residents at risk for not receiving appropriate care and services. Findings Included: Observation on 06/22/2023 at 5:22 p.m. revealed Resident #1 was being fed via her G-tube. Record review of Resident #1's Face Sheet, dated 06/22/2023, revealed a [AGE] year-old female who was admitted to the facility on [DATE]. Her diagnoses included heart failure, gastrostomy status (an artificial external opening into the stomach for nutritional support), dietary folate deficiency anemia (Vitamin B9 deficiency), hypothyroidism (to little thyroid hormone) and vitamin deficiency. Record review of Resident #1's admission MDS, dated [DATE], revealed a BIMS score of 3 out of 15 indicating severe cognitive impairment. Further review revealed Resident #1 required two-person assist with toileting and bathing, and one-person assist with feeding. Resident #1's Nutritional Approaches section reflected a feeding tube. Record review of Resident #1's orders, dated 06/22/2023, reflected in part . cleanse G Tube site with NS, pat dry, apply drain sponge, and secure with tape .elevate hospital bed 30-45 degrees at all times during internal feeding and for 30 minutes after feeding has completed .Jevity 1.5 cal per feeding pump @ 75ml/hr x 16hrs (4pm-8am), free water flush 140ml Q 4hr bowel rest, pump off 8am-4pm daily every shift related to gastrostomy status. Record review of Resident #1's Care Plan, dated 05/08/2023, revealed it did not reflect Resident #1's need for tube feeding. In an interview on 06/22/2023 at 5:50 p.m., the DON said she and the ADON were responsible for completing care plans. She said Resident #1's need for tube feeding was not documented on the resident's care plan but should have been included. She said it was not added on the care plan because the Page 1 of 3 676396 676396 06/22/2023 S.P.J.S.T. Rest Home 3 248 Wisteria Lane El Campo, TX 77437

F 0656 Level of Harm - Minimal harm or potential for actual harm Dietitian had to increase her caloric intake. The DON said she forgot to go back and update the care plan once the change was completed. She said the risk posed to residents when the required information was not included on their care plan was not getting the proper care. Record review of facility's policy titled Care Plans-Comprehensive revised on 09/2010, reflected in part . Residents Affected - Few 3. Each resident's comprehensive care plan is designed to: a. Incorporate identified problem areas; b. Incorporate risk factors associated with identified problems; . 676396 Page 2 of 3 676396 06/22/2023 S.P.J.S.T. Rest Home 3 248 Wisteria Lane El Campo, TX 77437

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to dispose of garbage and refuse properly for 2 of 2 waste receptacles reviewed for garbage disposal. Residents Affected - Some -Both dumpster's contained waste; Dumpster #1 had its top front lids missing; and Dumpster #2 had one front top lid missing and the other front top lid was open. These failures could place residents at risk for exposure to germs and diseases carried by vermin and rodents. Findings Included: Observation on 06/20/2023 at 9 a.m. accompanied by the Dietary Manager revealed both dumpster's contained waste. Dumpster #1's front top lids were missing, and Dumpster #2's front top lid was open, and the front top right lid was missing. Observation on 06/22/2023 at 5:35 p.m. accompanied by the Administrator revealed no waste in either dumpster. Dumpster #1's front top lids were missing and Dumpster #2's front top right lid was missing. In an interview on 6/22/2023 at 4 p.m., the Administrator said the facility did not have a Food-Related Garbage and Refuse Disposal Policy. In an interview on 06/22/2023 at 5:10 p.m. the Dietary Manager said she did not think the facility had a policy regarding the dumpster and trash disposal but that the doors should have been closed. She said the risk to residents is bugs and rodents could get into the trash. She said the worst thing that can happen to the resident when proper protocols are not practiced was residents could get sick. In an interview on 06/22/2023 at 5:16 p.m., the Administrator said the policy or procedure for disposing of trash was to lift the lid and throw the trash toward the back if there was space and close the lid if it was able to be closed. She said she had contacted the trash company 8 months ago when they asked for the 2nd dumpster and requested new dumpster's then and she requested new dumpster's again 3 months ago, but they refused to provide her with new ones. She said the company they use is the only one that services this area and cannot find another in the rural area. She said the requests for new dumpster's was over the phone. She said the risk to residents was if left in the facility, infection, rodents, but the dumpster's were too far from the facility it didn't pose a risk to the residents. She said the worst thing that could happen to resident when proper protocols are not practiced was, again if waste was not taken out of the facility then it could result in residents getting infections. 676396 Page 3 of 3