Health inspection·November 9, 2023

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to review and revise the person-centered care plan to reflect the current condition for 1 resident (Resident #30) of 18 residents reviewed for care plan accuracy. The facility failed to ensure Resident #30's care plan was updated to reflect her current feeding status of puree diet. This failure could place residents at risk of not receiving appropriate interventions to meet their current needs. Findings include: Record review of Resident #30's face sheet dated 11/09/23 reflected an [AGE] year-old female who was admitted to the facility on [DATE]. Her diagnoses included respiratory failure, shortness of breath, chronic obstructive pulmonary disease, muscle weakness, anxiety disorder. Record review of Resident #30's admission MDS dated [DATE], section C revealed a BIMS score of 15 which indicated the resident was cognitively intact. Record review of Resident #30's care plan dated 09/27/23 reflected that Resident #30 was care planned for tube feeding related to a swallowing problem, and weight loss. Date initiated was 09/27/23. The goal reflected the resident will maintain adequate nutritional and hydration status. The care plan did not include the information on her diet of puree texture. Record review of Resident #30's physician's order dated 10/04/23 revealed an order - Regular diet Pureed texture, Regular consistency, thin. puree with gravy and broth per ST Active 10/04/2023 to 11/04/2023 Observation and interview on 11/07/23 at 10:00AM, revealed Resident #30 was in her bed using her tablet. She was alert and oriented. In an interview, she said her breakfast was good. She said she was happy that she could eat again. Observation and interview on 08/12/23 at 12:15AM , revealed Resident #30 was in the dining room having lunch. Her meal was a regular, puree diet. She said her food was good and had no complaints. In an interview with LVN D on 11/08/23 at 10:00AM, he said Resident #30 had a G-tube for her Page 1 of 2 676400 676400 11/09/2023 Mrc the Crossings 255 N Egret Bay Blvd League City, TX 77573

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few medication only. He said Resident #30 was previously on G-tube feedings but the G-tube feeding was discontinued sometime ago, and the G-tube was left for her medication. During an interview with the MDS coordinator on 11/09/23 at 1:00PM, she said Resident #30's care plan was done by the interdisciplinary team. She said the dietitian usually updated the care plan whenever there were new orders. In an interview with the Dietitian on 11/09/23 at 1:30PM, she said she wrote her notes on Resident #30's clinical record. She said she should have updated the care plan to reflect her diet change from tube feeding to oral puree diet. She said not updating the care plan could result in Resident #30 not being served her meals. She said she would update Resident #30's care plan to reflect her puree diet. Record review of facility's policy on care plan dated 2001 updated March 2022 read in part-policy statement A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. 1 The interdisciplinary team (IDT), in conjunction with the resident and his/her family or legal representative, develops and implements a comprehensive, person-centered care plan for each resident. .9. Care plan interventions are chosen only after data gathering, proper sequencing of events, careful consideration of the relationship between the resident's problem areas and their causes, and relevant clinical decision making. 10. When possible, interventions address the underlying source(s) of the problem area(s), not just symptoms or triggers. 11. Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change. 12. The interdisciplinary team reviews and updates the care plan: a. when there has been a significant change in the resident's condition. b. when the desired outcome is not met; 676400 Page 2 of 2