Health inspection·October 6, 2023

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to refer a resident with newly evident or possible serious mental disorder for a PASRR Level II resident review upon a significant change of condition for 3 of 3 Residents (Residents #8, #53 and #62) reviewed for PASRR The facility failed to refer Resident #8 for a PASRR Evaluation upon admission due to a primary diagnosis of bipolar disorder. The facility failed to refer Resident #53 for a PASRR Evaluation upon admission for schizophrenia and upon receiving later diagnoses of anxiety disorder and major depressive disorder. The facility failed to refer Resident #62 for a resident review after updating the Resident's diagnosis to indicate a diagnosis of mental illness. These failures could place residents at risk of not receiving the needed PASRR services. The findings were: Record review of Resident #8's Face Sheet dated 10/6/23, documented a [AGE] year-old female admitted to the facility on [DATE]. Her primary diagnosis was bipolar disorder, unspecified (A disorder associated with episodes of mood swings ranging from depressive lows to manic highs). On 06/20/23, the diagnosis of generalized anxiety disorder (a normal reaction to stress an intense, excessive, and persistent worry and fear about everyday situations) was added to the face sheet. Record review of Resident #8's PASRR I screening, completed by the referring entity dated 05/19/23, prior to admission on [DATE] indicated in Section C PASRR Screen questions C0100 asks is there evidence or an indicator this individual has Mental Illness? The answer was 0 (0. No). Record review of Resident #8's Quarterly MDS dated [DATE] revealed a BIMS score of 13, indicating she was cognitively intact; a score of 12 on the PHQ-9 Mood Assessment, indicating she was moderately depressed; and it listed her Active Diagnoses as anxiety disorder, depression and bipolar disorder. Record review of Resident #8's care plan revealed a Focus of R #8 will have a PASRR screening according to regulatory guidelines. This was completed on admit. The Interventions revealed No specialized services are required at this time. The Care Plan had a revision date of 05/31/23. Another Focus of this care plan with a revision date of 05/31/23 revealed R #8 uses psychotropic medication related to bipolar disease. The Goal was listed as Will reduce the use of psychoactive medication through Page 1 of 6 676406 676406 10/06/2023 Trucare Living Centers - Selma 16550 Retama Parkway Selma, TX 78154

F 0644 the review date in efforts to DC or least dose to manage signs and symptoms of behaviors. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #53's Face Sheet dated 10/06/23 documented an [AGE] year-old female with an original admission date of 04/19/22 with the last admission date of 05/07/23. Resident #53 had a diagnosis of schizophrenia (a disorder that affects a person's ability to think, feel, and behave clearly) with an onset date of 04/01/22, a diagnosis of anxiety disorder with an onset date of 05/29/22 and a diagnosis of major depressive disorder, recurrent, mild (a mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life) with an onset date of 05/25/23. Residents Affected - Some Record review of Resident #53's PASRR I screening, completed by the referring entity dated 03/23/22, prior to admission on [DATE] indicated in Section C PASRR Screen questions C0100 asks is there evidence or an indicator this individual has Mental Illness? The answer was 0 (0. No). Record review of Resident #53's Quarterly MDS dated [DATE] revealed a BIMS score of 15, indicating she was cognitively intact, and Active Diagnoses that included anxiety disorder, depression and schizophrenia. Record review of Resident #53's Care Plan documented a Focus of R #53 uses anti-anxiety medications related to anxiety disorder, with a revision date of 06/01/22 and a Focus of R #53 has a potential psychosocial well-being problem related to anxiety with a revision date of 06/01/22. Resident #53 also had a Focus of R #53 uses antidepressant medication related to depression. Review of Resident # 62's Face Sheet dated 10/06/2023 revealed Resident #62 was admitted to the facility on [DATE] with the primary diagnoses including but not limited to the following: Acute posthemorrhagic anemia ( a condition in which a person quickly loses a large volume of circulating hemoglobin). Resident #62's face sheet revealed an updated diagnosis of Bipolar Disorder, current episode mixed, unspecified on 07/03/2023 and Major Depressive Disorder, Recurrent, Unspecified. Review of Resident #62's MDS dated [DATE] revealed in Section C a BIMS of 6 indicating severe cognitive impairment. Review of Resident # #62's older MDS Assessment with a submission date of 07/04/2023 revealed in Section A, A 1500 has documented 0. No for Has the resident been evaluated by Level II PASSR and determined to have a serious mental illness and/or Mental retardation or a related condition?. Review of Resident #62's PASSR Level I Screening, completed by the referring entity prior to admission on [DATE] indicated in Section C PASRR Screen questions C0100 asks is there evidence or an indicator this individual has Mental Illness? The answer was 0 (0. No). Interview with the MDS Coordinator on 10/06/23 at 12:56 p.m., the MDS Coordinator stated, Resident #62 should have had a PL 1 upon admission. I am new to the facility, but the previous MDS Coordinator should have made sure the Resident was evaluated for PASSR services and followed through. If the diagnosis came after, the resident should have been evaluated by the Authority. If a resident has Bipolar, Depression, Schizophrenia or any diagnosis that could make them eligible for PASSR services they should be evaluated when that diagnosis is presented. If the Resident is not evaluated correctly, they will not get the services they are supposed to receive. After being asked by the Survey team about whether or not Resident #62 had been evaluated for PASRR services we started auditing and are putting a new process into place to ensure the PASSR evaluations are completed. I was told by the 676406 Page 2 of 6 676406 10/06/2023 Trucare Living Centers - Selma 16550 Retama Parkway Selma, TX 78154

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Administrator; I will be in charge of that process to make sure the residents get the services they are supposed to get. Interview with the Administrator on 10/06/23 at 2:30 p.m., the Administrator said the PASSR process was used to make sure the needs of the residents were individually met. Each resident should be evaluated for PASSR services and followed through with based on needs. If a resident was not evaluated correctly, they would not get the services they are supposed to receive. The current MDS Coordinator and I are both new to the facility and are currently auditing the PASSR process in this facility to ensure all residents who are supposed to be evaluated for or receiving PASSR services receive them as they should. A PASSR policy was requested from the facility Administrator during the interview on 10/06/2023 at 2:30 p.m. , the Administrator stated the facility did not have a PASSR policy which she was able to locate at that time. A PASSR policy was not provided to the survey team prior to exit. 676406 Page 3 of 6 676406 10/06/2023 Trucare Living Centers - Selma 16550 Retama Parkway Selma, TX 78154

F 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to ensure all Pre-admission Screening and Resident Review (PASRR) Level I residents with mental illness were provided with a PASRR Evaluation assessment for 2 of 2 residents (Residents #8 and #53) reviewed for PASRR screening, in that: Residents Affected - Some Residents #8 and #53 did not have an accurate PASRR Level 1 assessment when they had a diagnosis of mental illness. These failures could place residents with an inaccurate PASRR Level 1 Evaluation at risk for not receiving care and services to meet their needs. The findings were: Record review of Resident #8's Face Sheet dated 10/6/23, documented a [AGE] year-old female admitted to the facility on [DATE]. Her primary diagnosis was bipolar disorder, unspecified (A disorder associated with episodes of mood swings ranging from depressive lows to manic highs). On 06/20/23, the diagnosis of generalized anxiety disorder (a normal reaction to stress an intense, excessive, and persistent worry and fear about everyday situations) was added to the face sheet. Record review of Resident #8's PASRR I screening, completed by the referring entity dated 05/19/23, prior to admission on [DATE] indicated in Section C PASRR Screen questions C0100 asks is there evidence or an indicator this individual has Mental Illness? The answer was 0 (0. No). Record review of Resident #8's Quarterly MDS dated [DATE] revealed a BIMS score of 13, indicating she was cognitively intact; a score of 12 on the PHQ-9 Mood Assessment, indicating she was moderately depressed; and it listed her Active Diagnoses as anxiety disorder, depression and bipolar disorder. Record review of Resident #8's care plan revealed a Focus of R #8 will have a PASRR screening according to regulatory guidelines. This was completed on admit. The Interventions revealed No specialized services are required at this time. The Care Plan had a revision date of 05/31/23. Another Focus of this care plan with a revision date of 05/31/23 revealed R #8 uses psychotropic medication related to bipolar disease. The Goal was listed as Will reduce the use of psychoactive medication through the review date in efforts to DC or least dose to manage signs and symptoms of behaviors. Record review of Resident #53's Face Sheet dated 10/06/23 documented an [AGE] year-old female with an original admission date of 04/19/22 with the last admission date of 05/07/23. Resident #53 had a diagnosis of schizophrenia (a disorder that affects a person's ability to think, feel, and behave clearly) with an onset date of 04/01/22, a diagnosis of anxiety disorder with an onset date of 05/29/22 and a diagnosis of major depressive disorder, recurrent, mild (a mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life) with an onset date of 05/25/23. Record review of Resident #53's PASRR I screening, completed by the referring entity dated 03/23/22, prior to admission on [DATE] indicated in Section C PASRR Screen questions C0100 asks is there evidence or an indicator this individual has Mental Illness? The answer was 0 (0. No). Record review of Resident #53's Quarterly MDS dated [DATE] revealed a BIMS score of 15, indicating 676406 Page 4 of 6 676406 10/06/2023 Trucare Living Centers - Selma 16550 Retama Parkway Selma, TX 78154

F 0645 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some she was cognitively intact, and Active Diagnoses that included anxiety disorder, depression and schizophrenia. Record review of Resident #53's Care Plan documented a Focus of R #53 uses anti-anxiety medications related to anxiety disorder, with a revision date of 06/01/22 and a Focus of R #53 has a potential psychosocial well-being problem related to anxiety with a revision date of 06/01/22. Resident #53 also had a Focus of R #53 uses antidepressant medication related to depression. During an interview with the MDS Coordinator on 10/05/23 at 3:06 p.m., she stated, the social worker and I work together with [the local mental health authority] to discuss PASRRs. The local authority can often give us the history of the person. The MDS Coordinator acknowledged that Resident #53 had a diagnosis of schizophrenia, major depressive disorder and anxiety disorder and should have been marked positive. Resident #8 also had a diagnosis of bipolar disorder and should have been marked positive on the PASRR I screening. The MDS Coordinator was aware that a Form 1012 could be used to make this correction. On 10/06/23 at 2:47 p.m., the MDS Coordinator presented copies of Form 1012 for Resident #8 and Resident #53 to surveyors. The MDS Coordinator stated I have talked with [NAME], the representative from the local mental health authority, and she will be here next week to conduct a PASRR Evaluation on Resident #8 and Resident #53. A PASSR policy was requested from the facility Administrator during the interview on 10/06/2023 at 2:30 p.m. The Administrator stated the facility did not have a PASRR policy which she was able to locate at that time. A PASSR policy was not provided to the survey team prior to exit. 676406 Page 5 of 6 676406 10/06/2023 Trucare Living Centers - Selma 16550 Retama Parkway Selma, TX 78154

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 garbage and refuse properly for 2 of 2 dumpsters reviewed for proper storage of garbage and refuse in that: Residents Affected - Few The facility failed to keep the dumpsters lids closed and the area free of trash and outside of the dumpster. This failure could affect the residents placing them at risk for infection and a decreased quality of life due to having an exterior environment which could attract flying pests, rodents and other animals. The evidence is as follows: On 10/03/2023 at 10:05 a.m. the following observations and interviews were made: Two dumpsters enclosed in a locked fence behind a solid enclosure. Items on the ground in various places on the outside of the dumpsters on the ground were identified by the DM as bags of trash on both sides of each dumpster that should have been placed in the dumpsters. The dumpster lids were pushed back and all dumpster lids for the two dumpsters were completely opened. There was one bag of trash torn and partially opened hanging out the side door of one dumpster exposing food items. During an interview with the DM, while viewing the dumpster area, on 10/03/2023 at 10:05 a.m., the DM stated, we got a tag for the same thing last year, they should not be like that the trash is supposed to be inside with the lids closed. The DM did not comment further. During an interview with the Administrator, on 10/06/2023 a.m. at 4:51 p.m., the Administrator said, I did see the dumpsters, I immediately called the dumpster company and asked them to come and empty the dumpsters. They came on Tuesday afternoon and emptied them. The lids should have been closed and they were not. They should have been closed so nothing comes out and for sanitation reasons. I do not think that affects the residents in any way. Record review of a policy, Food related Garbage and Rubbish Disposal, Revised December 2008, provided by the Administrator prior to exit revealed: 1. All garbage and rubbish containing food wastes shall be kept in containers. 2. All garbage and rubbish containers shall be provided with tight-fitting lids or covers and must be kept covered when stored or not in continuous use. 5. Garbage and rubbish containing food wastes will be stored in a manner that is inaccessible to vermin. 7. Outside dumpsters provided by garbage pick up service will be kept closed and free of surrounding litter. 676406 Page 6 of 6