Health inspection·June 28, 2023

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. 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 maintain an effective pest control program for 1 of 1 facility reviewed for pests in that: Residents Affected - Some Flies were observed in multiple areas of the facility. This failure could affect residents by placing them at an increased risk of exposure to pests and vector-borne diseases and infections. Findings included: Observation on 06/27/23 at 10:10 AM revealed Resident #2 was in the dining room eating a snack with a drink present. Three flies were noted on the table. The resident was noted repeatedly attempting to keep the flies off his snack. Observation and interview on 06/27/23 at 10:28 AM in resident room [ROOM NUMBER] revealed two flies on Resident #1's bed and one fly flying around his head. Interview with Resident #1 revealed the flies kept him up at night getting in his nose and ears. He stated he tried to keep it clean in his room, but it didn't make any difference. He stated he would swat at them all the time. Resident #1 stated the flies were constantly in his room on a daily basis and they were worse the hotter it got. Observation on 06/27/23 at 10:35 AM revealed Resident #4 (room [ROOM NUMBER]) was laying in his bed under a sheet. There were six flies observed in his room. One fly landed on his pillow and one fly landed on his ankle. Observation and interview on 06/27/23 at 10:50 AM in resident room [ROOM NUMBER] revealed four flies on Resident #3's bed. Interview with Resident #3 revealed the flies bother him all day and aggravate him. Resident #3 stated the flies were constantly in his room on a daily basis and they get in his food. He stated he has a fly swatter, but it doesn't help. Observation on 06/27/23 at 11:05 AM revealed two flies were observed in resident room [ROOM NUMBER]. There was no resident present. Observation and interview on 06/27/23 at 12:28 PM revealed about seven flies in the dining room while residents ate lunch. Flies were observed on the plates and cups of five residents. Residents were observed to be swatting at flies and four flies landed on residents. Interview with Resident #3 revealed the flies were bad especially during meals. Page 1 of 3 676411 676411 06/28/2023 Clarendon Nursing Home Ten Medical Center Dr Clarendon, TX 79226

F 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Observation and interview on 06/27/23 at 12:30 PM, Resident #5 was observed sitting at his table at lunch. His plate had a fly on it. When asked about the flies, Resident #5 stated, They get in food and will get worse when they get hotter. Observation and interview on 06/27/23 at 12:40 PM, Resident #6 was observed sitting at his table at lunch. He had flies landing in his food. Resident #6 stated, It sucks, they get in my food, and they don't do a damn thing here. During an interview on 06/28/23 at 11:45 AM, the Maintenance Supervisor stated they had a contract with {pest control company} that sprays the building monthly and prn if needed and they have automatic fly sprayers at each doorway and several in each hall. The Maintenance Supervisor stated, We are working on getting our fly lights fixed, they broke recently and {pest control company} is getting prices for us. We also have a landfill that's about a 1/4 mile from this facility that causes a problem. Observation on 06/28/23 at 01:39 PM, two flies were observed in the conference room. During an interview on 06/28/23 at 1:40 PM, the Administrator said there were always flies in the building and the residents go in and out the patio door all the time and sometimes the residents leave the door open to the patio. She stated she had instructed all staff to keep the door shut. The Administrator stated, We use a spray in our wall sprayers that is safe for residents and is supposed to kill flies. It is a wall mounted air freshener type thing on the wall in the dining room and hall. {Pest control company} comes out and sprays monthly for pests. When asked if the monthly visits include flies, the Administrator stated she assumes the pest control contract covers flies. The Administrator stated the maintenance man would have the documentation of what {pest control company} sprays for in the contract. When asked about the outcome for the residents the Administrator stated, Flies do carry disease and it is an infection problem. The Administrator stated every time someone complains about the flies, she calls {pest control company} to come out and spray again. Record review of facility provided pest control log revealed, in part, dates and treatments as follows: Treatment dates and services performed: 6-13-2023 - performed an inspection on the interior and exterior of all areas 5-6-2023 - serviced roach bait stations, multi catch traps, fly lights and glue boards 4-4-2023 - performed an inspection of all areas; recommend replacing broken outdated fly lights $250 each - 2 broken Species listed in treatment: Flies, fruit flies, crickets, mice . Record review of the facility provided pest control logs for the dates listed above revealed documentation on 06/13/23 as follows: Open actions from previous service - Fly light not working Recommendation - replace unit 676411 Page 2 of 3 676411 06/28/2023 Clarendon Nursing Home Ten Medical Center Dr Clarendon, TX 79226

F 0925 Status - pending Level of Harm - Minimal harm or potential for actual harm Location - dining room Residents Affected - Some Record review of the facility's undated policy Pest Control reflected This facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents. 676411 Page 3 of 3