Health inspection·July 17, 2025

F 0880 Provide and implement an infection prevention and control program. 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 establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 3 of 4 residents [TF1] (Resident # 18, Resident #83, and Resident #37) and two of Two staff (interviewed and reviewed for infection control.Based on observation, interview and record review the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 3 of 4 residents Resident # 18, Resident #83, and Resident #37) and two of Two staff (interviewed and reviewed for infection control. The facility failed to ensure hand hygiene was completed when passing lunch trays to residents in hall 300. This failure could place residents at risk of diseases and infections. Findings include:1. Record review of Resident #18's [AGE] year-old female resident who was admitted to the facility on [DATE]. Resident #18 had diagnoses which included: anxiety disorder (A mental health condition characterized by excessive and persistent worry and fear, often impacting daily activities. It can manifest with physical symptoms like increased heart rate, sweating, and difficulty sleeping. cough, unspecified, nasal congestion (A cough that clears the throat or airways but without a known or specified cause), Muscle wasting and atrophy (A decrease in muscle mass and strength), cataract (A clouding of the eye's natural lens), arthritis (Inflammation of one or more joints, causing pain, swelling, stiffness, and reduced range of motion), osteoporosis (A disease that weakens and thins bones), intellectual disabilities (A condition characterized by limitations in mental functioning and adaptive skills like communication and self-care), hyperlipidemia (Elevated levels of lipids, such as cholesterol and triglycerides, in the blood.), and protein-calorie malnutrition(Occurs when a person's calorie and/or protein intake is inadequate to meet their body's needs). Record review of Resident #18's Quarterly MDS, dated [DATE], reflected a BIMS score that was blank. Record review of Resident #18s care plan, dated 11/14/2023, and last revised on 02/27/2025, reflected: Focus on significant unplanned or unexpected weight loss, nutritional problems or potential nutritional issues, poor intake and choking precautions, falls, and the Resident was at risk for unplanned weight loss or gain. 2. Record review of Resident #83's [AGE] year-old medical diagnosis reflected a female resident who was admitted to the facility on [DATE]. Resident #83 had diagnoses which included: obstructive and reflux uropathy (blockage in the urinary system that makes it difficult or impossible for urine to flow normally), anxiety disorder (This is a mental health condition characterized by persistent and excessive worry, fear, and apprehension that interferes with daily life), urinary tract infection (This is an infection of any part of the urinary system), malignant neoplasm of rectum (development of cancerous tumors in the rectum), hypertension (High Blood Pressure), chronic mastoiditis (infection of the mastoid bone, which is located behind the ear in the skull), visual loss in both Residents Affected - Some Page 1 of 3 676427 676427 07/17/2025 Skilled Care of Mexia 501 E Sumpter St Mexia, TX 76667

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some eyes, altered mental status (change in a person's mental function, awareness, or behavior), history of falling, and sequelae of cerebral infarction ( long-term or lasting effects that occur after a cerebral infarction, which is also known as a stroke (a blockage of blood flow to part of the brain). Record review of Resident #83's Quarterly MDS, dated [DATE], reflected a BIMS score that was blank. Record review of Resident #83's care plan, dated 07/16/2023 and last revised on 02/27/2025, reflected: tract Infection, hospice services, Anticoagulant therapy, enhanced barrier precautions, impaired cognitive function/dementia (a decline in mental ability severe enough to interfere with daily life) or impaired thought processes, impaired visual function, communication problem, self-care performance deficit, bladder incontinence and uses a bed rail to assist themselves with ADL's 3. Record review of Resident #37's [AGE] year-old medical diagnosis reflected a female resident who was admitted to the facility on [DATE]. Resident #37 had diagnoses which included: cerebral infarction (schemic stroke), major depressive disorder (recurrent severe without psychotic features), unsteadiness on feet(difficulty maintaining balance and coordinated movement), transient cerebrovascular attack (mini-stroke), muscle weakness ( decrease in the strength of one or more muscles), muscle wasting atrophy (A decrease in muscle mass (wasting or thinning of muscle tissue), hyperlipidemia (hardening of the arteries), gastro-esophageal reflex disease without esophagitis (digestive disorder where stomach acid frequently flows back into the esophagus, but without causing inflammation or damage), dysphagia (Difficulty swallowing), repeated falls, lack of coordination, hypokalemia (blood contains abnormally high levels of lipids (fats), and anxiety disorder[. Record review of Resident #37's Quarterly MDS, dated [DATE], reflected a BIMS score of 8, which indicated moderate cognitive impairment. Record review of Resident #37's care plan, dated 07/16/2023 and last revised on 02/27/2025, reflected: uses a bed rail to assist themselves with ADLs, potential fluid deficit, risk for unplanned weight loss or gain (Mechanical Soft texture), swallowing problem, coughing or choking during meals or swallowing meds, risk for falls, risk for wandering, ADL Self Care, hearing deficit, impaired visual function, and impaired cognitive function/dementia or impaired thought processes. Observation on 07/10/2025 at 12:15 PM during the lunch service in hall 300 revealed CNA X and CNA served food trays to residents in their rooms. The CNA X and CNA Y did not sanitize their hands between grabbing and handing out food trays to residents in the rooms during the lunch service. The residents in rooms #18, #83, and #37 were at risk, but none of them were in isolation Interview on 07/17/2025 at 12:35 PM with CNA X revealed she had been working at the facility for 3 months. When asked what the process was for handing out food trays to residents, CNA X did not mention she needed to clean her hands. CNA X stated she was new to that hall and forgot to wash her hands before handing out food trays. CNA X stated she received in-service training on hand hygiene and infection control when she first started. CNA X said that when she did not clean her hands, the resident was at risk of getting an infection. Interview on 07/17/2025 at 12:35 PM with CNA Y revealed she had been working at the facility for 2 weeks. CNA Y said she was supposed to clean her hands before passing resident trays in their rooms. CNA Y said she forgot to wash her hands. CNA Y said she normally washed her hands when serving residents their trays. CNA Y said if she did not wash her hands, then residents were at risk of getting an infection. CNA Y said she had training on infection control and hand hygiene in orientation. Interview on 07/17/2025 at 12:43 PM with LVN revealed she had been working at the facility for 7 years. She said she was supposed to always sanitize her hands before grabbing a tray for another tray so residents do get sick. LVN said she had in-services on hand hygiene and infection control. The LVN said if proper hand hygiene was not followed, residents could get an infection. The LVN said this time she forgot to wash her hands, but she normally does it. The LVN said she had not seen any other staff not 676427 Page 2 of 3 676427 07/17/2025 Skilled Care of Mexia 501 E Sumpter St Mexia, TX 76667

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some washing their hands during meal service. The LVN stated if she saw other staff not washing their hands, she would remind them to do it. Interview on 07/17/2025 at 12:51 PM with CNA Z revealed she had been working at the facility for 7 1/2 years. She stated she was supposed to sanitize her hands before and after getting the tray for residents. She said she had in-service training on hand hygiene and infection control. She said if hand hygiene was not followed, residents could get an infection. She had not seen any other staff not cleaning their hands, and if she did, she would tell them they needed to wash their hand. She said this time she forgot to wash her hands. Interview on 07/17/2025 at 12:59 PM with RN revealed she had been working at the facility for 5 years. She said she would help serve trays to the residents when they were short-staffed. She said staff were to clean their hands before giving residents their trays of food. She said if this was not done, residents were at risk of getting an infection. The RN said she had in-service training on hand hygiene and infection control. The RN said she had not seen any staff not cleaning their hands when serving food trays to residents. If she saw staff not cleaning their hands, she would remind them to do it. She would then tell the DON and ADM, so staff could be trained. Interview on 07/17/2025 at 1:08 PM with DON revealed she had in-service training on hand hygiene and infection control within the last month. The DON said that when staff did not clean their hands, residents were at risk of an infection. The DON said she had not seen any staff not sanitizing their hands while passing out trays to the residents. She said if she saw staff not doing this, she would talk with them, then provide training on hand hygiene and infection control. Record review on 07/17/2025 of facility policy titled, Infection Prevention and Control Program dated 02/01/2024 reflected the following: Policy . The facility will require staff to wash their hands after each direct resident contact, for which hand washing is indicated by accepted professional practice. 676427 Page 3 of 3