Health inspection·October 25, 2023

F 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record reviewed, the facility failed to ensure an encoded, accurate, and complete MDS discharge assessment was electronically transmitted to the CMS System for 1 of 25 residents records reviewed for MDS assessments. (Residents #35) Residents Affected - Few The facility did not ensure the discharge MDS assessment was completed and electronically transmitted as required for Resident #35. This failure could place residents at risk of not having their assessments transmitted timely. Findings included: Record review of Resident #35's admission record dated 10/25/23 indicated she was admitted on [DATE] with a discharge date of 06/26/23. Resident #35's diagnoses included joint replacement surgery. Record review of the MDSs for Resident #35 indicated the discharge MDS assessment was completed on 06/26/23. The discharge MDS assessment was marked current not transmitted or accepted. Record review of the nurse's notes from 06/16/23 to 06/26/23 indicated Resident #35 was discharged home on [DATE]. During an interview on 10/25/23 at 9:30 a.m., LVN C said she did not transmit Resident #35 discharge MDS assessment. She said she had received training on completing, preparing, signing and transmitting the MDS assessment to CMS. LVN C said Resident #35's MDS should have been sent so the resident records would be complete. During an interview on 10/25/23 at 9:45 a.m., the DON said when Resident #35 was discharged home, there should have been a discharge MDS completed and submitted. She said LVN C was responsible for transmitting and the used the RAI manual for the policy. During an interview on 10/25/23 at 10:00 a.m., the Administrator said he expected the discharge MDS assessments to be completed and transmitted. Review of the CMS's RAI Version 3.0 Manual obtained on 10/25/23 from the CMS website, https://downloads.cms.gov/files/mds-3.0-rai-manual-v1.17.1_October_2023.pdf indicated the following: CMS's RAI Version 3.0 Manual indicated . Discharge Assessment refers to an assessment required on resident discharge from the facility, or when a resident's Medicare Part A stay ends, but the resident remains in Page 1 of 5 676444 676444 10/25/2023 Bonne Vie 8595 Medical Center Boulevard Port Arthur, TX 77640

F 0640 Level of Harm - Minimal harm or potential for actual harm the facility (unless it is an instance of an interrupted stay, as defined below). This assessment includes clinical items for quality monitoring as well as discharge tracking information. RAI OBRA-required Assessment Summary .Discharge Assessment - return not anticipated (Non-Comprehensive) A0310F = 10 discharge date + 14 calendar days . Residents Affected - Few 676444 Page 2 of 5 676444 10/25/2023 Bonne Vie 8595 Medical Center Boulevard Port Arthur, TX 77640

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 1 of 24 residents reviewed for indwelling catheters. (Resident #63) The facility failed to prevent Resident #63's urinary catheter drainage bag from touching the floor. This failure could place residents at risk for urinary tract infections. Findings included: Record review of physician orders dated 10/25/23 indicated Resident #63, admitted [DATE], was a [AGE] year-old male with a diagnosis of disorder of the urinary system. The resident had an indwelling urinary catheter (a catheter which is inserted into the bladder to drain urine). The resident had a history of urinary tract infections and was ordered a prophylactic antibiotic Macrobid 100 mg 1 tablet every day. Record review of the most recent MDS dated [DATE] indicated the resident had a urinary catheter in place. The assessment did not indicate Resident #63 had a urinary tract infection in the last 30 days but did indicate the resident had a diagnosis of obstructive uropathy (a disorder of the urinary tract that occurs due to obstructive flow). Record review of a care plan dated 06/07/21 to present indicated Resident #63 had an indwelling urinary catheter and was at risk for increased urinary tract infections. Hospice prophylactic antibiotic order: Macrobid 100 mg one tablet one time a day. The goal was Foley catheter will remain patent and [Resident #63] will not develop increased incidents of UTI's over the next 90 days. The interventions included catheter care, encourage fluids, change catheter per order and did not indicate to keep the urinary catheter bag or tubing off the floor. During the following observations, Resident #63's urinary catheter bag was secured to the left side of the bed and the bag was touching the floor mat beside the resident's bed: *10/23/23 at 10:17 a.m., *10/24/23 at 9:40 a.m., and *10/25/23 at 9:59 a.m. During observation and interview on 10/25/23 at 9:59 a.m., CNA A entered Resident #63's room to perform indwelling catheter care. The resident's catheter bag was touching the floor mat upon entrance. CNA A said Resident #63's catheter bag should not be touching the floor or the floor mat. She said germs could get into the catheter. She said she was responsible for making sure the bag was not touching the floor, but she did not notice the catheter bag was on the floor. During observation and interview on 10/25/23 10:02 a.m., LVN B said the indwelling catheter bag was 676444 Page 3 of 5 676444 10/25/2023 Bonne Vie 8595 Medical Center Boulevard Port Arthur, TX 77640

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few touching the floor mat and should not be. She said all direct care staff were responsible for ensuring the urinary catheters were not touching the floor or floor mat. She said germs could travel up the catheter and cause infection. During an interview on 10/25/23 at 10:05 a.m., the DON said the indwelling urinary catheter bag should not be touching the floor or floor mat. She said the resident could be at increased risk of infection. She said her expectations were for the catheter bags to be kept off the floor. A Catheter Care policy updated March 2019 indicated: Responsibility: Licensed nurse and nursing assistant. Purpose: to prevent infection and prevent irritation. The policy did not indicate the indwelling catheter should be kept off the floor. 676444 Page 4 of 5 676444 10/25/2023 Bonne Vie 8595 Medical Center Boulevard Port Arthur, TX 77640

F 0847 Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse. Level of Harm - Minimal harm or potential for actual harm Based on record review and interview, the facility failed to ensure the arbitration agreement contained all the required elements for 1 of 1 facility reviewed for Arbitration Agreements. Residents Affected - Many The facility did not ensure the arbitration agreement contained the required element of informing residents of their right to rescind in 30 calendar days of signing the agreement. This failure could place the residents or the residents' responsible parties in binding agreements not fully understood, cause a loss of their legal rights, and cause negative psychological issues. Findings included: During an interview and record review during the entrance conference on 10/23/23 at 8:30 a.m., the Administrator provided a copy of the facility's admission packet, and the binding Arbitration Agreement was included in the admission packet. The Arbitration Agreement did not include information on the right to rescind the agreement within 30 days of signing. During an interview on 10/24/23 at 4:00 p.m., the Administrator said the arbitration agreement in the admission packet did not include the information on the right to rescind the agreement within 30 calendar days of signing. The Administrator said the right to rescind the agreement within 30 calendar days of signing was to protect the resident's rights. He said the facility had 40 to 50 admissions in the last 30 days. Record review of undated admission Agreement, undated included: .page 23 ARBITRATION AGREEMENT In accordance with the provisions of the Federal Arbitration Act 9 . and in further consideration of the duties and obligations contracted for in the admission and financial Agreement, . the parties to the admission Agreement hereby understand and agree that any dispute, controversary or claims arising out of or relating to the admission Agreement, or the services performed thereunder, the breach thereof or any dispute in tort or in medical malpractice . shall be resolved through arbitration . By signing the admission Agreement, it is understood and agreed by the parties that the right to a jury or court trial . is waived. 676444 Page 5 of 5