Health inspection·January 12, 2023

F 0576 Ensure residents have reasonable access to and privacy in their use of communication methods. Level of Harm - Minimal harm or potential for actual harm Based on interview, record review and observation, the facility failed to ensure the residents received mail for 4 of 9 residents reviewed for rights to forms of communication. (Resident #s 6, 12, 36, 49, 55, 56, 57, 61 and 65) Residents Affected - Some The facility did not implement a system for delivering mail on Saturday. Resident #s 6, 49, 57 and 65 said the mail is not always delivered on Saturday. This failure could place the residents at risk of not receiving mail in a timely manner and a diminished quality of life. Findings included: During a group interview on 01/10/2023 at 9:30 a.m., Residents 6, 49, 57 and 65 said mail is delivered to the facility on Saturday and sometimes they get their mail and at other times they have to wait until Monday. They said sometimes they might receive a package that is delivered on the weekend but most of the time they do not receive mail on the weekend. During an interview on 01/10/2023 at 2:19 p.m., the Activity Director said she passes the mail Monday through Friday. She said she goes to the front and gets the mail from the business office manager's office. She said she sorts the mail and passes the resident's mail to them. She said the weekend mail waits until Monday, but not every Monday. She said sometimes someone pass the resident's mail on the weekend, but she was not sure who passes the resident mail to them. During an interview on 01/10/2023 at 2:24 p.m., Receptionist D said she works Monday through Friday. She said when she receives the mail, she places it in the bin for the business office manager. She said the Activity Director has been coming and getting it from the bin because the business officer manager has been out of the office. She said she does not know what the Activity Director does with the mail, and she does not know how the mail is handled on the weekend. She said when she comes in on Monday, sometimes mail from the weekend is in the mailbox. She said she will get the mail, sort it and place the mail in the bin for the business officer manager. During an interview and observation with the Administrator on 01/10/2023 at 2:29 p.m., she said, the weekend Receptionist E, will receive the mail, sort it, and pass the mail to the residents. During this interview, the Administrator was asked to contact weekend Receptionist E by telephone. When questioned by this surveyor, weekend Receptionist E said she works as the weekend Receptionist. She said when the mail person brings the mail into the facility, she will sort it and take the resident's mail to the nurse's station, and someone passes it to the residents. She said she is not sure who passes the resident mail. Weekend Receptionist E said, if the mail is not brought into the facility, Page 1 of 6 676458 676458 01/12/2023 Mabank Nursing Center 18957 US Hwy 175 W. Mabank, TX 75147

F 0576 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some it remains in the mailbox until Monday. She said mail is not brought into the facility on the weekend, approximately 90% of the time. When asked, the Administrator said, a combination of people will check the mail on Monday, whoever gets here first. She said she has not assigned a designated person to handle the mail on the weekend. When asked if the mailbox is locked, the Administrator said no, it's right outside the front door. Upon observation, the facility mailbox was mounted on a brick column, approximately 8 feet from the front door of the facility. Record review of the undated facility's policy, titled Resident Mail, revealed: 2. All resident mail is delivered to residents unopened on the day it is delivered to the facility. 676458 Page 2 of 6 676458 01/12/2023 Mabank Nursing Center 18957 US Hwy 175 W. Mabank, TX 75147

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview and record review, the facility failed to ensure that one (1) of eight (8) medication carts (500 hall) containing drugs and biologicals was secure and inaccessible to unauthorized staff and residents reviewed for drug storage. RN B left the 500-hall medication cart unlocked and the keys in the lock when administering medication during the medication pass. This failure could place residents at risk for drug diversion and accidental ingestion of unsecured medications. Findings included: During an observation of the medication pass on 01/10/2023 at 09:01 AM, RN B unlocked the cart and obtained the medication she was to administer. RN B entered the resident's room and left the medication cart unlocked and the keys still in the lock. The cart's status was no longer visible to RN B once she was at the resident's bedside. After completing the medication administration, RN B returned to the cart. The cart was locked, and the keys were not present. During an interview on 01/10/2023 at 03:50 PM, the DON confirmed she had noted the cart unlocked with the keys in it and she had locked the cart and taken the keys while the nurse was in the resident's room. She said she knew there was an issue with leaving the med carts unlocked and was working on it. The DON also said she had spoken to the nurse about the incident. During an interview on 01/12/2023 at 09:50, RN B was asked about leaving the medication cart unlocked with keys still in lock to which RN B replied, It was an accident. Record Review of the facility's undated Storage of Medications Policy included the following: Compartments containing medications are locked when not in use. Trays or carts used to transport such items are not left unattended. All controlled drugs are stored under double-lock and key. 676458 Page 3 of 6 676458 01/12/2023 Mabank Nursing Center 18957 US Hwy 175 W. Mabank, TX 75147

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** Residents Affected - Few 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 disease and infections 1 of 1 resident (Resident #235) reviewed for infection control. The facility failed to place resident #235 in contact isolation. These deficient practices could place residents at risk for cross contamination and/or spread of infection. The findings were: Record review of Resident #235 face sheet dated 1/4/2023 revealed a [AGE] year-old female re-admitted on [DATE] with original admission date of 4/6/2017with diagnoses which included ESBL (ESBL is extended spectrum beta-lactamase. It's an enzyme found in some strains of bacteria. ESBL-producing bacteria can't be killed by many of the antibiotics that doctors use to treat infections, like penicillin's and some cephalosporins. This makes it harder to treat), METABOLIC ENCEPHALOPATHY (is a problem in the brain. It is caused by a chemical imbalance in the blood), MALIGNANT NEOPLASM OF BLADDER (cancer of the bladder) dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities) and need for assistance with personal care. Record review of Resident #235's admission MDS assessment, dated 1/5/2023, revealed the resident had altered level of consciousness, as indicated by any of the following criteria: vigilant - startled easily to any sound or touch; lethargic - repeatedly dozed off when being asked questions, but responded to voice or touch; stuporous - very difficult to arouse and keep aroused for the interview; comatose - could not be aroused? Cognitively intact for daily decision-making skills, was occasionally incontinent of bladder and frequently incontinent of bowel. Record review of Resident #235's comprehensive person-centered care plan, revision date 1/5/2023 revealed the resident requires contact isolation due to: ESBL Urine/Encephalopathy. Record review dated 1/5/23 at 4:31a.m. a nurses written by LVN(H) noted revealed: Resident is receiving Skilled Services for the following: Return from hospital with ESBL in urine. Infection treatment/observation ESBL with IV Ertapenem QD Isolation precautions Contact isolation. Record Review dated 1/9/2023 at 5:19am a nurses note written by LVN(J) revealed: Remains in contact isolation for ESBL of urine. Continue Ertapenem 1 gram IV for UTI with NARN. Midline LUE patent, dressing CDI. Remains on hospice services with comfort measures in place. Resting quietly. During an attempt to interview resident #235 on 1/9/2023 at 10:29 am, resident in semi-private room, resting in bed, no verbal communication, noted IV to L upper arm. Upon entering resident #235's room there was no signage of isolation, no visual signs of contact isolation set up outside or inside of room. During an interview on 1/10/2023 at 10:30 am, CNA A said she was the CNA for Hall 1 today and there 676458 Page 4 of 6 676458 01/12/2023 Mabank Nursing Center 18957 US Hwy 175 W. Mabank, TX 75147

F 0880 Level of Harm - Minimal harm or potential for actual harm are 18 residents on this all I she had 9 including resident #235, and was not aware of any resident that were in isolation., CNA A said she did not use a gown while in the room and she placed incontinent briefs in the trash and linen in a regular barrel for cleaning. CNA A said if she knew of any resident who was on isolation there would have been an isolation set up before you enter the room, which there was not, and it is usually the DON or Housekeeping supervisor who sets up the room. Residents Affected - Few During an interview on 1/10/2023 at 10:35 a.m. with RN(B) she said she was not aware of any resident being on isolation, but she knew that resident#235 was on ABT (antibiotic Therapy) she said yes the 24 hour report stated, the resident was on contact isolation, but there was not a isolation set up., She said the DON usually takes care of the setup of isolation. During an interview on 1/10/2023 at 10:45am the DON stated, she was not aware of any residents being on isolation. Surveyor asked if any residents had ESBL what would the facility do, the DON said that resident would be placed on isolation. The DON stated any one with ESBL should be on contact isolation per facility policy. The DON said it was her responsibility to follow up on any residents who are to be placed in isolation and she did not catch this one. She said she reviews the 24hour report and physicians' orders for any new orders and this failure could place other residents at risk for cross contamination and/or spread of infection. During an interview on 1/10/2023 at 11:06 am with housekeeping staff (F) she said she was not aware of any resident on contact isolation. During an interview 1/10/2023 at 11:10 am with housekeeping staff(G) she said she was the housekeeper who cleans the rooms on Hall 1where resident #235 is a resident and she was not aware of any one on isolation. During an interview1/10/2023 at 11:15am with housekeeping supervisor, she said if she was aware of anyone on isolation there would be a set up outside the door and will would gown up to enter and boxes would be placed for personal items and linen. She said she would have been notified during the morning stand up meeting, but nothing had been mentioned. Record review of 24-hour report date: 1/4/2023 revealed Resident #235 returned from local hospital at 5:00p.m. admitted to local Hospice and on contact isolation. During a record review of the 24-hour Report/Change of Condition Report revealed on these days: 1/4/23,1/5/2023, 1/6/23,1/7/2023, 1/8/2023, 1/9/2023.1/10/2023 resident was to be on Contact isolation. During an interview with the Administrator on 1/12/2023 @10a.m. she stated it is was the DON responsibility to follow up on infection control issues, but any nurse can set up an isolation room. Record review of Isolation - Contact Procedure 492, undated policy states: to facilitate transmission-based precautions whenever measure more stringent than Standard Precautions are needed to prevent or control the spread of infection. Procedure: o Obtain Physician order for contact isolation o 676458 Page 5 of 6 676458 01/12/2023 Mabank Nursing Center 18957 US Hwy 175 W. Mabank, TX 75147

F 0880 Notify housekeeping to obtain isolation bin and yellow bags Level of Harm - Minimal harm or potential for actual harm o Place isolation supply bin outside room door Residents Affected - Few o Place sign on room door for visitors to consult unit nurse prior to entering o Place resident in a private room if it is not feasible to contain drainage, excretions, blood, or body fluids. If a private room is not available, the Infection Control o *Coordinator will assess various risk associated with other residents' placement options Yellow biohazard bag of lines is closed and takes to the laundry 676458 Page 6 of 6