Health inspection·January 6, 2024

F 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that the transfer or discharge was documented in the resident's medical record and appropriate information was communicated to the receiving health care institution or provider for one (Resident #1) of 4 residents reviewed for facility-initiated discharges. The facility failed to provide documentation for an immediate facility-initiated discharge for Resident #1 that the resident's needs could not be met and attempted to meet the resident's needs. The failure could affect residents by placing them at risk of not having access to adequate care in a nursing home facility. Findings included: Review of Resident #1's admission record, dated 01/07/24, revealed the resident was a [AGE] year-old male, admitted to the facility on [DATE], and discharged on 01/02/24, with the diagnoses of hemiplegia (brain damage or spinal cord injury leading to paralysis), dementia, epilepsy (seizure), and acute kidney failure. Review of Resident #1's Quarterly MDS Assessment, dated 10/01/23, revealed Resident #1 had a BIMS score of 6, which indicated severe cognitive impairment. Review of Resident #1's care plan, revised on 01/05/24, revealed Resident #1 had a history of substance abuse and cannabis usage with interventions of observe for signs and symptoms of impairment. There were no other interventions listed. Interview on 01/06/24 at 10:15 AM with the Administrator revealed Resident #1 was admitted to the hospital on [DATE] for a possible seizure. Upon admission to the hospital, the resident tested positive for illegal substances (methamphetamine and cocaine). The Administrator stated APS was contacted and that based on the facility's drug policy, the resident was provided a notice to move. She stated that she suspected the family was bringing drugs to the resident. Interview on 01/06/24 at 10:33 AM with the DON revealed Resident #1 was sent to the hospital on [DATE] due to the family stating he was choking. She stated Resident #1 was verbal, even if his BIMS score was 6 (which indicated severe cognitive impairment). The DON stated the resident had been to the hospital before on 11/22/23 due to a stroke and tested positive for cannabis and methamphetamine. The second time the resident went to the hospital on [DATE], the resident was found with cocaine in Page 1 of 2 676480 676480 01/06/2024 Mesquite Village Wellness & Rehabilitation 825 W. Kearney Street Mesquite, TX 75149

F 0622 his system. Level of Harm - Minimal harm or potential for actual harm Interview on 01/06/24 on 4:17 PM with Resident #2, Resident #1's roommate, revealed he used to smoke marijuana and would know if anyone smoked it. Resident #2 stated Resident #1 had a g-tube and Resident #2 would know if anyone put medications or drugs into his feed. Residents Affected - Few Interview on 01/06/24 at 6:15 PM with the Administrator and the DON revealed the facility could not readmit Resident #1 to the facility because the facility would not have been able to meet the resident's needs. She stated with the resident unpredictably taking illegal substances from the resident's family, the facility would not be able to ensure the resident did not have adverse effects to the medications the resident was already prescribed. The Administrator and the DON stated with substance abuse, the facility would then be required to constantly adjust the medications, which placed the resident at risk for side effects the facility would be liable for. Review of Resident #1's hospital records, dated 11/27/23, revealed toxicology urine drug screen positive for cannabis and benzodiazepines. Review of Resident #1's hospital records, dated 01/03/24, revealed toxicology urine drug screen positive for polysubstance abuse, positive for methamphetamines, and positive for cocaine. Hospital record reviewed that patient's wife who reports she is concerned that his sister may have brought elbow brownies to him at the local skilled nursing facility. Resident #1 was monitored for withdrawal symptoms. Review of Resident #1's electronic record revealed no evidence of a 30-day notice provided to Resident #1, a discharge summary, documentation of contact with the resident's physician to indicate transfer or discharge was necessary. Review of the facility's Transfer or Discharge Notice, revised 03/2021, revealed no mention of immediate discharge due to drug use. Documents and related policy supporting Resident #1's immediate discharge with the rationale that the resident's needs could not be met was requested on 01/06/24 at 6:15 PM. The facility did not provide any documentation at exit . 676480 Page 2 of 2