Health inspection·August 18, 2022

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. 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 ensure services provided, met professional standard of quality for 2 (Resident #15 and #67) of 20 residents assessed for physician's order in that: Residents Affected - Few The facility failed to follow Resident #15's physician's order to hold blood pressure (BP) medication when his blood pressure was below the ordered parameter. The facility failed to follow Resident #67's best practice, policy and procedure for labeling formula at bedside when administered. These failures could place residents at risk of not receiving the care and services ordered by the physician and a decline in health status. Findings Included: Resident #15 Record review of Resident #15's admission face sheet revealed he was an [AGE] year-old male who was admitted to the facility on [DATE] . His diagnoses included hypertensive heart disease with heart failure (heart conditions as a result of elevated blood pressure), coronary artery disease, hyperlipidemia major depressive disorder, type II diabetes, and congestive heart failure. Record review of Resident #15's physician's order summary report revealed Clonidine 0.3 mg Give one tablet by mouth every eight hours for hypertension. Hold for BP less than 130/70. The order was dated 03/02/2022. Record review of Resident #15's quarterly MDS assessment dated [DATE] revealed a BIMS score of 11 which indicted his cognition was moderately impaired. The MDS revealed one of Resident #15's active diagnosis included hypertension. Record review of Resident #15's care plan dated 06/15/2022 read in part: Focus: The resident has altered cardiovascular status related to congested heart failure, hypertension, coronary artery disease, hyperlipidemia. Goal: The resident will be free of complications of cardiac problems. Interventions: Give all cardiac medications as ordered by the physician. Page 1 of 5 676482 676482 08/18/2022 Cypress Pointe Health & Wellness 8561 Easton Commons Dr. Houston, TX 77095

F 0658 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #15's Medication Administration Record (MAR) dated 08/01/2022 - 08/31/2022 revealed Clonidine 0.3Mg Give one tablet by mouth every eight hours for hypertension. Hold for Blood Pressure (BP) less than 130/70. Continued review of Resident #15's MAR revealed the medication was administered on the following dates and times with the following BP: Residents Affected - Few 08/01/2022 at 4:00 PM BP was 128/70 08/02/2022 at 4:00 PM BP was 109/64 08/03/2022 at 4:00 PM BP was 128/63 08/04/2022 at 12:00 AM BP was 120/64 and 8:00 AM BP was 128/63 08/05/2022 at12:00 AM BP was 128/63 08/06/2022 at 12:00 AM BP was 123/68 In a telephone interview on 08/17/2022 at 3:44PM , MA A stated the check mark and her initials on the MAR indicated she gave the medication on Monday 08/01/2022. MA A stated when she gave blood pressure medications, she checked the resident's blood pressure first, then she reviewed the MAR for any parameters. If she saw the blood pressure was too low, she would not give the medication. MA A stated she would discuss the issues with the nurse on duty. MA A stated she did not remember who she spoke with but if she was told to give the medicine then she would. MA A stated the risk of giving the blood pressure medication outside the ordered parameters it could cause the resident's blood pressure to drop. In a telephone interview on 08/17/2022 at 3:59 PM , MA B stated the check mark and the initials on the MAR indicated she gave the medication on 08/02/2022. MA B stated her process to give blood pressure medications was to check the blood pressure first, then check the MAR for the parameters. MA B stated if she found the resident's blood pressure was below the parameter, she would not give the medications. The risk of giving the medications outside the parameter was it could cause the resident's blood pressure to drop low. MA B stated she should not have administered the medication when the blood pressure was below the parameter. MA B stated that going forward, she would pay more attention, but it must have been an oversight. In an observation and interview on 08/18/2022 at 9:45AM , Resident #15 was sitting up in bed awake and alert. Resident #15 stated he was doing well, and he was getting his medications alright. Resident #15 stated the staff was taking his blood pressure before he got his medications. In an interview on 08/18/2022 at 9:55AM, RN C stated the check mark on the MAR indicated the medication was administered and the initials were from the first and last name of the person who administered it. RN C stated when blood pressure medications were administered, the staff first check the blood pressure and check to see if there were parameters to hold the medication ordered by the physician. He stated if the blood pressure was below the parameter, the medication was held. The risk of giving the medication was it could cause the resident's blood pressure to go too low. In an interview on 08/18/2022 at 10:02 AM, the DON stated the expectation was the blood pressure medications were to be given when within the parameters ordered. The medications were not expected to be given when outside the parameter. The DON stated this was important because there was a risk the 676482 Page 2 of 5 676482 08/18/2022 Cypress Pointe Health & Wellness 8561 Easton Commons Dr. Houston, TX 77095

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few resident's blood pressure could go too low. Our plan to prevent this from occurring again was to educate and review all resident medication administration records. In an interview on 08/18/2022 at 10:28 AM, with the Administrator she stated she was not clinical, but her expectations were the physician's ordered were followed for administering medications. She stated she was unable to answer what the risk was to the resident if blood pressure medications were administered outside the physician's ordered parameter. The Administrator stated the plan to prevent this from occurring again was to audit all resident's medication records and educate the staff on administering blood pressure medications. The Administrator stated Resident #15's physician was notified of the issue. In a telephone interview with Resident #15's physician, he stated the parameters for the resident's Clonidine (blood pressure medication) was set high because he thought the medication maybe too strong for the resident but the resident did not have any problems from it, so he will lower the parameter. The risk of giving the medication outside the parameter was the resident's blood pressure could drop too low, but Resident #15's did not. Resident #67 Record review of Resident #67's admission face sheet revealed he is a [AGE] year-old-male who was admitted to the facility on [DATE]. His diagnoses include: other sequelae of other cerebrovascular disease (medical conditions that affect the blood vessels of the brain and the cerebral circulation), Type II Diabetes. Dementia (is the loss of cognitive functioning - thinking, remembering, and reasoning), Obstructive Hydrocephalus (excess fluid build-up in fluid-containing cavities of the brain, which results in developmental, physical, and intellectual impairments). Record review of Resident #67's quarterly MDS assessment dated [DATE] revealed a BIMS score of 99 which indicted he was unable to participate in assessment. The MDS revealed Resident #67's active diagnoses included Aphasia. During an observation on 8/16/22 at 9:27 am, Resident #67 was lying in bed with HOB raised and his eyes closed. The tube feeding machine was noted a hist bedside, but was not infusing and without writing on label as to date/time/rate hung/administered by staff member. In an interview and observation during med pass on 8/17/22 7:09 am, RN D observed the enteral formula should have been labeled by nurse from previous shift with name of resident, time or date when enteral product was hung. When asked why they placed residents' name, drug, dose, time and date when hanging enteral product, she stated to assure correct residence, correct formula, correct time, correct dose. When I asked why it's important to do this, she reported the milk could spoil and harm resident. In an interview on 8/17/22 2:00 pm with the DON, she stated in best practice nursing, the nurse would have checked orders and placed the information the on label: resident's name, type of formula, date and time formula was hung, rate of administration. The DON stated the information placed in the residents' chart would be: resident's name, type of formula, date and time formula was hung, rate of administration. The DON handed the Policy and Procedure: Enteral Tube Feeding via Continuous Pump Revised dated November 2018,to the surveyor, and reviewed policy and procedure regarding enteral feeding via continuous pump. When asked why the nurse should have labeled the formula, she stated it was best practice to label the enteral product when it was hung. When asked where was resident name, 676482 Page 3 of 5 676482 08/18/2022 Cypress Pointe Health & Wellness 8561 Easton Commons Dr. Houston, TX 77095

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few type of formula, date and time formula was hung, rate of administration documented, she stated it was documented on the label of the enteral formula at bedside and on the Medication Administration Record (MAR) in the resident's chart. Called LVN D, 08/18/22 10:43 am left message with request for call back with call back number, regarding enteral formula not being labeled with initials, date and time the formula was hung/administered, and initial that the label was checked against the order as observed on 8/17/22 during medication administration with RN D. Record review of the facility policy titled Policy and Procedure: Enteral Tube Feeding via Continuous Pump Revised dated November 2018 read in part .Section: Initiate feeding #5, states On the formula labeled document initials, date and time the formula was hung/administered, and initial that the label was checked against the order. Record review of the facility policy titled Administering Medications Revised dated April 2019 read in part . Policy Statement Medications are administered in a safe and timely manner, and as prescribed . 4. Medications are administered in accordance with prescriber orders, including any required time frame . 676482 Page 4 of 5 676482 08/18/2022 Cypress Pointe Health & Wellness 8561 Easton Commons Dr. Houston, TX 77095

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety for the refrigerator in that: Residents Affected - Some The facility stored unlabeled foods in the refrigerator. This failure had the potential that could place residents at risk of serious complications from foodborne illness as a result of their compromised health status Findings include: Observation and interview on 08/16/22 starting at 9:07 a.m. of the walk-in freezer revealed 1 unlabeled bag of breadsticks, an unlabeled bag of what appeared to be frozen chicken, and another unlabeled bag of chicken. The Dietary Manager identified the contents of the unlabeled bags of food. She stated that the bags should be labeled and that she should have checked that. She stated, That food needed to be labeled so that residents are not served food that has gone beyond the expiration date and that it's safe for the residents. Leftovers can be stored in the refrigerator for 72 hours, and food unopened can be stored for a week. Interview with the Director of Food Services Supervisor on 08/16/22 at 10:08 a.m., stated that the policy for storing food is everything should have been labeled and dated. The Director of Food Services Supervisor stated in the refrigerator, everything should have been labeled with the date it arrived and date opened. The Director of Food Services Supervisor previously stated that on 08/16/22 at 9:07 a.m., she was supposed to have checked that, referring to labeling and dating the items on the bags of food that were unlabeled. Record review of the Facility's Food Storage policy dated 12/01/11 stated, to ensure freshness, opened and bulk items are stored in tightly covered containers. All containers are labeled and dated .f. Where possible, items are left in the original cartons placed with the date visible . g. The first-in, first-out rotation method is used. Packages are dated and new items are placed behind existing supplies, so that older items are used first .e. All refrigerated foods are dated, labeled and tightly sealed, including leftovers, using clean, nonabsorbent, covered containers that are approved for food storage. All leftovers are used within 48 hours. Items that are over 48 hours old are discarded .e. Frozen foods are stored in moisture-proof wrap or containers that are labeled and dated . Record review of in-services or trainings revealed the following: tr Food Storage dated 01/11/2022, Food storage & Cooling & Reheating foods- Label and Dating dated 09/17/2021, In-service training on Hazardous foods Stored Properly dated 04/26/2022, In-service training on All Foods off Floor, dated, not expired dated 04/26/2022, In-service training on Label & Dating dated 08/16/2022, In-service training on All Foods covered, Labeled, Dated, Open dated in Fridge dated 04/26/2022. 676482 Page 5 of 5