Health inspection·July 21, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents were treated with respect and dignity and care for each resident in a manner and in an environment, that promotes maintenance or enhancement of his or her quality of life, for one Resident (Resident #120) of eight residents reviewed for dignity issues. The facility failed to place the urinary catheter drainage bag in a privacy bag, leaving the urine in the bag visually exposed. This failure could place residents at risk of feeling uncomfortable and disrespected and could decrease residents' self-esteem and/or quality of life. Findings included: Record review of Resident # 120's physician orders, dated 7/21/23 indicated Resident #120 was an [AGE] year-old male, was admitted to the facility on [DATE]. Resident #120's diagnosis included hyperlipidemia (abnormally elevated levels of any or all lipids or lipoproteins in the blood), extended spectrum beta lactamase resistance (enzymes produced by bacteria that provide multi-resistance to beta-lactam antibiotics) and urinary tract infection. Physician orders indicated an order to check catheter every shift for placement and may use leg strap to secure catheter in place, order date, 07/13/23. Record review of Resident #120's care plans, initiated on 07/13/23 indicated Resident #120 had a catheter. Interventions included to monitor for s/sx of discomfort on urination and frequency. Observation on 07/18/23 at 2:16 pm revealed Resident #120 in his room, in bed. Resident #120's urinary catheter drainage bag was half full and was clipped to his bedrail, without a privacy bag and touching the floor. Resident #120 said he was not aware that his urinary catheter drainage bag was not covered with a privacy bag. Resident #120 said I do not want anyone to see my urine, because it is embarrassing. Interview on 07/18/23 at 2:18 pm with CNA A said Resident #120's urinary catheter bag should be placed in a privacy bag and should not be touching the floor. CNA A said Resident #120 might be embarrassed that everyone who came into the room to assist him or visit him would see his urine. CNA A said the urinary catheter bag also needed to be in a privacy bag in case it touched the floor as it was because it could get bacteria and cause infections for the resident. CNA A said the CNAs were Page 1 of 5 676495 676495 07/21/2023 Starr County Nursing and Transitional Care 5260 Brand St Rio Grande City, TX 78582

F 0550 responsible to make sure the urinary catheter bag was in a privacy bag and off the floor. Level of Harm - Minimal harm or potential for actual harm Interview on 07/18/23 at 2:57 pm with LVN B revealed the urinary catheter drainage bag should have been placed inside a privacy bag and not touching the floor. The bag should not be on the floor because it could cause contamination or infections. The resident's dignity is not respected if the urinary bag was not in privacy bag where no one can see his urine. Residents Affected - Few Interview on 07/21/23 at 9:22 am with the DON revealed the urinary bag should not touch the floor due to contamination and the urinary bag should be covered with the privacy bag to protect the resident's privacy. Interview on 07/21/23 at 9:32 am with CNA G revealed staff was trained that all urinary drainage bags should be placed inside a privacy bag for dignity and the urinary bag should not be touching the floor to prevent contamination. Record review of facility policy titled Promoting/Maintaining Resident Dignity dated 1/13/23 indicated the policy It is the practice of this facility to protect and promote resident rights and treat each resident with respect and dignity as well as care for each resident in a manner and in an environment 676495 Page 2 of 5 676495 07/21/2023 Starr County Nursing and Transitional Care 5260 Brand St Rio Grande City, TX 78582

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain clinical records on each resident that were complete and accurate, for one Resident (R#114), of four residents reviewed for clinical records, in that; The facility did not document physician orders that indicated to document the level of pain every shift with a scale of 0-10. This failure could place residents at risk for not receiving proper care and treatments. The findings were: Record review of Resident #114's Order Summary report dated 07/21/2023 indicated Resident #141 was a [AGE] year-old male who was admitted to facility on 07/11/2023 with diagnoses that included: Hypertension, Major Depressive Disorder, Alzheimer's Disease, Dementia, and Pain. Physician orders revealed; Assess and document pain level 0-10 every shift, date started 07/12/2023. Record review of Resident #114's Medication Administration Record dated 07/21/23 revealed. -Assess and document pain level 0-10 every shift, star date 07/21/23: 07/12/23 revealed that the entry was checked with a check mark instead of 0-10 scale. 07/13/23 revealed that the entry was checked with a check mark instead of 0-10 scale. 07/14/23 revealed that the entry was checked with a check mark instead of 0-10 scale. 07/15/23 revealed that the entry was checked with a check mark instead of 0-10 scale. 07/16/23 revealed that the entry was checked with a check mark instead of 0-10 scale. 07/17/23 revealed that the entry was checked with a check mark instead of 0-10 scale. 07/18/23 revealed that the entry was checked with a check mark instead of 0-10 scale. 07/19/23 revealed that the entry was checked with a check mark instead of 0-10 scale. 07/20/23 revealed that the entry was checked with a check mark instead of 0-10 scale. 07/21/23 revealed that the entry was checked with a check mark instead of 0-10 scale. Record review of Resident #114's admission Pain evaluation dated 07/12/23 revealed; Has the resident complained of pain in the last 5 days? Yes If yes, were interventions effective;Yes 676495 Page 3 of 5 676495 07/21/2023 Starr County Nursing and Transitional Care 5260 Brand St Rio Grande City, TX 78582

F 0842 Record review of Resident #114's pain evaluation full assessment dated [DATE] revealed; Level of Harm - Minimal harm or potential for actual harm Has the resident complained of pain in the last 5 days? No Residents Affected - Some In an interview on 07/21/23 at 10:12 a.m., DON said after reviewing Resident #114's MARS in their computer system that staff did not enter the pain level in Resident #114's MARS was because the nurse that did the admission on [DATE] forgot to click a button in the MARS that would have allowed the nurses to add a scale number, instead of a check mark. She said even though there was no 0-10 scale number in the MARS the nurses were still checking for pain every shift. She said the Resident #114 had not received pain medication since admission. On 07/21/23 at 10: 18 a.m., surveyor attempted to interview Resident #114, however he was not interviewable. Observation of Resident #114 revealed there was no signs of a grimaced face. In an interview on 07/21/23 at 10:22 a.m., LVN C said any nursing staff was able to do an admission assessment which included creating the MARS. She said the nurse that did the admission assessment for Resident #114 did not click in a tab to allow nurses to be able to add a scale number. She said they were still checking Resident #114 for pain, however not adding the scale numbers. She said was aware of the check mark instead of adding the 0-10 scale. LVN C said she did not change the MARS or communicated with anyone about not being able to add the scale numbers. In an interview on 07/21/23 at 10:32 a.m., LVN D said according to the physician's order nurses were supposed to add a 0-10 scale under the MARS, however the MARS was not allowing them to add the scale only a check mark. LVN said she did not communicate anyone about it. She said the Resident #114 was still assessed for pain in every shift. Record review of facility's policy on Documentation in Medical Records dated 10/24/22 revealed: Policy: Each resident's medical record shall contain an accurate representation of the actual experience of the resident and include enough information to provide a picture of the resident's progress through complete, accurate, and timely documentation. 676495 Page 4 of 5 676495 07/21/2023 Starr County Nursing and Transitional Care 5260 Brand St Rio Grande City, TX 78582

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 maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to prevent the development and transmission of communicable disease and infections for 1 of 2 Residents (Resident #24) observed for infection control procedures, in that: Residents Affected - Few Hospitality Aide B failed to donn Personal Protective Equipment (PPE) while in a Resident #24's room who was in contact isolation. This failure could place the residents on isolation precautions at risk for cross contamination and infection. Findings were: Record review of Resident #24's admission Record dated 7/21/23 revealed a [AGE] year-old female with diagnoses of Other acute osteomyelitis (sudden, serious infection of the bone) right ankle and foot, Non-pressure chronic ulcer of skin of other site with unspecified severity. In an observation on 7/18/223 at 10:35 am it was observed signage at entrance of Resident #24's room stating Contact Precautions Everyone Must: Providers and staff must also: Put on gloves before room entry. Discard gloves before room exit. Put on gown before room entry. Discard gown before room exit. In an observation on 7/19/23 at 3:55 pm, Hospitality Aide B was observed to be inside Resident #24's room not wearing Personal Protective Equipment (PPE). Outside, on door of Resident #24 was signage of contact isolation precautions and PPE was inside a container by the entrance of her room. Interview on 7/19/23 at 4:00 pm Hospitality Aide B said she forgot to donn (put on PPE) before going inside Resident #24's room. She said she has been given training for wearing PPE when entering a resident's room who is in isolation. Interview on 7/21/23 at 1:03 pm, the DON said they conduct staff trainings on donning, doffing (remove item of clothing) and handwashing for infection control every month. They do check offs randomly in different departments as well. The DON also said that if staff or visitors do not observe precautions, they can potentially get infected by resident's who are on isolation precautions. The DON stated that Resident #24 was on contact isolation due to Extended Spectrum Beta Lactamase (ESBL, germs that cannot be killed by many antibiotics) to the wound on the left foot. She stated that staff are supposed be donning PPE prior to entering Resident #24's room. Record review of Facility's Infection Control Manual Updated September 2019 stateds; Isolation - Categories of Transmission-based Precautions .Transmission-Based Precautions shall be used for residents who are documented or suspected to have communicable diseases or infections that can be transmitted to others. 676495 Page 5 of 5