Health inspection·September 13, 2022

F 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 residents who need respiratory care are provided and consistent with professional standards of practice and the resident's care plan for 1 (Resident #10) of 2 resident reviewed for oxygen use, in that, Residents Affected - Few Resident #10 received oxygen at 5 Liters Per Minute trach collar instead of 2 LPM as per physician's order. This deficient practice could place residents receiving respiratory care and services at risk of respiratory complications. The findings included: Record review of Resident #10's admission Record, dated 09/13/22, revealed Resident #10 was a [AGE] year old female, who was admitted to the facility on [DATE], diagnoses included: Acute respiratory failure (breathing is affected) with hypercapnia (too much carbon dioxide in the bloodstream, usually caused by inadequate respiration), and tracheostomy status (incision into the trachea that forms a permanent or temporary opening). Record review of Resident #10's Quarterly MDS, dated [DATE], revealed Resident #10: -was rarely/never understood, -was rarely/never able to understand others -used oxygen therapy -had an active diagnoses of tracheostomy status Record review of Resident #10's Care plan revealed: Date Initiated: 05/25/22, revised on 06/21/22 Tracheostomy r/t impaired breathing mechanics secondary to traumatic brain injury An intervention was to give humidified oxygen as prescribed. Record review of Resident #10's Order Summary Report, dated 09/13/22 revealed: Cool aerosol at 2 liters FiO2 via trach-collar every shift Page 1 of 3 745000 745000 09/13/2022 Las Alturas DE Penitas 414 Liberty Blvd. Penitas, TX 78576

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an observation and interview on 09/11/22 at 9:32AM, revealed Resident #10 laying in bed, with her head of bed elevated. Resident #10 had a tracheostomy, and oxygen running at 5LPM. Resident #10 did not respond to surveyor. In an observation and interview on 09/11/22 at 9:42AM, LVN B said Resident #10 has an order for oxygen at 2LPM. LVN B said Resident #10 was currently set at 5LPM, but she was not sure who increased the oxygen. LVN B said Resident #10 has an order to increase oxygen if needed, but it was not reported to her, that Resident #10's oxygen had been increased. Record review of Resident #10's Order Summary Report dated 09/13/22, revealed there was no order to increase oxygen as needed. In an interview on 09/12/22 at 2:03PM, the DON said Resident #10 was not able to move on her own, but does have reflexes. The DON said the doctor was the one responsible for adjusting the oxygen order, and the nurses are the only ones that will adjust the oxygen. The DON said Resident #10 had an order for 2LPM, and there was no PRN order to increase the oxygen. Record review of facility's policy, Oxygen Administration, implemented 03/14/19, and revised on 01/2022, revealed: A resident receives oxygen therapy when there is an order by a physician. 745000 Page 2 of 3 745000 09/13/2022 Las Alturas DE Penitas 414 Liberty Blvd. Penitas, TX 78576

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure, in accordance with State and Federal laws, all drugs and biologicals were stored in locked compartments under proper temperature controls, and permitted only authorized personnel to have access to the keys for 1 of 1 medication refrigerators reviewed for medication storage. The facility failed to ensure the medication room had a permanently affixed lock box inside the medication refrigerator. This failure could place residents at risk of drug diversion. Findings include: During an observation and interview on 09/13/22 at 8:23 a.m., accompanied by LVN A, revealed a refrigerator in the locked medication room. Inside the refrigerator, there was a lock box that was attached to the refrigerator shelving with a snap clip cord. The lock box was not permanently attached. LVN A said that is where the narcotics are kept. In an interview and observation on 09/13/22 at 8:30 AM, with the DON, DON opened the narcotic box, revealing 3 bottles of Lorazepam (narcotic medication used to relieve anxiety, treat seizure disorders, or help with sleeping problems). The DON was able to remove the snap clip cord from the refrigerator shelf. DON said she thought the cord could not be removed. In an interview on 09/13/22 at 9:43 AM, DON said anyone can just take the lock box if it is not permanently attached. Record review of the facility's policy, titled, Pharmacy Services: Provisions of Medications and Biologicals, dated [DATE], and revised on November 2021, revealed: Storage of medications and biologicals Controlled medications (Schedule II of the Comprehensive Drug Abuse Prevention and Control Act of 1976) and other medications subject to abuse are stored in separately locked, permanently affixed compartments: -Compartments include drawers, cabinets, rooms, refrigerators, carts, and boxes: 745000 Page 3 of 3