Health inspection·February 12, 2024

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to assure that one (Resident #10) of five residents reviewed for enteral feeding, received appropriate treatment and services to prevent complications of enteral feeding. -The facility failed to ensure that Resident #10's feeding tube bags were labeled with name of resident, date, and time the administration began to ensure residents maintain nutritional status within optimal parameters. This failure could place residents receiving enteral feedings at risk of not being provided the correct enteral feeding and not receiving feeding care in a timely manner to prevent complications. Findings included: Record review of Resident #10's face sheet dated 02/09/2024, revealed an [AGE] year-old male who was admitted on [DATE]. Diagnosis included Ileus (intolerance of oral intake due to inhibition of the gastrointestinal propulsion without signs of mechanical obstruction), gastrostomy status (presence of artificial opening to stomach), and dysphagia (swallowing difficulties). Record review of Resident #10's quarterly MDS assessment dated [DATE], revealed a BIMS of 06 which indicates severe cognitive impairment. The Swallowing/Nutritional Status section revealed a feeding tube was in place and the resident had not had weight loss or gain of 5% in the last month or 10% or more in the last 6 months. Record review of Resident #10's comprehensive care plan dated 02/09/2024 revealed Resident #10 required enteral feedings and maintains nutritional status via peg/gastrostomy tube feeding related to diagnosis of dysphagia. Interventions in place included administer peg/gastrostomy/enteral feedings/flushes per MD order. Record review of Resident #10's physician order dated 10/26/2023 revealed Enteral Feed Order every shift Isosource 1.5 at 65cc/hr via G-tube stationary pump. Observation on 02/09/2024 at 12:33 p.m., of Resident #10 revealed the tube feeding container was infusing via pump and into the resident. The formula container was Isosource 1.5, and the feeding pump was running at 65 ml/hour. The feeding container had a used by date of March 8th, 2024. The feeding container was not labeled with the resident's name, the date, the time it was hung, the initials of who had hung it, and tube feeding order information. Page 1 of 4 745038 745038 02/12/2024 Avir at Tierra Este 14300 Pebble Hills Blvd El Paso, TX 79938

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation and interview on 02/09/2024 at 1:20 p.m. with ADON C, observed the feeding formula was not labeled. The ADON C stated the tube feeding formula had to be labeled in order to ensure it was the correct patient and the right formula for the resident. The ADON C said she did not know who started the formula or when it was started. Record review of facility policy titled Care and Treatment of Feeding Tubes dated 2023, reads in part It is a policy of the facility to utilize feeding tubes in accordance with current clinical standards of practice, with interventions to prevent complications to the extent possible. 745038 Page 2 of 4 745038 02/12/2024 Avir at Tierra Este 14300 Pebble Hills Blvd El Paso, TX 79938

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 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 in 1 of 1 kitchen reviewed for professional standards for food service safety. -On 02/09/2024 at 11:51 a.m., [NAME] L and [NAME] M had beards and were not wearing beard nets while preparing food in the kitchen. This failure could affect residents by placing them at risk of food borne illness. Findings included: Observation on 02/09/2024 at 11:50 a.m., revealed a sign posted on the kitchen entrance door that reads Hairnets must be worn upon entering. Observation and interview on 02/09/2024 at 11:51 a.m., revealed Cooks L and M with beards. [NAME] L was preparing plates for lunch. [NAME] M was preparing dessert for lunch trays. [NAME] L said the DM recently stopped working at the facility and they did not have a DM at the time of the visit. [NAME] L said that no one had said anything about needing to wear a beard net. [NAME] M said no one had told him anything about needing to wear a beard net. During an interview on 02/09/2024 at 1:30 p.m. the Administrator said she was in the process of hiring a new dietary manager for the kitchen. The Administrator said dietary staff are to wear hair nets to include beard nets whenever they are in the kitchen and working with food. The Administrator said the risk was hair could fall into the food contaminating the food. The Administrator said wearing hair nets was part of the facility dietary policy for personal hygiene. The Administrator said she was overseeing the dietary staff while waiting for new DM to start working at the facility. The Administrator said she was in the process of in-servicing all kitchen staff on personal hygiene policy. During an interview on 02/12/2024 at 10:55 a.m., the RDCO said the kitchen should be a sanitary area. The RDCO said all staff in the kitchen need to wear hair nets and staff with facial hair should wear beard nets. The RDCO said the risk of not wearing hair nets accordingly is hair could fall into food and contaminate the food. Review of facility provided policy Dietary Employee Personal Hygiene dated 2023, reads in part It is the policy of the facility to utilize the following as guidelines for employee personal hygiene to prevent contamination of food, by food service employees. Hair Restraints: All dietary staff must wear hair restraints (e.g., hairnet and/or beard restraint) to prevent hair from contacting food. Review of Food Code 2022 revealed: 2-402 Hair Restraints. FOOD EMPLOYEES shall wear hair restraints such as hats, hair coverings or nets, beard restraints, and clothing that covers body hair, that are designed and worn to effectively keep their hair from contacting exposed FOOD; clean EQUIPMENT, UTENSILS, and LINENS; and unwrapped SINGLE-SERVICE and SINGLE-USE ARTICLES. 745038 Page 3 of 4 745038 02/12/2024 Avir at Tierra Este 14300 Pebble Hills Blvd El Paso, TX 79938

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 help prevent the development and transmission of communicable disease and infection for 1 (Residents #12) of 10 residents reviewed for infection control. Residents Affected - Few - The facility failed to ensure staff followed infection control practices of washing hands after glove use during patient care. These deficient practices could place residents at risk for infection due to improper care practices. Findings included: Record review of Resident #12's face sheet dated 02/09/2024, revealed a [AGE] year-old female, with an admission date of 01/02/2024. Resident 12's diagnoses included: quadriplegia (paralysis of all four limbs), and history of urinary tract infections. Record review of Resident #12's quarterly MDS assessment dated [DATE] revealed a BIMS score of 11 indicating moderate cognitive impairment. Review of Resident #12's Functional Abilities and Goals revealed resident was dependent on staff for all transfers. Observation on 02/09/2024 at 1:28 p.m., revealed Restorative Aide I and CNA J performed a mechanical lift transfer of Resident #12. Both staff members wore gloves during the process that involved patient contact. Following procedure CNA J was observed taking off disposable gloves and tossing them in the restroom trash can. CNA J then proceeded to pick up the trash can and take the can to a cleaning closet to toss out the contents. CNA J returned the trash can to the restroom in Resident #12's restroom. CNA J then went to Resident #12's bedroom without performing any type of hand hygiene and touched Resident #12 on the shoulder and repositioned the resident who was seated on a wheelchair. CNA J put on disposable gloves prior to performing a mechanical lift of Resident #12. Following mechanical lift process of Resident #12, CNA J was observed taking off and throwing disposable gloves away and using hand sanitizer. During an interview on 02/12/2024 at 10:55 a.m., the Regional Director of Clinical Operations (RDCO) said staff are trained on hand hygiene including the need to wash hands before and after glove use. The RDCO said the risk of not performing hand hygiene between glove use was infection control. Review of facility provided policy titled Infection Prevention and Control Program dated 2023, reads in part Standard Precautions: all staff shall assume that all residents are potentially infected or colonized with an organism that could be transmitted during the course of providing resident care services. Hand hygiene shall be performed in accordance with facility's established hand hygiene procedures. 745038 Page 4 of 4