Hallettsville Nursing and Rehabilitation Center

Inspectors wroteBased on interview and record review, the facility failed to ensure the resident's right to formulate an advance directive for one (Resident #12) of twenty-five residents reviewed, in that:Resident #12's OOH-DNR was witnessed by two unqualified witnesses and was therefore invalid. This deficient practice could place residents at risk of having their end of life wishes dishonored, and of having CPR performed against their wishes.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure it was free of a medication error rate of five percent (5%) or greater. A total of 6 errors out of 36 opportunities were observed, resulting in a 16.67% error rate for 1 of 3 residents (Resident #33) reviewed during medication pass, in that: Medication Aide E failed to administer Resident #33's medications at the correct time. These deficient practices could place residents at risk for not receiving the intended therapeutic benefits of their medications and exacerbation of their medical conditions.

Inspectors wroteBased 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 one of one kitchen reviewed for sanitation. 1. The facility failed to clean an approximate 2x2 ft ceiling vent in the main kitchen area. 2. The facility failed to replace a light bulb in the main kitchen area. 3. The facility failed to clean an approximate 6x5 inch ceiling vent and paint several areas of missing paint in the food storage room. 4. The facility failed to clean an approximate 1x1 ft ceiling vent in the dish-room. 5. The facility failed to clean an approximate 6x6 inch ceiling vent in the employee's bathroom. 6.-The facility failed to clean an approximate 1 ft in parameter size ceiling vent in the Dietary Manager's office. These failures could place residents at risk for food borne illness.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public on 1 of 6 resident hallways (Hallway 500) and 2 of 5 shower rooms (Hallways 100 and 200), and the laundry room reviewed for environmental concerns. The facility failed to:1-replace a light bulb in room [ROOM NUMBER]'s bathroom.2-clean a ceiling vent and repair missing ceiling paint in hallway 100's shower room.3-replace a bathroom sink light bulb in hallway 200's shower room.4-clean a ceiling vent and replace an overhead light bulb in the laundry room. These failures could place residents and staff at risk of a diminished quality of life due to exposure to an environment that is unpleasant, unsanitary, and unsafe.

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for 1 of 25 (Residents #8 and #64) residents reviewed for comprehensive care plans, in that: 1. Resident #8's care plan did not include his diet. 2. The facility failed to revise a care plan to address Resident #64's insulin usage. These deficient practices could result in residents' needs not being identified and addressed.

Inspectors wroteBased on interviews and record reviews the facility failed to review and revise a comprehensive person-centered care plan for each resident, consistent with the resident rights, that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for 1 of 24 residents (Resident #4) reviewed for care plans, in that:Resident #4's care plan incorrected noted that the resident received tube feeding as well as food by mouth. This failure could have placed residents at risk of not having their needs identified and met.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure incontinent care was provided in accordance with appropriate treatment and service practices to prevent urinary tract infections and to restore continence to the extent possible for 1 of 2 residents (Resident #22) reviewed for incontinent care, in that: The facility failed to ensure, while providing incontinent care for Resident #22, CNA C used a front to back motion to clean Resident #22's buttocks. These deficient practices could place residents at-risk for infection and skin break down due to improper care practices.

Inspectors wroteBased on observation, interview, and record review, the facility failed to establish and 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 diseases and infections for 1 of 6 residents (Resident #22) observed for infection control, in that: The facility failed to ensure, while providing incontinent care for Resident #22, CNA D sanitized her hands after touching part of the resident's environment. This deficient practice could place residents who receive assistance with personal care at risk for infection due to improper care practices.

Inspectors wroteBased on observation, interview, and record review the facility failed to establish and maintain identical policies and practices regarding transfer, discharge, and the provision of services under the state plan for all residents regardless of payment source for 1 of 6 residents (Resident #1) reviewed for resident discharge rights in that: The facility failed to allow Resident #1 the ability to discharge with FM A and follow their internal policies for discharge and decision making when no POA or guardianship was available. The failure placed residents at risk of decline in their satisfaction with life and feeling of self-worth.

Inspectors wroteBased 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 to help prevent the development and transmission of communicable diseases and infections for 5 of 7 residents (Residents #22, #26, #42, #61 and #71) reviewed for infection control in that: 1. The facility failed to ensure CNA-B sanitized her hands after blowing her nose, wiping her runny nose with her finger, and coughing into her hand while feeding Resident #26 during the noon meal. 2. The facility failed to ensure CNA-C changed his gloves after going from dirty to clean while providing incontinent care to Resident #71. 3. The facility failed to ensure LVN-D followed Enhanced Barrier Precautions (EBP) by not wearing a gown while administering medications via g-tube for Resident #71. 4. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for 1 of 1 kitchen reviewed for physical environment, in that: 1. The 8 double florescent lights in the main kitchen area and the 3 double florescent lights in the dish machine room did not have a lid cover over the light bulbs. 2. One of the 8 double florescent lights in the main kitchen area and 1 of the 3 double florescent lights in the dish machine room had light bulbs that were not operating. 3. One of the 4 panel lights in the main kitchen area did not have a light bulb that was operating. 4. The light strip inside the refrigerator in the kitchen storage room was not attached on one side and the LED bulb was not operating. 5. The overhead ceiling light in the employee bathroom was not operating. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident environment remains as free of accident hazards as is possible, and resident receives adequate supervision and assistance devices to prevent accidents for 1 (100 hall) of 6 hallways reviewed for accidents and hazards, in that: The shower room on 100 hall was unlocked and contained a disinfectant cleaner with a warning label, Danger, Keep Out of Reach of Children. This deficient practice could result in residents, staff, and or the public exposure to a potentially dangerous substance.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents received adequate supervision and assistance devices to prevent accidents for 1 of 4 residents reviewed for accidents (Resident #1). CNA A failed to use a gait belt while performing a sliding board transfer for Resident #1 resulting in Resident #1 being improperly lowered to the ground and receiving a fracture of the proximal tibia and fibula (a fracture or break in the shinbone just below the knee). This deficient practice could affect residents at the facility who required a gait belt while receiving sliding board transfers by contributing to injury.

Inspectors wroteBased 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 1 of 1 kitchen, in that: 1. There were storage containers of food in the reach in cooler that were not properly sealed. 2. [NAME] E wore jewelry on both hands while engaged in food preparation in the kitchen. 3. [NAME] E portioned food onto plates in an unsanitary manner during the lunch meal service on 08/24/2023. These failures could place residents who received meals and/or snacks from the kitchen at risk for food borne illness.

Inspectors wroteBased on observation, interviews and record reviews, the facility failed to treat each resident 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, recognizing each resident's individuality and protecting the rights of each resident for 1 of 24 residents (Resident #5) observed for dignity, in that: LVN A stood while she fed Resident #5 at lunchtime. This deficient practice could affect residents who require feeding and could result in decreased self-esteem.

Inspectors wroteBased on observation, interviews and record reviews, the facility failed to ensure the assessment accurately reflected the resident's status for 1 of 8 residents (Resident #12) reviewed for MDS assessments, in that: Resident #12's MDS assessment inaccurately reflected he had a stage 3 pressure ulcer. This deficient practice could affect residents who require assessments and could result in missed or inaccurate care.

Inspectors wroteBased on observation, interviews and record reviews, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that include measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for 1 of 8 residents (Resident #72) reviewed for comprehensive care plans, in that: Resident #72's wishes for DNR status was not reflected in her comprehensive care plan. This deficient practice could result in residents wishes for advanced directives to not be honored and could result in residents who do not want CPR getting CPR performed on them.

Inspectors wroteBased on observation, interviews and record reviews, the facility failed to review and revise the comprehensive care plan by the multidisciplinary team after each assessment, including both the comprehensive and quarterly review assessments for 1 of 8 residents (Resident #12) reviewed for comprehensive care plans, in that: Resident #12's comprehensive care plan was not revised to reflect he no longer had a Stage III pressure sore. This deficient practice could affect residents with comprehensive care plans and could result in missed or unnecessary care.

Inspectors wroteBased 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 to help prevent the development and transmission of communicable diseases and infections, for 2 residents of 7 residents (Residents #34 and #183) observed for infection control, in that: LVN D failed to sanitize the blood pressure cuff between Residents #34 and #183 to prevent cross contamination. This deficient practice had the potential to affect residents in the facility by placing them at risk of contracting, spreading and/or exposing them to pathogens that could lead to the spread of communicable diseases.