Hico Nursing and Rehabilitation

Inspectors wroteBased on observations of Resident #2 plate in the room, interviews with staff, and record reviews, the facility failed to ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs for Resident #2 (1 of 1 Resident reviewed). The facility failed to follow the care plan and provide Resident #2 with a mechanically soft diet that he could eat. This could cause the resident to experience unplanned weight loss due to inability to eat properly. The facility failed to prepare a textured diet to the consistency required for Resident #2.

Inspectors wroteBased on interviews and record review, the facility failed to consult with the resident's physician when there is a significant change in the resident's physical, mental, or psychosocial status, for 1 of 7 residents (Resident #1) reviewed for changes in condition. The facility failed to notify Resident #1's mental health primary care provider (MHNP) when there was a change of condition in behaviors after an incident with Resident #1 having unsolicited sexual advances/behaviors toward another resident on 01/08/25. This failure could place residents at risk of not having their physicians notified of changes resulting in a delay in decision making for medical interventions.

Inspectors wroteBased on interview and record review the facility failed to develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care within 48 hours of the resident's admission for 1 of 7 residents (Resident #2) reviewed for baseline care plans. The facility failed to include Resident #2's fall history/fall risks in her baseline care plan. This failure could result in residents not receiving needed care and treatment. Findings Included: [...]

Inspectors wroteBased on interviews and record review the facility failed to develop and implement a comprehensive person-centered care plan consistent with the resident rights that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs and describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 of 7 residents (Resident #1) reviewed for care plans in that: The facility failed to ensure that Resident #1's newly identified sexual behaviors were documented in his care plan with interventions after an incident with Resident #1 having unsolicited sexual advances/behaviors toward another resident on 01/08/25. [...]

Inspectors wroteBased on interview and record review, the facility failed to use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week for 2 of 90 days (FY Quarter 3 2024 - April 1 - June 30) reviewed for RN coverage. The facility failed to ensure they had an RN on duty on for 2 days: 06/08/24 and 06/09/24. This failure placed residents at risk of missed nursing assessments, interventions, care, and treatment.

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 the facility's only kitchen: 1. The facility failed to label and date food and dry goods in a manner that identified the product and/or its use-by or discard date. 2. The facility failed to clean and sanitize the internal components of the ice machine. 3. The facility failed to properly discard food products which were expired or contaminated with mold. 4. The facility failed to store food in a manner that would prevent deterioration or contamination of the food, including growth from microorganisms. 5. The facility failed to store food in a manner that would maintain the look, taste, and integrity of the food. 6. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents had the right to be treated with respect and dignity for 1 of 6 residents (Resident #35) residents reviewed for dignity, in that:. Resident # 35 was left alone in her room with the door shut with food covering the front of her blouse. This failure placed residents at risk of not being treated with dignity.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents had the right to reside and receive services in the facility with reasonable accommodation of resident needs for 1 of 6 residents (Resident #35) who were reviewed for accommodation of needs. The facility failed to ensure Residents #35's call light was placed within their reach. This failure could place dependent residents at risk of injuries and unmet needs.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents are given the appropriate treatment and services to maintain or improve his or her ability to carry out the activities of daily living (ADLs) for 2 of 6 residents (Resident #14 and Resident #35 ) reviewed for ADL abilities, in that:. 1) Resident #14 appeared disheveled, had ground meat covering the front of her blouse after her meal covered up with her blanket in her wheelchair 2 hours after lunch. 2) Resident #35 was lying in a soiled bed with a brown smear approximately 12 inches by 3 inches on bed sheet. This deficient practice could place residents who required assistance at risk for not receiving care and services to meet their needs and avoid ADL decline.

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 4 residents (Resident #35) reviewed for infection control . CNA C failed to wash or sanitize his hands while going from a dirty to clean surface while performing incontinent care for Resident #35. These deficient practices could place residents at risk for cross contamination and the spread of infection.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that residents are free from abuse, neglect, misappropriation of resident property, and exploitation; the facility failed to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish or emotional distress for two (Resident #1, Resident #2) of five residents reviewed for neglect. The facility failed to: 1. ensure Resident #1's pain in her arm and hip was addressed after a fall on [DATE] by providing her prescribed tramadol which had run out and hospice nurse reported constant pain in left forearm 2. ensure Resident #1's neuro checks were completed and documented after a fall [DATE] in which she hit her head and displayed an increase in confusion 3. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure it developed and implemented written policies and procedures that prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property for two (Resident #1, Resident #2) of five residents reviewed for neglect. The facility failed to implement its policies and procedures that were designed to prevent abuse, neglect and exploitation by failing to: 1. ensure Resident #1's pain in her arm and hip was addressed after a fall on [DATE] by providing her prescribed tramadol which had run out and hospice nurse reported constant pain in left forearm 2. ensure Resident #1's neuro checks were completed and documented after a fall [DATE] in which she hit her head and displayed an increase in confusion 3. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that pain management is provided to residents who require such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for two (Resident #1, Resident #2) of five residents reviewed for pain. The facility failed to: 1. ensure Resident #1's prescribed tramadol was in the facility and provided to Resident #1 for her pain after Resident #1 suffered a fall on [DATE] around 5:47 am and reported constant pain in her left arm and had a visible hematoma (swollen knot) on her right forehead. 2. [...]

Inspectors wroteBased on interview and record review, the facility failed to immediately notify the resident's representative(s) when there was a significant change in the resident's physical status for one (Resident #1) of five residents reviewed for changes in condition, in that: The facility failed to notify Resident #1's RP (FM) after she experienced a fall on 01/14/24 at 5:47 am which resulted in the resident sustaining a bump to her head and a complaint of pain to her hip and leg. This failure placed residents at risk of a delay in treatment and their responsible party not being informed and involved in care decisions.

Inspectors wroteBased on interview and record review, the facility failed to ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours if the alleged violation involved abuse or neglect resulted in bodily injury, to other officials (including the State Agency) for one (Resident #1) of five residents reviewed for abuse, neglect, and misappropriation of property, in that: The facility failed to: -Report to the State Agency (SA) within two hours after Resident #1 had a fall on 01/14/24 at 5:57 am and the subsequent x-ray results reflected a possible fracture to her left femur. This failure could place residents at risk of not having injuries related to abuse, neglect, reported.

Inspectors wroteBased on interview and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident and failed to provide a system of medication records that enables periodic accurate reconciliation and accounting for all controlled medications for 2 (fridge and Hall 2) of 3 medication locations that were reviewed for pharmacy services, failed to reconcile narcotic sheets, and failed to ensure medications were given to residents within the prescribed times. The facility failed to: 1. ensure narcotic sheets were filled out at shift change 2. reconciliation of narcotic sheets compared to MAR Resident #1 to ensure every narcotic that was signed out for Resident #1 was administered and documented as administered in the MAR 3. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure that the governing body, or designated persons functioning as a governing body, that was legally responsible for establishing and implementing policies regarding management and operation of the facility appointed an Administrator who was licensed by the State, responsible for management of the facility and reports to and was accountable to the governing body. The governing body did not appoint a licensed Nursing Home Administrator who was licensed by the State and had been without an Administrator since 7/15/2023. This deficient practice could have resulted in the facility not being managed in a responsible manner, which could affect the health and safety of all residents and risk of their needs not being met. Findings Include: [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure the pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident, in that. -medication room with OTC products contained two bottles of expired medication. This failure had the potential to place residents who receive medications from Medication Rooms at risk for not receiving the intended therapeutic benefit of their medication.

Inspectors wroteBased on observation, interview, and record review the facility failed to achieve a medication error rates are not 5 percent or greater. There were 22 errors out of 30 opportunities, resulting in a 73 percent medication error involving 4 of 5 residents. The facility were deficient in the following areas: 1. LVN A Failed to provide medication to Resident # 28. 2. RN A Failed to administer medications within 1 hour before or after of physician's order for resident #17 and # 36 3. RN A failed to provide Dilantin according to physician orders to Resident # 05 Failure to achieve medication error rate below 5 percent can lead to potential outcome of residents at the facility not being adequately cared for.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents were free of significant medication errors for one (Resident #05) of five residents reviewed for significant medication errors in that:. RN A failed to administer the correct dose of Dilantin 125mg/ 5ml to Resident #05 according to physician's order. This deficient practice failure could affect residents who were receiving Dilantin by placing them at risk of confusion, extreme lethargy(tiredness), and coma. Based on observation, interview, and record review the facility failed to ensure residents were free of significant medication errors for one (Resident #5) of five residents reviewed for significant medication errors in that: RN A failed to administer the correct dose of Dilantin 125mg/ 5ml to Resident #5 according to physician's order. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to maintain an effective pest control program so that the facility is free of pest and rodents in that : The facility failed to ensure the facility was free from flies, crickets, and grasshoppers. This failure could place residents at risk for the potential spread of infection, cross-contamination, and decreased quality of life. Findings Included: Observation on 07/18/23 at 12:00PM of the Dining hall, Hallways, and the Restrooms in the hallways, revealed there were dozens of crickets and grasshoppers roaming around. Observation of the kitchen on 07/18/23 at 2:00PM revealed, there were flies circling around in the kitchen and landing on various food products. There were crickets and grasshoppers on the floor on various locations. [...]

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a baseline care plan for each resident within 48 hours of resident's admission that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care for 1 of 5 residents (Resident #90) reviewed for baseline care plan. The facility failed to ensure Resident #90's baseline care plan or comprehensive care plan that include the minimum healthcare information necessary to properly care for a resident was developed and implemented within 48 hours of her admission. This failure could affect newly admitted residents and place them at risk of not receiving continuity of care and communication among nursing home staff to ensure their immediate care needs are met.

Inspectors wroteBased on observation, interview, and record review, the facility failed to post in a place readily accessible to residents, and family members and legal representatives of residents, the results of the most recent survey of the facility for one of one facility. The facility failed to ensure the survey result from the previous recertification survey was readily available. This failure could place residents at risk of not being able to fully exercise their rights or have them exercised on their behalf by members of the community.