Paradigm at Kountze

Inspectors wroteBased on observation, interview and record review the facility failed to ensure residents assessments accurately reflected the resident's status for 5 of 13 residents (Residents #4, #25, #39, #40 and #41) reviewed for accuracy of assessments. 1. The facility failed to accurately complete the MDS assessment to indicate Resident #4's tobacco use. 2. The facility failed to accurately complete the MDS assessment to indicate Resident #25's nutritional status and approaches. 3. The facility failed to accurately complete the MDS assessment to indicate Resident #39's tobacco use. 4. The facility failed to accurately complete the MDS assessment to indicate Resident #40's PASRR positive for diagnoses included cerebral palsy. 5. The facility failed to accurately complete the MDS assessment to indicate Resident #41's tobacco use. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to properly store, prepare, distribute and serve food in accordance with the professional standards for food service safety for 1 of 3 refrigerators (Refrigerator #1) in the kitchen reviewed for food and nutrition services. The facility failed to ensure food items in Refrigerator #1 were labeled, dated, sealed, and not expired. This failure could place residents at risk for health complications, foodborne illnesses, and decreased quality of life.

Inspectors wroteBased on observation, interview and record review the facility failed to coordinate assessments with the pre-admission screening and resident review (PASRR) program under Medicaid to the maximum extent practicable to avoid duplicative testing and effort for 1 of 5 residents (Resident #4) reviewed for PASRR. 1. The facility failed to ensure Resident #4's PL1 was updated to reflect the resident's diagnosis of disorganized schizophrenia (a mental illness characterized by disorganized thinking, speech and behavior and unusual reactions to situations). 2. The facility failed to refer Resident #4 for PASRR Level II assessment to the state designated authority. These failures could place residents at risk for not receiving needed assessment, care, and specialized services to meet their needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure an environment that was free of accident hazards for 1 of 43 residents (Resident #24) reviewed for accidents hazards. The facility failed to ensure safety measures were in place after Resident #24 received a second-degree burn (burns that involve the epidermis and part of the lower layer of skin, the dermis. The burn site looks red, blistered, and may be swollen and painful) from hot coffee that required treatment. An Immediate Jeopardy (IJ) situation was identified on [DATE] at 9:33 a.m. While the IJ was removed on [DATE], the facility remained out of compliance at a scope of isolated and a severity of no actual harm with potential for more than minimal harm, due to the facility's need to evaluate the effectiveness of the corrective systems. [...]

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 safety in the facility's only kitchen. The facility did not ensure: 1. Food items were labeled and dated. 2. Hair restraints were worn. 3. The microwave was clean and free of food debris. 4. The outside of the ice machine was clean. 5. The condiment cart was free from a dark/light substance. 6. The plate domes were stacked without water pooled in between them. 7. [NAME] D's nails were clean and free of a black substance. 8. The iced tea maker cart was free from a brown substance. 9. The trash can used for food waste had a lid. These failures could place residents at risk for foodborne illness.

Inspectors wroteBased on record review and interviews the facility failed to ensure the arbitration agreement contained all the required elements for 1 of 1 facility reviewed for Arbitration Agreements. The facility did not ensure the arbitration agreement did not contain language that prohibited or discouraged the resident or anyone else (e.g., resident's representative) to communicate with federal, state, or local officials such as federal and state surveyors, other federal or state health department employees, and representative of the Office of the State Long Term Care Ombudsman. This failure could place the residents or the residents' responsible parties in binding agreements not fully understood, have a loss of their legal rights, and cause negative psychological issues.

Inspectors wroteBased on interview and record review, the facility failed to ensure assessments accurately reflected the resident status for 5 of 12 residents (Resident # 12, Resident #27, Resident 28, Resident #17, and Resident #40) reviewed for MDS assessment accuracy. 1. The facility failed to ensure Resident # 12's, Resident #27's, and Resident #28's, Plavix (an antiplatelet drug you can take to prevent blood clots) was coded correctly under antiplatelet on the MDS. 2. The facility failed to ensure Resident #28's Aspirin (a common drug for relieving minor aches, pains, fever an anti-inflammatory or blood thinner) was coded correctly under antiplatelet on the MDS. 3. The facility inaccurately coded Resident #17 as having received dialysis on her MDS assessment dated [DATE]. 4. [...]

Inspectors wroteBased on interview, and record review the facility failed to review and revise the person-centered care plan to reflect the current condition for 3 of 16 (Residents #6, #27, and #19) residents reviewed for care plan revisions. The facility failed to update Resident #6's and #27's care plans for their Code status from Full Code to DNR. The facility failed to update Resident #27's and Resident #19's care plans for fall interventions. These failures could affect residents by placing them at risk of not receiving appropriate interventions to meet their current needs.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the meals served met the nutritional needs of residents for 1 of 1 meal (the lunch meal) reviewed for nutritional adequacy. The facility did not ensure the correct scoop size was used for the ground chicken during the lunch meal on 07/22/2024 . This failure could affect all residents in the facility who require ground food consistency by placing them at risk of not receiving adequate nutritive food value needed to promote/maintain health.

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 and to help prevent the development and transmission of communicable diseases and infections for 1 of 4 residents (Resident #35) and 2 of 2 staff (CNA S and RN B) reviewed for infection control. 1. The facility failed to ensure CNA S performed hand hygiene before providing incontinent care to Resident # 35 on 07/22/2024. 2. The facility failed to ensure CNA S changed her gloves when going from dirty to clean when she provided incontinent care to Resident #35 on 07/22/2024. 3. The facility failed to ensure CNA S transported the dirty linen properly when she was walking down the hall on 07/22/2024. 4. [...]

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed protect and promote the rights of the residents for 1 of 16 residents (Resident #31) reviewed for resident rights. The facility failed ensure CNA M provided privacy when she assisted Resident #31 in getting dressed on 07/25/2024. This deficient practice could place residents at risk for loss of dignity.

Inspectors wroteBased on interview and record review, the facility failed to implement written policies and procedures that prohibit mistreatment, neglect, and abuse of residents, for 1 of 16 residents (Resident #144) reviewed for abuse. The facility failed to follow their policy to report to HHSC when Resident #144 alleged that CNA N had sat her down on the toilet too hard hitting her back on [DATE]. These failures could place residents at risk of abuse, physical harm, mental anguish, and emotional distress.

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 were reported immediately, but no later than 2 hours after the allegation was made, for 1 of 16 residents (Resident #144) reviewed for abuse and neglect reporting. The facility failed to investigate when Resident #144 alleged that CNA N let her sit down on the toilet too hard hitting her back on [DATE]. This failure could place residents at risk of abuse, physical harm, mental anguish, and emotional distress.

Inspectors wroteBased on interviews, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs, for 1 of 6 (Resident #24) residents reviewed for the care plan. The facility failed to care plan Resident #24's coffee spill that resulted in a 2nd-degree burn. This failure could affect residents by placing them at risk of not receiving appropriate interventions to meet their current needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure respiratory care was provided with professional standards of practice for 1 of 3 residents reviewed for quality of care. (Resident #19) The facility failed to ensure Resident #19's oxygen order was changed to as needed or discontinued. This failure could place residents who receive respiratory care at risk for developing respiratory complications.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were seen by a physician at least once every 30 days for the first 90 days after admission for 1 of 16 residents (Resident #245) reviewed for physician services. The facility failed to ensure Resident #245 was seen by a physician within the first 30 days of her admission to the facility. This failure could place the residents at risk for medical conditions not being identified, care needs not being met, and a decline in health status.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to provide pharmaceutical services, which included procedures that assured the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals, to meet the needs of each resident for 1 of 8 resident (Resident #15) reviewed for pharmacy services. The facility did not ensure LVN A administered Resident #15's nasal spray according to the manufacturer's instructions. This failure could place the resident at risk of medical complications and not receiving the therapeutic effects of their medications.

Inspectors wroteBased on interview and record review, the facility failed to ensure that residents were free of significant medication errors for 1 of 9 residents reviewed for pharmacy services. (Resident #19) The facility failed to ensure Resident #19's amlodipine (blood pressure medication) was not administered when her blood pressure was outside of the ordered parameters on 07/06/2024, 07/15/2024, and 07/21/2024. The facility failed to ensure Resident #19's losartan (blood pressure medication) was not administered when her blood pressure was outside of the ordered parameters on 07/06/24 and 07/21/24. These failures could place the resident at risk of medical complications and not receiving the therapeutic effects of their medications.

Inspectors wroteBased on interview and record review, the facility failed to ensure laboratory services were obtained to meet the needs of 1 of 16 residents reviewed for laboratory services. (Resident #4) The facility did not ensure Resident #4's Keppra (a medication for seizure disorder) level was obtained and monitored. This failure could affect residents by placing them at risk for not having their medications at a therapeutic level and increasing their risk for seizures.

Inspectors wroteBased on interviews, and record reviews, the facility failed provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service for 1 out of 7 dietary staff. The facility did not ensure [NAME] E had a current food handler permit. This failure could place residents who consumed food prepared from the kitchen at-risk of foodborne illness or nutritional deficiencies.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the medical record was complete and accurately documented for 1 of 8 residents (Resident #244) reviewed for resident records. The facility did not ensure LVN A documented physician notification when Resident #244 refused his Lasix (medication used to treat swelling). This failure could place the resident at risk for not receiving appropriate care due to incomplete/inaccurate information being documented.

Inspectors wroteBased on interview and record review, the facility failed to collaborate with hospice representatives and coordinate the hospice care planning process for each resident receiving hospice services, to ensure quality of care for the resident, ensuring communication with the hospice medical director, the resident's attending physician, and others participating in the provision of care for 2 of 3 residents (Residents #'s 10 and 6) reviewed for hospice services. The facility failed to obtain Resident #10's most recent updated hospice plan of care and hospice medication record. The facility failed to maintain Resident #6's hospice binder containing information related to hospice services provided for the resident. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure residents received treatment and care in accordance with professional standards of practice for 16 of 16 residents (Resident #s 1, 7, 10, 13, 15, 19, 20, 22, 24, 26, 30, 32, 37, 38, 40, and 43) reviewed for quality of care. The facility did not obtain informed written consents or document verbal consents, including risks, benefits, and potential adverse reactions, prior to IV vitamin and hydration infusions. The facility did not monitor residents, including documenting assessments, for a full 72 - hours, following infusion for adverse reactions. The facility licensed nursing staff were not trained in IV therapy, including post-care assessments and monitoring, and resident plans of care were not initiated prior to IV infusion. An Immediate Jeopardy was identified on 06/13/23. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents who require dialysis received such services, consistent with professional standards of practice, the comprehensive person-centered care plan and the residents' goals and preferences for 1 of 15 residents (Resident # 3) reviewed for dialysis. The facility failed to have a physician's order for dialysis for Resident #39. This failure could place the residents at risk for complications and not receiving proper care and treatment to meet their needs.

Inspectors wroteBased on observation, interview, record review the facility failed to ensure drugs and biologicals were stored in locked compartments in accordance with state and federal laws for 1 of 4 medication carts reviewed for drug storage. (Hall 100 medication aide cart) The facility failed to secure the medication aide cart for Hall 100. This failure could place residents at risk for an adverse drug event and drug diversion.