The Cottages at Texarkana

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure a resident received an evaluation and treatment, as appropriate, in a time frame that would meet the medical needs of the resident in accordance with professional standards of practice. Specifically, the facility failed to notify the Physician of a low blood sugar, failed to notify the Physician of resident ' s multiple refusals of evening blood glucose checks for the month of October, and failed to notify the Physician and other facility staff after a resident had a fall. This failed practice resulted in actual harm for Resident #29 who fell and sustained a right femur fracture and right hip fracture and did not receive appropriate medical care for 6 days. The failed practice affected 1 (Resident #29) of five residents reviewed for accidents.

Inspectors wroteBased on observation, record review, interview, and review of the menu, the facility failed to ensure meals were prepared and served according to the planned written menu to meet the nutritional needs of the residents for 3 of the 3 meals observed in 6 of 6 cottages.

Inspectors wroteBased on observation, record review, interview, and facility policy review, the facility failed to ensure foods stored in the freezer, refrigerator and dry storage area were covered; refrigerated foods were kept refrigerated; dented cans were removed from stock; expired food items and leftover food items were promptly removed / discarded on or before the expiration or use by date; dietary staff washed their hands between dirty and clean tasks and before handling clean equipment; manufactures instructions were followed; Cold food items were maintained at 41 degrees Fahrenheit or below and hot food items were maintained at above 135 degrees Fahrenheit on the steam table, while awaiting service for 3 of 3 meals observed.

Inspectors wroteBased on record review and interview, the facility failed to ensure a Minimum Data Set (MDS) assessment was completed accurately to reflect a resident was considered to be a PASARR (Preadmission Screening and Record Review) Level II by the State Authority for PASARR assessments for 1 (Resident #18) of 1 sampled resident reviewed for PASARR.

Inspectors wroteBased on observations, record review, interview and policy review, the facility failed to ensure staff followed enhanced barrier precautions (EBP) and performed appropriate hand hygiene to prevent the potential for cross contamination when administrating medications through a feeding tube for 1 (Resident #29) of 3 sampled residents, observed for medication administration.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident was transferred in a safe manner to prevent injury for one (Resident #1) of two (Resident #1 and Resident #2) sampled residents.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure ongoing staff training, competencies, and evaluations for all nursing staff.

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to ensure medications were kept secure to prevent unauthorized access in Cottages 2, 2A, 3, 4 and 5.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow proper sanitation and food handling practices to prevent the possible outbreak of foodborne illness. The facility failed to ensure food safety was maintained when implementing various culture change initiatives; that equipment was in a safe, useable condition; to store, prepare, and serve food in a safe and sanitary manner; and failed to ensure the facility was free from pests. This failed practice had the potential to affect 15 sampled residents and 53 residents that eat from the kitchen.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure shower supplies and spray disinfectant was stored appropriately behind a locked cabinet to prevent possible injury. This failed practice had the potential to affect 1 sampled (Resident #15) and 18 residents that ambulate and self-propel on East Hall. The facility failed to raise and lower resident with the rear casters in the unlocked position on the mechanical lift to prevent instability. This failed practice affected 1 (Resident #37) of 5 sampled and had the potential to affect 9 residents requiring mechanical lift assistance.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure only licensed staff operated feeding pumps to reduce the risk of aspiration for 1 (Resident #40) of 1 sampled resident with a feeding tube.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure dietary preferences were followed for 1 (Resident #16) to prevent weight loss or nutritional deficits. This failed practice had the potential to affect 15 sampled and 53 residents that eat from the kitchen.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide perineal care in a safe, sanitary manner to prevent cross contamination for 1 (Resident #40) of 5 sample residents and 18 residents on East Hall requiring perineal care assistance.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure food items stored in the refrigerator, freezer and dry storage areas were sealed, covered, dated, and were stored in accordance with the manufacturer's instructions; failed to ensure expired food items were promptly removed/discarded by the expiration or use by dates, to prevent potential for food borne illness for residents who received meals from 1 of 1 kitchen. These failed practices had the potential to affect 45 residents who received meals from 1 of 1 kitchen (total census: 46), as documented on the list provided by Dietary Supervisor on 2/16/23 at 8:31 PM.

Inspectors wroteBased on observation, interview, and record review the facility failed to develop and implement a baseline Care Plan that included the instructions needed to provide effective and person-centered care for the resident to meet the professional standards for of quality care for 2 (R #100 and R #302) of 4 (R #8, R #100, R #301, and R #302) sample residents according to the list provided by the Administrator on 2/15/23 at 4:01pm

Inspectors wroteBased on observation, interview, and record review the facility failed to review and revise the Care Plan to include that a resident received oxygen therapy to ensure appropriate coordination of care for 1 (Resident #17) of 7 (Resident #8, R #11, R#17, R#19, R #29, R #32, and R #100) sample residents that had orders for oxygen therapy. The facility failed to review and revise the Care Plan to include a resident had pressure injuries to ensure appropriate coordination of care for 1 (Resident #23) of 4 (Resident #10, R #19, R #23, and R #40) sampled residents that had pressure injuries. [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to follow Physician's Orders to change oxygen tubing weekly to prevent the potential for infection, and failed to ensure an oxygen in use sign was in place to ensure appropriate safety precautions were taken related to oxygen therapy for 1 (Resident #17) of 7 (Residents #8, R #11, R #17, R #19, R #29, R #32 and R #100) sampled residents who had Physician's Orders for oxygen therapy. The failed practice had the potential to affect 8 residents that had Physicians Orders for oxygen therapy according to a list provided by the Director of Nursing (DON) on 2/15/23 at 2:20PM.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure food was prepared by methods that maintained appearance; hot foods were served hot and cold foods were served cold to maintain palatability and encourage adequate nutritional intake for 2 of 2 meals observed on the East Hall, and Central Hall. The failed practice had the potential to affect 15 residents who received meal trays in the rooms on East Hall, 16 residents who received meal trays in their rooms on Central Hall as documented on a list provided by Dietary Supervisor on 2/15/2022 at 8:31 AM.

Inspectors wroteBased on observation and interview, the facility failed to ensure pureed food items were blended to a smooth, lump-free consistency to minimize the risk of choking or other complications for residents who required pureed diets for 1 of 2 meals observed. This failed practice had the potential to affect 4 residents who received pureed diets, as documented on the Diet List provided by the Dietary Supervisor on 2/16/2023.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure the Current Minimum Data Assessment (MDS) accurately reflected the use of a non-insulin type Diabetes medication to facilitate the ability to plan, coordinate and provide necessary care for 1 (Resident #23) sample resident who had received a Glucagon-Like Peptide-1 [GLP-1]. This failed practice had the potential to affect 2 (R #23, and R #250) residents who received a GLP-1 medication for treatment of Diabetes Mellites according to a list provided by the Assistant Director of Nursing (ADON) on 02/16/23 at 2:58 PM.