The Heights of Tyler

Inspectors wroteBased on observation, record review and interview, the facility failed to develop and implement a comprehensive person-centered care plan for each resident that included measurable objectives and timetables to meet residents highest practicable physical, mental, and psychosocial needs for 1 of 4 residents reviewed for care plans, (Resident #1). Resident #1 was not care planned for making allegations of a consensual relationship with a staff member (CNA B), including that the staff member would no longer provide care for her. This failure could place residents at risk of not having their individualized needs met, and a decline in their quality of care and life.

Inspectors wroteBased on observations, interviews and record review, the facility failed to ensure sanitation and housekeeping services were sufficient to maintain a clean and sanitary interior environment, including areas under resident's beds, for 4 of 11 resident rooms observed, (room [ROOM NUMBER] A & B, room [ROOM NUMBER] A & B, room [ROOM NUMBER] A & B, and room [ROOM NUMBER] A & B), observed for sanitary conditions. The facility failed to ensure and maintain a clean and sanitary interior environment, as evidenced by trash not empty, dust accumulation, debris, and lack of routine or incomplete daily housekeeping in resident's rooms and under-bed cleaning. These failures could result in inadequate sanitation, increased risk of respiratory irritation, infection, or pest attraction.

Inspectors wroteBased on observations, interviews, and record reviews. the facility failed to ensure that a resident who needs respiratory care, including tracheostomy care and tracheal suctioning is provided such care consistent with professional standards of practice, the comprehensive person-centered care plan and the residents goals and preferences for 2 of 3 residents (Resident #18, Resident #63) reviewed for oxygen therapy. The facility failed to ensure Resident #18 received oxygen at the rate ordered by the physician. Resident #18's oxygen was set at 3.5 LPM on 2 consecutive days and at 4.0 LPM on the third day instead of 2 LPM as ordered by the physician. The facility failed to ensure Resident #63's nasal cannula (a medical device to provide supplemental oxygen therapy to people who have lower oxygen levels) was stored in a bag when not in use. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for 1 of 1 kitchen observed food service safety , in that: *Steam tables were dirty with food spatter on glass on all 4 Satellite Kitchens *12 Dirty cookie sheets containing carbon build-up on rack *2 Dirty muffins pans containing carbon build up were stacked against each other *Dishwasher test log, had been filled in and completed for the entire day These failures could place residents who ate food from the kitchen at risk of foodborne illness

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure MDS data accurately reflected the resident's status for 1 of 6 residents (Resident #76) reviewed for MDS accuracy. This facility failed to indicate Resident #76's current nutritional approach was by feeding tube in MDS dated [DATE]. This failure could put residents at risk for an inaccurate comprehensive assessment record.

Inspectors wroteBased on interviews, and record review, the facility failed to meet professional standards of care for 1 of 6 residents (Resident #3) reviewed for professional standards when diagnosing a mental health disorder. The facility did not ensure Resident #3 had sufficient clinical documentation to support a new diagnosis of schizophrenia. This failure could place residents at an increased risk of inappropriate care planning, psychosocial stigma, and future treatment decisions based on incorrect clinical information.

Inspectors wroteBased on observations, interviews, and record reviews, 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 for 1 of 4 residents (Resident #16) reviewed for pharmacy services. LVN C failed to flush Resident #16's enteral tube with water during medication administration as ordered by the physician. This failure could place residents who receive medications via a gastric tube (also called an enteral tube) at risk for tube occlusion (clogging), medication-nutrient interactions, reduced drug efficacy, and potential toxicity.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure residents had the right to have reasonable access to the use of a telephone and a place in the facility where calls could be made without being overheard for 3 of 7 residents (Residents #4, #27, #33, #36, #53, #58 and #85) reviewed for telephone use. The facility failed to provide a phone that could be used in an area, which would prevent resident conversations from being overhead. This failure could place residents at risk of having conversations being overheard and privacy rights not being respected.

Inspectors wroteBased on observation, 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 for 1 of 4 residents (Residents #6) reviewed for pharmacy services. The facility failed to ensure a physician's order provided clearly written instructions for the dose of cholecalciferol (Vitamin D3) Resident #6 was to be given. This failure could place residents at risk for not receiving accurate doses of medications and the intended therapeutic response of prescribed medications.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to establish and maintain an infection prevention and control program 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 #304) reviewed for infection control practices. 1. RN A failed to don appropriate PPE prior to providing wound care to Resident #304. 2. CNA B failed to don appropriate PPE prior to providing incontinent care to Resident #304. These failures could place the residents under their care at risk for exposure to possible transmission of communicable diseases and infections.

Inspectors wroteBased on interview, and record review, the facility failed to ensure in accordance with professional standards of practices, the medical records on each resident were accurately documented for 2 of 3 residents (Resident #1 and Resident #2) reviewed for accurate medical records. MA C failed to correctly document in the EMR with regards to Resident #1's metoprolol Tartrate 50 mg, on 9/14/24. MA E failed to correctly document in the EMR with regards to Resident #2's entresto 24/46 mg adminstration on 9/29/24. These failures could place resident's at risk of unnecessary treatment, adverse drug reactions, or inadequate treatment.

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 for 1 of 3 residents (Resident #1) reviewed for pharmacy services. MA B failed to hold Resident #1's metoprolol (a medication used to treat high blood pressure and elevated heart rate) when Resident #1's pulse was outside of the physician ordered parameters on 9/18/24 as well as 9/30/24. These failures could place residents at risk of receiving unnecessary medication and significant adverse effects from medication error.

Inspectors wroteBased on interview, and record review, the facility failed to ensure resident who were transported by the facility were free from abuse for 1 of 1 resident (Resident #1 ) reviewed for abuse. The facility failed to ensure Resident # 1 was protected from abuse. The noncompliance was identified as PNC. The noncompliance began on 09/22/2023 and ended on 09/27/2023. The facility had corrected the noncompliance before the survey began. This failure had the potential to affect all residents who depend on the facility for transportation to medical appointments or other social outings.

Inspectors wroteBased on observations, interviews, 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 3 of 10 residents (Resident #1, Resident #2, and Resident #3) reviewed for infection control practices. 1. The facility failed to ensure a wound vacuum cannister with red - brown liquid was not left in Resident #1's and Resident #2's room on 08/28/24. 2. The facility failed to ensure a brown substance was not present on the handrail in Resident #3's bathroom on 08/28/24. These failures could place residents at risk of exposure to communicable diseases, cross-contamination, and infections.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food under sanitary conditions in 1 of 1 kitchen and 4 of 4 satellite kitchens reviewed for food service. Opened food packaging in the pantry and walk-in freezer were not closed after opening. Packages of food items were not labeled, dated, and re-sealed. A bulk container of popcorn had cups left inside the product. Food storage containers were not kept clean when stored. Satellite kitchens on the halls had soiled microwaves and dried coffee spills inside cabinet drawers. A carton of thickened liquid was not dated when opened. These failures could place residents who ate food from the kitchen at risk of foodborne illness.

Inspectors wroteBased on interview and record review, the facility failed to ensure the Pre-admission Screening and Resident Review (PASRR) Level I assessment accurately reflected the resident's status for 1 of 6 residents (Resident #102) reviewed for PASRR Level I screenings. The facility failed to ensure the accuracy of the PASRR Level 1 screening for Resident #102. The PASRR 1 Level screening did not indicate a diagnosis of mental illness, although the diagnosis was present upon admission. This failure could place residents who had a mental illness at risk of not receiving a needed assessment (PASRR Evaluation), individualized care, or specialized services to meet their needs.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident who needed respiratory care was provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 1 of 1 resident (Resident #366) reviewed for respiratory care and services. The facility failed to obtain a physician's order for oxygen administration for Resident #366. The facility failed to follow their oxygen administration policy This failure could place residents at risk for developing respiratory complications.

Inspectors wroteBased on an interview and record review, the facility failed to ensure that the facility's medical director or his/her designee attended the Quality Assessment and Assurance/Quality Assurance and Performance Improvement Committee meetings, for 1 of 1 facility, reviewed for QAA/QAPI. The facility failed to ensure the medical director attended their QAA and QAPI meetings for the months of January 2023, February 2023 and March 2023. This failure could place residents at risk for quality deficiencies being unidentified and no appropriate plans of actions developed or implemented.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were free of any significant medication errors for 1of 6 residents (Resident #1) reviewed for significant medication errors. The facility did not provide Resident #1's physician ordered Potassium Chloride ER Tablet for four days. The noncompliance was identified as PNC. The IJ began on 8/12/2023 and ended on 8/17/2023. The facility had corrected the noncompliance before the survey began. This failure could place residents at risk of not receiving the intended therapeutic benefit of the medications.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure, in accordance with State and Federal laws, medications were stored in locked compartments under proper temperature controls and permitted only authorized personnel to have access to the keys for 3 of 5 medication carts (100 Hall and 200 Hall Medication Carts) reviewed for pharmacy services. 1. RN G failed to ensure the Nurse Medication cart for 100 Hall was not left unlocked, unsecured, and unattended. 2. The facility failed to ensure the Nurse Medication Cart for 100 Hall and 200 Hall were not left unlocked, unsecured, and unattended near the nurse station. 3. The facility failed to ensure two medications (Fluticasone Propionate Nasal Spray 50 mcg and Ultra Lubricant Eye Drops) were left at Resident #2's bedside. 4. [...]

Inspectors wroteBased on interview and record review the facility failed to ensure, in accordance with accepted professional standards and practices, medical records were maintained on each resident that were complete and accurately documented, for 1 of 6 residents (Resident # 1) reviewed for resident records. The facility failed to accurately record Resident #1's Potassium Chloride ER on the MAR from 8/12/23 to 8/15/23. This failure could place residents at risk for incomplete and inaccurate clinical records which could lead to miscommunication, a delay in services or a potential decline in resident 's health.