Amarillo Medical Lodge

order with corresponding start date: 03/09/26 ceftriaxone Sodium Intravenous Solution Reconstituted

ceftriaxone Sodium Intravenous Solution Reconstituted 1 GM .

Use 1 gram intravenously every 24

only for PICC placement for 1 Day .During an observation and interview on 03/10/26 at 02:49 PM Resident #97 was sitting up in his bed.

His nurse stated Resident #97 received IV antibiotics.During an interview on 03/12/26 at 08:45 AM RN A stated the purpose of a baseline care plan was to provide quality care, and make sure there is a treatment plan, and we are hitting all of our goals.

She stated central and PICC lines should be included in baseline care plans due to cleaning, flushing, and dressing changes. RN A stated a life vest, and dialysis should both be included in baseline care plans.

She stated not have this information in a baseline care plan could negatively impact a resident if a baby nurse or an inexperienced nurse was assigned to provide care to the resident.During an interview on 03/12/26 at 08:52 AM ADON B stated baseline care plans were completed by herself, DON, ADON C, and MDS LVN.

She stated the purpose of a baseline care plan was to outline how the facility was going to take care of the resident.

She stated central lines, PICC lines, dialysis, and life vests should be included in baseline care plans.

She stated she did not know why they were not included in the baseline care plans of Residents #40, #76, #86, and #97 unless it was because some of the residents were not here (in facility) very long. ADON B stated leaving the above mentioned information out of a baseline care plan could potentially negatively impact a resident if someone is new to taking care of them (residents) and doesn't know what is going on with them (residents).

During an interview on 03/12/26 at 09:21 AM DON stated ADON B and MDS LVN were responsible for completing baseline care plans.

She stated the purpose of the baseline care plan was to have the base of patient care. DON stated of central lines and PICC lines, It should be included on there (baseline care plan) just because that (central and PICC lines) is something that we are monitoring.

She stated she did not know why they were not included in Residents #76, #86, and #97's baseline care plans, but she would ensure they were added. DON stated a life vest should be included in the baseline care plan.

She stated she did not know why it was not included in Resident #97's baseline care plan. DON stated dialysis should be included in a baseline care plan. DON stated an incomplete or inaccurate baseline care plan would not affect the resident's care because nurses followed physician orders and the care plan was just our goals that we set.

Record review of an undated facility policy titled, Baseline Care Plan Policy revealed the following: .The purpose of this policy is to ensure that every resident admitted to the facility receives a timely, person-centered baseline care plan that addresses immediate needs and supports safe, effective care during the initial admission period.

The facility will develop and implement a baseline care plan within 48 hours of a resident's admission.

The plan will include essential information needed to provide safe and appropriate care until the comprehensive care plan is completed.

Timing The baseline care plan must be completed within 48 hours of the resident's admission.

675282 03/12/2026

Amarillo Medical Lodge 9 Medical Dr Amarillo, TX 79106

interview on 03/12/2026 at 10:08 AM the DON stated they did not have a policy specific to

becomes the comprehensive care plan.

Record review of the facility provided policy titled Baseline

interdisciplinary plan developed after completion of the full MDS assessment.7.

Transition to Comprehensive Care Plan: The comprehensive care plan must be completed withing 7 days after completion of the MDS assessment.All relevant information for the baseline plan must be incorporated into the comprehensive plan.

675282 03/12/2026

Amarillo Medical Lodge 9 Medical Dr Amarillo, TX 79106

During an interview on 03/11/26 at 11:28 a.m., CNA F stated she

treatments until they were completed.

She stated she believed that was the expected practice.

During an observation and interview on 03/12/26 at 9:44 a.m., Resident #46 was observed with an empty nebulizer mask on the bedside table.

The resident stated she completed her first breathing treatment of the day at approximately 9:15 a.m. and no staff were with her during the treatment. Resident #46 stated the night-shift nurse left the medication in the mask and she administered it herself after waking up. Resident #46 stated that if she experienced shortness of breath during a breathing treatment, she would place her oxygen on and attempt to relax.

She stated staff were not present and she had to manage the situation herself. Resident #46 stated that she believed she was stable, but felt she should be monitored during treatments because anything could happen.

The resident further stated nurses had never taken her vital signs after breathing treatments.

During an interview on 03/12/26 at 9:54 a.m., RN A stated she had worked at the facility for about 13 months and worked on the hallway where Resident #46 resided. RN A stated that the policy of the facility, during breathing treatments, was to remain within line of sight of the resident. If the resident was stable, staff could leave the room, but vital signs were to be taken before and after treatment. RN A stated she was not aware Resident #46 administered a breathing treatment at 9:15 AM because she did not administer the medication. RN A stated a potential negative outcome of not monitoring a resident during a breathing treatment could include adverse reactions, heart palpitations, and increased heart rate. RN A stated if a breathing treatment medication was prepared at 5:00 AM but not administered until 9:00 a.m., it could pose a safety concern because another resident could access the medication.

During an interview on 03/12/26 at 10:03 a.m., the DON stated staff were expected to ensure breathing treatments were administered correctly.

She stated, for stable residents, staff should ensure the breathing treatment was running and check on residents before, during, and after treatment.

The DON stated vital signs were to be taken before and after treatment, and staff were expected to remain in the hallway during the treatment.

She stated a possible negative outcome of a resident not being monitored could be that a resident may not receive their full breathing treatment.

Review of the undated facility's policy, Oxygen Therapy Policy, revealed the following: Purpose: This policy establishes procedures for the safe and effective administration, monitoring and documentation of oxygen therapy in accordance with Texas Health and Human Services Minimum Licensing Standards, CMS Requirements of Participation and accepted clinical practice. 6.

Administration Procedures Set up oxygen equipment and/or nebulizer according to manufacturer instructions.

Ensure correct flow rate, medication and delivery device.Frequently monitor the resident based on clinical stability.Document assessments and resident response.Educate the resident and family on oxygen safety. 7.

Monitoring and DocumentationNursing staff will frequently monitor the resident based on clinical stability, provider orders, and changes in condition.

Monitoring includes oxygen saturation levels, respiratory assessment, resident tolerance, equipment function, adverse reactions, and interventions or notifications.

Residents requiring continuous oxygen or those with unstable respiratory status will receive more frequent monitoring, with documentation reflecting the resident's condition and clinical judgement. 10.

Care planningThe resident's care plan will include diagnosis requiring oxygen, flow rate, delivery method, safety needs, monitoring frequency, and resident preferences or goals.