Focused Care Of Center

During interviews on 4/17/2025 between 3:56 PM and 4:32 PM the following staff across multiple shifts were able to appropriately describe abuse, ways to prevent abuse, de-escalation techniques of abuse, 1 to 1 monitoring and the grievance process: CNA F, LVN G, LVN H, CNA J, Floor Tech, CNA K, LVN L, CNA M, Activity Director, CNA N, Cook, Dietary Aide, and CNA E.

Record review of skin assessment dated [DATE] for Resident #3.

Record review of skin assessment dated [DATE] for Resident #3.

Record review of behavioral hospital paperwork for Resident #3 dated 3/25/2025 through 4/2025.

Record review of in-service, dated 4/16/2025, on the following topics: Prevention, Identification and Reporting/Investigation of Abuse; How to Immediately Protect Residents when abuse is suspected; Possible Interventions to Assist with De-escalation after an Incident with 39 staff signatures.

Record review of every 15-minute monitoring for Resident #3 revealed 1 to 1 monitoring started on 4/16/2025 at 7:30PM and ended on 4/17/2025 at 7:52AM when Resident #3 discharged from the facility.

Record review of 66 safe surveys conducted on 4/16/2025 with no noted concerns.

Record review of inservice dated 4/17/2025 for completing grievance/complaint investigation report for with 11 staff signatures.

The Administrator was informed the Immediate Jeopardy was removed on 4/17/2025 at 4:35 PM.

The facility remained out of compliance at a severity level of no actual harm with potential for more than minimal harm that is not immediate jeopardy and a scope of pattern due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place.

675398 04/22/2025

Focused Care of Center 501 Timpson Center, TX 75935

During an interview on 4/16/2025 at 1:21pm Resident #3 said when he was 28, he was in the hospital for 2 months and that's when he was diagnosed with the Wilson's disease. He said he is a sweet guy but when you him make him mad, he turns into the devil. He said he did not receive counseling services at the facility. He said he had only talked to a counselor 1 time since he had been at the facility. He said when he has the incidents with other residents, he will go an apologize after the incident was over. He said he did not have control over his actions when he gets mad, and he gets anxious. He said he told Resident #4 to tie his shoe and Resident #4 told him to shut up and for him to tie it and said he got up and started walking over to him and they just began fighting and fell to the ground in the smoking area. He said he kicked Resident #6 because he was jealous the staff were feeding Resident #6 and not him. He said he went to the behavior hospital after he kicked Resident #6.

He said he got kicked out of another nursing facility for trying to bite the medication aide's finger.

During an interview on 4/17/2025 at 1:25pm Resident #4 said he did not like Resident #3 and said on the day in question he was in the smoking area. He said Resident #3 told him his shoe was untied and he told Resident #3 it was none of his business. He said Resident #3 would not leave him alone and he got mad and him and Resident #3 mutually began fighting and fell on the ground. He said after the incident he did not like Resident #3 but he just tried to stay away from him and stay out of trouble.

Record review of the facility's policy titled Abuse, dated 2/1/2017, reflected: .

All events that involve an allegation of abuse or involve a suspicious serious bodily injury of unknown origin must be reported immediately or not later than 2 hours of alleged violation

675398 04/22/2025

Focused Care of Center 501 Timpson Center, TX 75935

jeopardy to resident health or Operations(DCO) and/or designee on the following topics: Prevention, Identification and safety Reporting/Investigation of Abuse.

All staff not present at time of in-service will not be permitted back to work until in-service is complete.

The EDO/DCO were in-serviced on 4-16-25 by the RDCO on Prevention, Identification and Reporting/Investigation of Abuse. 4-16-25: Resident #3 was placed on one-to-one monitoring at 7:20pm.

Discharge Planning initiated to family.

Family agreed by phone to discharge resident to their care on 4-16-25 at 9pm.

Resident remained on one-to-one monitoring until discharge on [DATE] at 7:52am. 4-16-25: Safe Surveys were conducted by DRSS and/or designee with all residents cognitively able to participate.

Results of and action after Safe Surveys are as follows: 3 residents expressed that Resident #3 was rude- Resident #3 was on one-on-one monitoring, 1 resident expressed that a nurse was unsure of what to do for his wound care-resident no longer in facility, 1 resident expressed a CNA was rough during her bed bath-the resident was reinterviewed by DCO to get details, the resident did not think the CNA had been abusive or intentionally rough, it was determined that due to her current clinical condition she requires 2 person assistance for bed mobility and personal care, the care plan and tasks were updated on 4-17-25, One-on-one in-service to be completed on 4-17-25 with CNA. 4-17-25: All residents identified as at risk for physically aggressive behaviors were reviewed by the CRC/ADCO to ensure they had an accurate care plan, appropriate interventions and appropriate Psych Services or Counseling Services The DCO/ADCO/EDO will monitor EMR documentation including the 24-hour report, incident reports and alerts, and Grievances to identify potential abuse or situati[TRUNCATED]

675398 04/22/2025

Focused Care of Center 501 Timpson Center, TX 75935

Administrator and DON.

jeopardy to resident health or During interviews conducted on 4/17/2025 between 8:45 am - 9:15 am CNA M, PTA, CNA B, CNA F, safety CNA N, Activity Director, HSK, Floor Tech, Laundry U, Laundry V, Receptionist, BOM, CNA K, ADON, CNA S, LVN H, LVN T, LVN A, and LVN G all verbalized if a resident is missing a code pink is called.

entering a code the Administrator was to be notified so it can be changed.

They all said the gates on the unit must be checked every 4 hours and the inside buttons to be checked to make sure the light was green.

They said if the lawn care service was present, they were to be let in and then back out when they were finished.

On 4/17/2025 at 9:55am, the Administrator was notified the IJ was removed.

However, the facility remained out of compliance at a level of no actual harm with the potential for more than minimal harm with a scope identified as isolated due to the facility's need to monitor the implementation and effectiveness of its POR.

675398 04/22/2025

Focused Care of Center 501 Timpson Center, TX 75935

Findings included: An observation on 4/17/25 at 12:30 p.m. in the facility kitchen revealed dead insects on top of dry-food storage shelves and stuck to the walls below a food preparation area.

During an interview on 4/17/2025 at 12:40 p.m., the Dietary Aide said there had been roaches in the kitchen for at least a month.

She said had reported the roaches to the Dietary Manager and ADM, but the issue had not been addressed.

During an interview on 4/17/2025 at 12:45 p.m., the [NAME] said there had been roaches in the kitchen off and on since December of 2024.

She said she had reported the issue to both Dietary Manager and ADM but there were still roaches in the kitchen.

During an interview on 4/17/2025 at 1:00 p.m., the Dietary Manager said she had worked at the facility for 4 months and there had been an issue with roaches in the facility kitchen.

She said pest control had come out today to spray for pests.

During an interview on 4/17/25 at 2:00 p.m., the ADM said the facility had roaches in the walls in the kitchen since December of 2024.

She said facility maintenance staff saw roaches in the walls in the kitchen while repairing a leak on or around 4/11/25.

She said facility staff sprayed the area with a can of pesticide, but she did not call pest control because they were coming out next week for a scheduled monthly visit.

She said there was no risk to residents from roaches in the kitchen.

Review of the Pest Control service visits revealed a Service Order for a visit on 4/16/25.

The service order instructions indicated there were reports of roaches in the dining room cabinets and kitchen.

Pest control products were applied in the kitchen, dish pit, dining room, break room, and common area targeting pests American Roaches and German Roaches with a follow-up visit recommended to be scheduled in a week.

Review of a facility policy titled Pest Control last revised in May 2008 indicated .This facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents .

The facility failed to immediately report an allegation of resident-to-resident abuse to HHSC after the allegation was made on 11/30/2024. On 11/30/2024 at 6:45 PM Resident #4 and Resident #3 had a physical altercation while outside in the smoking area.

2.

The facility failed to report immediately report an allegation of resident-to-resident abuse to HHSC after the allegation was made on 3/25/2025 at 8:09 AM. On 3/25/2025 Resident #3 kicked Resident #6 multiple times during breakfast.

These failures could place residents at risk of further potential abuse.

Findings include:

1.

Record review of the electronic face sheet for Resident #3 indicated Resident #3 admitted to the facility on [DATE] with the most recent readmission on 4/2/2025 with diagnosis that included: bipolar disorder (significant shifts in mood, energy, and activity levels, causing periods of intense highs and lows), impulse disorder (difficulty controlling impulses, urges, or behaviors, leading to harmful or inappropriate actions), parkinsons (neurological disorder that primarily affects movement), wilsons disease (causes copper to build up in the liver, brain, and other organs).

Record review of Resident #3's admission MDS assessment dated [DATE] indicated a BIMS of 15, which indicates no cognitive impairment.

Record review of Resident #3's care plan dated 11/15/2024 indicated: I am exhibiting behavior of making flirtatious comments towards staff and some female residents.

Interventions included: 1. [Counseling] services evaluate and treat. 2.

Monitor/document/report PRN any signs/symptoms of resident posing danger to self and others. 3.

Staff will monitor for safe environment and to ensure no unusual episodes occur.

The care plan dated 3/4/2025 indicated I am exhibiting behavior of-verbal aggression to other residents, I like to stir the pot, boss people around and tell people what they can and can't do. I am often loud and obnoxious and often instigate arguments with staff and residents.

Interventions included: 1.

Monitor/document/report PRN and signs/symptoms of resident posing danger to self and others. 2.

Psychological services evaluate and treat. 3.

Staff will monitor for safe environment and to ensure no unusual episodes occur. 4.

When the resident becomes agitated: intervene before agitation escalates; guide away from source of distress; engage calmly in conversation; if response is aggressive, staff to walk calmly away and approach later.

675398

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 675398 B.

Wing 04/22/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Focused Care of Center 501 Timpson Center, TX 75935

The facility failed to ensure the secured unit courtyard gates were locked after lawn care services on [DATE]. On [DATE] Resident #1 eloped from the facility grounds through an unlocked gate in the courtyard of the secured unit. A good Samaritan encountered Resident #1 at a nearby doctor's office and Resident #1 was returned to the facility.

The facility failed to provide adequate supervision for Resident #2. On [DATE] Resident #2 eloped from the facility through the front door. A good Samaritan encountered Resident #2 at a nearby roadway intersection and returned Resident #2 to the facility.

An IJ was identified on [DATE].

The IJ template was provided to the facility on [DATE] at 4:51 PM.

While the IJ was removed on [DATE], the facility remained out of compliance at a scope of isolated and a severity level of no actual harm with the potential for more than minimal harm because (e.g.) all staff had not been trained on the facilities elopement policy.

This failure could place residents at risk of not being properly supervised resulting in injury or death.

Findings included:

1.

Record review of the electronic face sheet for Resident #1 indicated Resident #1 admitted to the facility on [DATE] with diagnosis that included: dementia (decline in cognitive function), muscle weakness, type 2 diabetes (high blood sugar).

Record review of Resident #1's annual MDS assessment dated [DATE] indicated a BIMS of 03, which indicates severe cognitive impairment. It also indicated Resident #1 was independent with walking 150 feet.

Record review of Resident #1's care plan dated [DATE] indicated: I am exhibiting behavior of wandering. I have dementia and may wander or pace. I may enter other's rooms uninvited. I respond well to redirection at this time. I have been moved to secured unit for safety.

Interventions included: Staff will monitor for safe environment and to ensure no unusual episodes occur.

Record review of Resident #1's elopement risk assessment dated [DATE] indicated an elopement score of 15 which was of high risk category.

Record review of Resident #1's elopement risk assessment dated [DATE] indicated an elopement score of 3 which was of medium risk category.

675398

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 675398 B.

Wing 04/22/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Focused Care of Center 501 Timpson Center, TX 75935