Focused Care At Beechnut
Focused Care at Beechnut in Houston, TX — inspection on July 2, 2024.
Found 10 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
Observation on 06/25/24 at 4:10PM of medication administration for Resident #20 via gastrostomy tube by RN A.
When RN A entered resident's room to administer resident medications, she did not close the door, nor did she pull Resident 20's privacy curtain. Resident #20 was sitting up in his specialized wheelchair watching a movie on his laptop. Resident #20 had a G-tube with a dressing at the site. RN A proceeded to check the resident's G-tube placement by raising the resident's shirt to auscultate (listen) resident's abdomen (stomach).
When RN A was done, she continued with checking the G-tube for any residual. RN A proceeded to administer the resident's medication via G-tube by gravity.
In an interview on 06/25/24 at 4:30PM RN A said whenever providing care for a resident, she was supposed to provide the resident with privacy by closing the door or pulling the curtain. RN A said she became nervous and forgot to provide privacy for Resident #20.
In an interview on 06/25/24 at 12:07PM the DON said whenever the staff provide care for the resident's they were supposed to provide privacy for the residents.
Record review of the NF policy on Meal Service dated 04/2022 revealed in part: .The dining experience will enhance the resident's quality of life .The staff member does not stand, when feeding or assisting the resident with eating.
Staff converse with the residents during mealtime .
Record review of the NF policy on Resident Rights revised December 2016 revealed in part: .Employees shall treat all residents with kindness, respect, and dignity .Federal and state laws guarantee certain basic rights to all residents of this facility.
These rights include the resident's right to: a dignified existence, be treated with respect, kindness, and dignity .privacy and confidentiality .
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Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072
reporting changes in condition to the ADON, the DON, and the MD, including missed appointments.
jeopardy to resident health or Interview with LVN N on 07/02/2024 at 2:08PM, he was in-serviced on scheduling and documenting safety appointments.
appointments and notifying the MD and the DON with changes in condition.
In an interview with LVN B on 07/02/2024 at 1:38PM, she was in-serviced on scheduling and following up with residents' appointments and notifying physicians with changes in condition.
In an interview with RN C on 07/02/2024, she said she was in-serviced regarding documenting, confirming, and following up with appointments.
Record review of in-services, all staff completed the following: Record review of policies/procedures, in-services provided 6/28/2024 to 7/2/2024 Policy: Skin Management: Prevention and Treatment of Wounds Effective: 11/01/2019 Last Revised: 10/06/2022 Catheter Policy: Indwelling, straight, Supra-Pubic and external, dated effective 4/20/2021.
Social Worker/Designee in-service on documentation of appointments.
Pain Assessment.
Department Head, Nurse Management Appointment In-service.
Wound Care Nurse Competencies.
Wound Care one on one-disciplinary action form.
Cath and Foley Care/securing catheter, skin assessment.
The Administrator and Interim DON was informed the Immediate Jeopardy was removed on 07/02/2024 at 3:45PM.
The facility remained out of compliance at a severity level of 2 and a scope of E due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place.
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Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072
place. A baseline plan of care to meet the resident's immediate needs shall be developed for each
Comprehensive Care Plan Meeting and Reviews by day 21 after Admission.
The Care Plan is revised
individualized basis.
The Care Plan process is an ongoing review process.
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Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072
because residents who wander can enter the room and get access to the razor.
The DON did not
talk to Resident #86's family member and make them aware to take the products back with them after
In an interview with the Administrator on 7/2/24 at 3:05pm, he said Resident #86 had an appointment which was why the products were in his room.
The Administrator said he wouldn't want the razor or body wash on the unit and those items should have been locked up for safety. If it was left unattended a resident who has wandering behaviors might get into them and that the best the facility can do was to educate and reduce the issue.
The Administrator said he will follow up with the family about the razor and body wash.
Record review of the facility's Resident Rights policy revised December 2016 revealed that resident have a right to retain and use personal possessions to the maximum extend that space and safety permit.
The policy did not specify razors or hygiene products, nor did other policies the facility provided review and discuss personal items.
into place.
jeopardy to resident health or Resident #54 safety Record review of Resident #54's face sheet dated 06/27/24 revealed he was a [AGE] year-old male
which included: diabetes mellitus (body do not produce enough insulin or cannot use it properly), hypertension (high or raised blood pressure), urinary tract infection (an illness in any part of the urinary tract), and neuromuscular dysfunction of the bladder (the nerves and muscles do not work together very well).
Record review of Resident #54's quarterly MDS assessment dated [DATE] revealed a BIMS score of 11 of 15 indicated moderate impaired cognition.
Further review revealed the resident had indwelling Foley.
Record review of Resident #5[TRUNCATED]
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Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072
immediately.
They are discarded after 72 hours unless otherwise indicated.
Scoops should not be left
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Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072
Findings included: Observation on 06-26-24 at 1:15 pm, revealed the facility's dumpster area, had 2 commercial -size dumpsters (dumpster A and dumpster B) ¾ full of garbage and the doors were open.
In an interview on 06-26-24 at 3:45 pm, with the Food Service Manager, she stated that the dumpster doors must always be closed to keep vermin, pests, and insects out of the dumpster and from entering the facility.
She further stated that housekeeping, and nursing also discard their waste garbage in the dumpster. It was the responsibility of staff from dietary, nursing and housekeeping for ensuring the food waste will properly be removed and disposed for from the community.
Record review of facility's Policies and Procedures on waste disposal dated 11/ 2023 revealed that food waste will be properly removed and disposed for from the community to ensure the food safety for the residents.
Garbage and refuse containing food wastes will be stored in a manner that is inaccessible to pests.
Outside dumpster provided by garbage pickup services will be kept closed and free of surrounding litter.
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Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072
During an observation and interview on 06/26/24 at 1:34 p.m., the Administrator said he could see the hand-washing soap broken.
The Administrator said the laundry aide should not go to the restroom to wash her hands because it was an infection control issue.
The Administrator stated LS A left one area to another area to wash her dirty hands, and she could have transferred the germs to the area where she went and washed her hands.
The Administrator said LS A could have contaminated her hands on her way back to the clean area in the laundry room and could have transferred the germs to the clean linens, which was an infection control issue.
The Administrator said clean linens should not be stored in dirty areas, and no clothes should be on the floor or staff personal items on the clean table for clean linen for infection control reasons.
Record review of the facility policy on laundry and bedding, soiled dated 2001 MED-PASS, Inc. (Revised October 2018) read in part . soiled laundry/bedding shall be handled, .processed according to best practices for infection prevention and control .transport #6 . clean linens are stored separately, away from soiled linens, at all times .
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Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072
The facility failed to prevent a disposable razor and hygiene products from being located unsupervised in Resident #86's room.
This deficient practice could result in residents coming into contact with dangerous materials which could place them at risk of injury or death.
Findings:
Record review of Resident #86's face sheet revealed a [AGE] year-old who was originally admitted on [DATE].
His medical diagnoses included hyperlipidemia (high amount of fats in the blood), dementia (unspecified), Major Depressive Disorder, Rhabdomolysis (breakdown of skeletal muscle), cognitive communication deficit, and abnormalities of gait and mobility.
Record review of Resident #86's Quarterly MDS dated [DATE] revealed a BIMS (a brief interview which assesses mental status) score of 11, indicating mild cognitive deficit.
Further review showed Resident #86 required supervision or touching assistance throughout the following activities: personal hygiene (shaving, washing/drying face and hands), oral hygiene, showering, toileting, and eating.
Record review of Resident #86's care plan last reviewed 06/06/2024 revealed:
-Resident #86 has an ADL self-care performance deficit due to Dementia. He required supervision and set up assist from staff to eat, dress, and for personal hygiene and oral care to maximize independence.
Observation and interview with Resident #86 on 7/1/2024 at 12:25pm revealed he was sitting on his bed, fully dressed.
There was a disposable uncovered razor on Resident #86's dresser, there were 3 bottles of body wash, and 2 deodorant sticks on his window ledge. Resident #86 stated he had no concerns and felt safe at the facility.
In an interview with CNA C on 7/1/2024 at 12:29pm, she observed the disposable razor on Resident #86's dresser and the hygiene products on the ledge and said it should not be there. CNA C said Resident #86's family member usually helped him get ready for doctor's appointments and most likely brought the hygiene products into the room. CNA C said it could be dangerous to have the razor in the room for his roommate who could hurt himself.
She would tell the charge nurse who would talk to the family about taking hygiene products with them when they're done.
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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 675000 B.
Wing 07/02/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072
The surveyors confirmed the plan of removal had been implemented sufficiently to remove the IJ by the following:
Observation and interview on 6/30/2024 at 11:00 am with Resident #72 was sitting in wheelchair eating a snack. He was well-groomed with no odors. Resident #72 said he is feeling okay but wondered why it took the facility so long to address his catheter. He said he was now afraid of an infection from his stoma to g-tube. Resident #72 raised his shirt at that time and a small pea-sized area was observed in what appeared to be a white cream. Resident #72 consented for the DON to come assess him with another staff member. He was then transported back to his room.
The DON later came and said that the white substance was not an infection but a cream that they used to treat the stoma called theravox, which was confirmed by viewing the container and conducting a record review of Resident #72's physician orders.
In an interview on 6/29/2024 at 10: 20 AM RN A said she had been working with the facility for 8 months 6:00 AM to 6:00 PM shift.
She had in-services on incontinent care, indwelling catheter care, securing catheter, hanging foley bag below the bladder, and reporting any abnormalities to the charge nurse like skin irritation. If there were any changes in the site notify the NP and check indwelling catheter every shift.
They were assessing catheter before daily but now every shift and for any slit to the penis they should document in the progress note.
In an interview on 6/29/2024 at 10: 49 AM LVN A said she had been working with the facility for 1 year on the 6:00 AM to 2:00 PM shift.
She had in-services on incontinent care, indwelling catheter placement, securing the catheter, and reporting any abnormalities to the doctor like skin irritation and document.
675000
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 675000 B.
Wing 07/02/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.