TEMPLE, TX – TLC WEST NURSING AND REHABILITATION

Based on observations, interviews, and record reviews, the facility failed to maintain an effective pest control program for 7 (Resident #1 thru Resident #7) of 20 residents reviewed, in that:

The facility failed to ensure the building was free of ants as Resident #1 was found with ants crawling on her, causing severe ant bites and [CONDITION(S)].

This failure resulted in an immediate jeopardy on 10/06/21. While the IJ was removed on 10/8/21 the facility remained out of compliance at a scope of isolated and a severity of actual harm due to the facility requiring more time to monitor the plan of removal for effectiveness. The IJ template was provided to facility staff at this time.

Review of Resident #1’s progress notes reflected on 10/03/2021 around 11:50 AM the aide alerted this nurse to resident’s room where hundreds of ants were observed crawling on resident’s body. Resident’s throat was red, swollen, and had multiple bites from the ants. Her clothing and bedding were removed, and staff attempted to remove the ants from her body before she was placed in the shower to remove them all. The nurse administered 50mg of [MEDICATION(S)]. Resident is non-verbal and was scratching her neck and body and had facial grimaces. She was transferred to the emergency room to monitor for [MEDICATION(S)].

In an interview on 10/6/21 at 4:28pm LVN A stated in the late winter or spring of 2021, she was alerted to ants in Resident #1’s bed but could not remember the exact time or what staff were involved. She stated she pulled back the covers and there were indeed ants in Resident #1’s bed with the resident, but the resident had not been bitten. LVN A stated she removed the resident from the room and reported it to the ADM or DON the same day and thinks that maintenance sprayed the room. This was not documented anywhere to LVN A’s knowledge. This past Saturday, CNA A reported to her that Resident #5 had ants coming through his window. LVN A informed RN A and they went to Resident #5’s room and saw ants coming through his window in the left bottom where the window meets the frame. He was up in his chair so did not get bit and his bed is away from the window. RN A informed LVN A she would handle it. She stated on the afternoon of 10/3/21, Resident #6 reported to her that something was crawling on him. LVN A checked him and saw nothing. She stated she had not heard of another incident involving ants and Resident #6. When this

Surveyor shared concerns there had been another ant incident with this resident, but the CNA involved denied it, LVNA A stated, that sounds about right. LVN A stated Resident #3 has complained about ants I don’t even know how many times, and that she has notified management and housekeeping. LVN A stated MA A notified her of ants last weekend, and she followed the chain of command and notified RN A. LVN A is not sure what RN A did about the concern but found out that ADM was not notified about the ants and the incident with Resident #1 until Monday morning. LVN A stated the first week of September 2021, Resident #7 had ants in his room, coming along his wall from the window on the wall that shares with Resident #3, they were in his dresser and a line to his closet. Management had the housekeeper clean out all the drawers in his nightstand, where it was found he had an unsealed bag of cookies in his drawer. LVN A stated the ant problem was an on-going issue and thought it was the lack of care by management, as management did not act on what the staff said and the only time management were out of their office is when state was in the building. She has seen someone come in and spray but not often and never the whole facility.