Inspection·October 2, 2023

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to review and revise the person-centered care plan to reflect the current condition for 1 resident (Resident #1) of 8 residents reviewed for care plan accuracy. The facility failed to ensure Resident #1's care plan was updated to reflect a diabetic foot ulcer and treatment. This failure could place residents at risk of not receiving appropriate interventions to meet their current needs. Findings include: Record review of Resident #1's undated face sheet printed 09/30/23 reflected a [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses including type 2 diabetes(condition in the way the body regulates and uses sugar as a fuel), chronic kidney disease stage 3(loss of function in the kidneys), osteoarthritis(wear down of protective tissue), and hyperlipidemia(excess fat in the blood). Record review of Resident #1's undated care plan reflected that Resident #1 did not have a care plan for wound care treatment. Record review of Resident #1's MDS dated [DATE] revealed in Section M skin conditions that Resident #1's foot problem indicated a diabetic foot ulcer. Section C revealed a BIMS score of 14 which indicated cognitive intactness. Record review of Resident #1's physician order dated 08/31/23 revealed apply betadine(antiseptic for minor wounds) to diabetic wound to left dorsal first toe daily. Every day shift for wound care. Physician order dated 08/29/23 revealed apply skin prep to discoloration to left heel/planter daily. Every day shift for wound healing. Physician order dated 09/20/23 revealed clean left heel open area with NS(normal saline)pat dry. Apply collagen powder and Xeroform gauze(antibiotic dressing). Cover with dry dressing every day shift for wound care. Physician order dated 09/20/23 revealed clean right heel open blister with NS(normal saline). Pat dry apply collagen powder and Xeroform gauze(antibiotic dressing). Cover with dry dressing every day shift for wound care. In an interview with the Administrator on 09/30/23 at 3:00 PM, stated that the care plan did not reflect wound care treatment for Resident #1. The Administrator stated she could not state why the care plan was not reflected in the wound care. The administrator stated the DON would have been (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 455503 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 455503 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosewood Heights 5700 E Central Texas Expwy Killeen, TX 76543 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)