Inspection·February 12, 2025

F 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews the facility failed to ensure that one (1) resident (Resident #1) of eight residents reviewed for transfer or discharge had the required documentation in the resident's medical record made by the physician and failed to provide information to the receiving health care provider for a safe and effective transition of care. The facility discharged Resident #1 on 9/18/2025 without physician documentation in the EMR and without providing any clinical information for continuity of care to the receiving provider. This failure could put residents at risk for inappropriate discharge from the facility and cause psychological harm. The findings included: Review of Resident #1's Face Sheet dated 2/7/2025 reflected a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included acute kidney failure, anemia (low iron count in the blood), anxiety disorder, sleep disorder, chronic pain syndrome, hypertension (high blood pressure), and traumatic brain injury. Review of Resident # 1's order dated 9/18/2025 reflected Discharge immediately to law enforcement after assault and resisting arrest. Resident is a danger to herself and others. Review of the MD letter dated 2/11/2025 reflected: By allowing [Resident #1] to remain in the facility I felt it would pose an immediate threat to the safety and wellbeing of the other residents residing in the facility. Review of Resident #1's progress notes dated 9/18/2025 at 12:20 pm reflected MD called regarding residents' behavior and new order given to immediately discharge resident [due to] her being a danger to herself and others. Further review reflected Resident #1 had become verbally and physically aggressive towards staff by ramming her walker into the staff. The police were called and had come to the facility and arrested Resident #1. Additional review of progress notes reflected no progress note from the MD regarding clinical or medical reasons for immediate discharge of Resident #1. During an interview on 2/12/2025 at 10:50 am the former MD stated Resident #1 had an escalation of behaviors on 9/18/2025 where she verbally and physically assaulted staff. He had given an order for her immediate discharge because the police had come to the facility and arrested Resident #1. The MD stated he had not provided any progress note in the EMR explaining how resident was a danger to (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 5 Event ID: 455515 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 455515 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copperas Cove Nursing & Rehabilitation 607 W Ave B Copperas Cove, TX 76522 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)