Health inspection·October 7, 2023

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to notify the resident's representative of the transfer or discharge for 1 (Resident #1) of 5 residents reviewed for transfers/discharges. The facility failed to notify Resident #1's representative of the resident's discharge to the hospital. This failure could affect residents at the facility by placing them at risk of being transferred/discharged and not having access to available advocacy services, discharge/transfer options, and appeal processes. Findings include: Record review of Resident #1's face sheet dated 10-7-2023 revealed a [AGE] year-old male resident admitted to the facility originally on 7-16-2023 and readmitted on [DATE] with diagnoses to include acute respiratory failure (occurs when the respiratory system is unable to either adequately absorb oxygen or excrete carbon dioxide), schizoaffective disorder (a mental health condition including schizophrenia and mood disorder symptoms), hypertension (a condition in which the force of the blood against the artery walls is too high), neuromuscular dysfunction of the bladder (when the nerves and muscle of the bladder do not function together adequately), dysphagia (difficulty or discomfort in swallowing), pain, central cord syndrome (the most common form of an incomplete spinal cord injury), and fusion of the spin, cervical region. Section-Miscellaneous Information-Date of Discharge-09-28-2023. discharged to: Acute Care Hospital. (Resident continues to reside in this facility at the time of this investigation). Record review of Resident #1's last MDS assessment reflected a quarterly MDS completed 8-10-2023 listing him with a BIMS of 12 indicating he was moderately cognitively impaired and that he had a functionality of requiring one to two-person assistance with all his activities. Record review of Resident #1's care plan dated of 8-4-2023 noted no care plan for discharge. Record review of Resident #1's face sheet dated 10-7-2023 revealed the following: Section: Miscellaneous InformationDate of discharge: [DATE] Acute Care Hospital. (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 4 Event ID: 455551 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 455551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Plainview Healthcare Center 2510 W 24th St Plainview, TX 79072 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)