Inspection·March 14, 2023

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure respiratory care was provided according to professional standards of practice for 1 of 14 residents reviewed for respiratory care and services. (Residents #15) Residents Affected - Few The facility did not provide Resident #15's oxygen concentrator with a clean filter. The filter was covered with a thick layer of white powdery substance. This failure could place residents who required respiratory care at risk of not receiving proper care and treatment and decreased quality of life. Findings included: Record review of the admission record indicated Resident #15 was admitted on [DATE]. Resident #15 was [AGE] years old male with diagnoses with chronic lung disease Record review of quarterly MDS assessment dated [DATE] indicated Resident #15 had moderately impaired cognition, and had not received oxygen during last 7 days. Resident#15 had diagnosis of chronic lung disease. Record review of the care plan dated 02/23/23 revealed Resident #15 was resistive to care with a history of non-compliance with O2 use as ordered. Interventions include an order for oxygen as ordered by physician. Record review of physician orders dated March 2023 indicated Resident #15 was [AGE] years old and had diagnoses of chronic lung disease. The orders included Administer O2 @ 2 LPM via N/C PRN (as needed) related to Chronic Obstructive Pulmonary disease (lung disease) with acute exacerbation (sudden worsening of symptoms) with a start date of 02/23/2023. During an observation and interview on 03/12/23 at 9:00 a.m., Resident #15 was receiving O2 at 2 LPM and filter on the concentrator was covered with a thick layer of white powdery substance. Resident #15 said the nurses change tubing and take care of that machine. During an observation on 03/13/23 at 9:38 a.m., Resident #15 concentrator's filter was still covered with a thick layer of white powdery substance. During an observation and interview on 03/13/23 at 10:00 a.m., LVN A checked Resident #15 concentrator's filter and said it was dirty and should have been cleaned last night. She said she normally (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: 455561 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 455561 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaumont Health Care Center 795 Lindbergh Dr Beaumont, TX 77707 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)