Health inspection·June 6, 2024

F 0880 Provide and implement an infection prevention and control program. 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 maintain an infection control program for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for 1 of 5 residents (Resident #1) reviewed for infection control. Residents Affected - Few Housekeeper A picked popcorn off the floor and placed it back into Resident #1's bag and was subsequently eaten by Resident #1. This failure could place residents at risk of exposure to pathogens from the floor. The noncompliance was identified as PNC. The noncompliance began on 03/20/24 and ended on 03/21/24. The facility corrected the noncompliance before the survey began. Findings included: Review of Resident #1's undated admission Record revealed the resident was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included pelvic fracture, history of falls, and dementia. Review of Resident #1's quarterly MDS, dated [DATE], revealed a BIMS score of 10 indicating mild cognitive impairment. Review of Resident #1's care plan, dated 05/13/24, revealed he had impaired cognitive function related to dementia, he suffered from depression related to being in the nursing home, and he is on anti-anxiety medications. Interview on 06/06/24 at 9:10 AM with Resident #1 revealed he had no recall of the event. Resident #1 stated he liked popcorn, and his family brought him popcorn as a snack. Interview on 06/06/24 at 11:00 AM with Resident #1's family member revealed the family reviewed video footage of Resident #1's room from 03/20/24. The video footage showed a female staff member, they assumed a housekeeper, cleaning the resident's room. The video also showed this staff member [Housekeeper A] picked some popcorn off the floor and placed it in the resident's bag of popcorn sitting at his bedside. The family member stated Resident #1 returned to his room later and continued to eat his popcorn, consuming the entire bag. The family notified the Administrator on 03/21/24 and supplied the video footage. Interview on 06/06/24 at 12:00 PM with Housekeeper B revealed she had been helping Housekeeper A (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: 455626 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 455626 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oakmont Guest Care Center 2712 N Hurstview Hurst, TX 76054 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)