Health inspection·September 4, 2024

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 or the resident's representative of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand and send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman for one (Resident #1) of three residents reviewed for discharge notices. The facility failed to notify Resident #1 or her representative in writing of her transfer/discharge to the hospital for behavioral reasons, the reason for the transfer, and the right to appeal and they failed to send a copy of the notice to the ombudsman as soon as practicable of the transfer/discharge. This failure could place residents at risk of being transferred or discharged , and not having access to available advocacy services, discharge/transfer options, and appeal processes. Findings included: Record review of Resident #1's face sheet, dated 09/04/24, reflected the resident was a [AGE] year-old female who was admitted to the facility on [DATE] and discharged [DATE] to an acute care hospital. Record review of Resident #1's 5-day scheduled MDS assessment, dated 03/26/24, reflected a BIMS score of 12, which indicated moderate cognition impairment. Her diagnosis included encephalopathy (brain dysfunction), legal blindness, acute respiratory failure, and schizophrenia. Record review of Resident #1's Nurses Notes, dated 03/28/24, reflected the following: [Resident #1] was discharged today to the VA Hospital due to her increasing and escalating mental health concerns that were preventing her from fully participating in her rehab here at this facility. VA LCSW confirmed she spoke with the VA physician as well as the VA ER LSW and sent notes stating [Resident #1] had been discharged from the VA CCN Contract program effective today due to her needs not being able to be safely met at this facility. Facility Administrator phoned and notified [Resident #1] guardian, [Guardian Name]. [Guardian Name] stated she and the family would be at this facility at some point this weekend to pick up [Resident #1] personal belongings. Review of Resident #1's clinical record reflected there was no documentation of the resident, the resident's responsible party, or the Ombudsman being notified in writing of the resident's discharge or the reason for the resident's discharge. (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: 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 09/04/2024 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)