Inspection·August 18, 2023

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to ensure residents received services in the facility with reasonable accommodations of each resident's needs for 3 of 9 residents (Resident #5, Resident #7, and Resident #9) reviewed for call lights in that: Residents Affected - Some Resident #5, Resident #7, and Resident #9 were observed in their rooms with call lights not within reach. This failure could affect all residents who needed assistance with activities of daily living and could result in needs not being met. Findings included: Review of Resident #5's face sheet dated 8/18/2023 reflected a [AGE] year-old male admitted on [DATE] with diagnoses that included: Type 2 Diabetes (blood sugar disorder), Hypertension (high blood pressure), Neuropathy (weakness, numbness, and pain from nerve damage), Chronic Obstructive Pulmonary Disease (breathing disorder), Dysphagia (difficulty swallowing), Anemia (low red blood cells), Hyperlipidemia (high cholesterol) and Cognitive Communication Deficit. Review of Resident #5's MDS dated [DATE] reflected a short and long memory problem under section Staff Assessment for Mental Status . and reflected Resident #'s functional status as: required extensive assistance with transfers, dressing, toilet use and personal hygiene. Bathing was listed as total dependence and eating listed as supervision assistance for Resident #5. Review of Resident #5's care plan dated 8/18/2023 revealed the problems: Resident has the potential for falls related to right above the knee amputation. Interventions included: Keep call light in reach when in bed; Resident has an ADL Self Care performance Deficit and is at risk for not having their needs met in a timely manner. Intervention included: Encourage resident to use call light to call for assistance before attempting any ADLs. Review of Resident #7's face sheet dated 8/18/2023 reflected a [AGE] year-old female admitted on [DATE] with diagnoses that included: Chronic Obstructive Pulmonary Disease (breathing disorder), Type 2 Diabetes (blood sugar disorder), Hyperlipidemia (high cholesterol), Difficulty in walking, Hypertension (high blood pressure), Peripheral Vascular Disease (blood circulation disorder), and Vascular Dementia (brain damage caused by strokes). Review of Resident #7's MDS dated [DATE] reflected A BIMS score of 4 indicating severe cognitive impairment . Resident #7's functional status reflected resident required no assistance for eating, (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 6 Event ID: 455631 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 455631 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Nursing Center 2035 N Granbury St Cleburne, TX 76031 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)