Health inspection·March 7, 2024

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews a facility must coordinate assessments with the pre-admission screening and resident review (PASARR) program under Medicaid in subpart C of this part to the maximum extent practicable to avoid duplicative testing and effort. Coordination includes, Incorporating the recommendations from the PASARR level II determination and the PASARR evaluation report into a resident's assessment, care planning, and transitions of care for 1 of 1 (Resident #1) resident with PASARR recommendations in that: Resident #1 NFSS for therapy services was not submitted timely. The Failures could affect residents with PASSR services and could result in residents not receiving the PASSR recommended services. The findings included: Record review of Resident #1's admission record dated 3/7/2024 was admitted on [DATE], re-admitted on [DATE] with diagnoses of Quadriplegic Cerebral Palsy, Schizophrenia, Severe intellectual disabilities, and Muscle Weakness. Record review of Resident #1's Quarterly MDS dated [DATE] revealed Resident #1's BIMS was severely cognitively impaired. Record review of Resident #1's Care plan dated 2/20/2024 revealed Resident had a positive PASRR evaluation related too: ID (intellectual development)/DD (developmental disability) severe intellectual disabilities. Resident requires specialized services: rehabilitative therapy (OT/PT), pending MCD(medicaid) eligibility, currently on services with MCR(Medicare) part B; behavioral support; specialized assessment; DME(Durable Medical Equipment); & habilitation coordination. Record review of Resident #1's P1(PASARR 1) dated 6/5/2023 revealed Resident #1 had an intellectual disability, indicated as yes. Record review of Evaluation revealed a response of Yes for Intellectual Disability, Developmental Disability Record review of Resident #1's PASSR Comprehensive Service Plan (PCSP) dated 2/2024 revealed Resident #1 was recommended Physical Therapy. Record review of complaint intake #482711 dated 2/7/2024 revealed Resident #1 has not received a Medicaid service as a result of the following: 1. The NF was notified and instructed to submit 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 2 Event ID: 455724 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 455724 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbor View Nursing & Rehabilitation 1213 Water St Kerrville, TX 78028 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)