Inspection·February 28, 2025

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to maintain medical records that were complete and accurately documented for 2 (Resident #1 and Resident #2) of 20 residents reviewed for clinical records, in that: 1. Resident #1's psychiatric provider notes included diagnoses not listed on the facility's list of diagnoses for the resident. 2. Resident #2's psychiatric provider notes included diagnoses not listed on the facility's list of diagnoses for the resident. These deficient practices could result in in errors in care and treatment. The findings were: 1. Record review of Resident #1's facesheet, dated 02/27/2025, revealed the resident was admitted to the facility on [DATE] with diagnoses including: Alzheimer's disease, Cerebral Infarction and Vascular Dementia Unspecified Severity Without Behavioral Disturbance. Record review of Resident #1's annual MDS, dated [DATE], revealed a BIMS score of 07 which indicated severe cognitive impairment. Record review of Resident #1's care plan, dated 02/27/2025, revealed, [Resident #1] has a behavioral problem where she has delusions [related to] dementia and a cerebral infarction. She says statements that after investigation have been found to be not true . The resident is/has potential to be physically aggressive to staff and others. Record review of Resident #1's psychiatric provider after visit note, dated 02/11/2025, revealed, Active Medical Problems .delusions . neuropathy .Assessment and Plan: Dementia with Behaviors. Further review of Resident #1's facesheet, dated 02/27/2025, revealed the diagnoses of delusions, neuropathy, and dementia with behaviors were not noted. 2. Record review of Resident #2's facesheet, dated 02/27/2025, revealed the resident was admitted to the facility on [DATE] with diagnoses including: Other Specified Interstitial Pulmonary Diseases, Anemia, and Insomnia. Record review of Resident #2's quarterly MDS, dated [DATE], revealed a BIMS score of 0 which (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 02/28/2025 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)