Health inspection·January 16, 2025

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 review the facility failed to ensure the resident has the right to reside and receive services in the facility with accommodation of resident needs and preferences for one (Resident #1) of five residents reviewed for reasonable accommodation of needs. Residents Affected - Few The facility failed to ensure the call light system was within reach of the Resident #1 lying in bed. This failure could place residents in the facility at risk of being unable to have a means of directly contacting caregivers. Findings included: A record review of Resident #1's MDS assessment dated [DATE] reflected Resident #1 was a [AGE] year-old male with a BIMS score 00 of 15, indicating severe cognitive impairment. Resident #1 was originally admitted to the facility on [DATE], and readmitted on [DATE] with the diagnoses including, neurogenic bladder, multiple sclerosis, and hemiplegia or hemiparesis (Hemiplegia: paralysis of one side of the body) with left elbow, and left wrist contracture. The review further reflected the resident was totally dependent on staff for the ADL's (activity of daily living). A record review of Resident #1's Comprehensive Care Plan dated 11/27/24 reflected Focus. At risk for falls r/t MS, seizures, impaired mobility, nonverbal, incontinent. Goal. Will be free of falls through the review date. Interventions. Anticipate and meet needs. Be sure the call light is within reach and encourage to use it to call for assistance as needed. Observation and interview on 01/15/25 at 10:32 AM Resident#1 was lying in bed. Resident#1's call light was on top of the nightstand. LVN A entered the room and stated the call light was not within reach of Resident#1 and took the call light from the nightstand and clip it to Resident#1 blanket. Interview on 01/15/25 at 10:33 AM LVN A stated the call light should be within residents reach all the time, and the risk to the resident could be not getting help on time could be a fall and possible injury. LVN A stated it was the responsibility of all the staff to make sure the call light was within resident reach before exiting the room. Interview on 01/15/25 at 12:14 PM the DON stated the call-light should be always accessible to the resident, and it was the responsibility of all staff to make sure the call lights always within reach of the residents. The DON stated the risk to the residents, if they cannot reach the call light, they could not call for help, and they would not get the help they needed. (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: 455727 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 455727 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Village Healthcare and Rehabilitation 207 E Parkerville Rd Desoto, TX 75115 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)