Health inspection·September 24, 2024

F 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless the discharge was necessary for the resident's welfare and the resident's needs could not be met in the facility for 1 of 1 resident (Resident #1) reviewed for discharge requirements. The facility failed to ensure Resident #1 was readmitted from the hospital she was transferred to for treatment. The facility failed to provide Resident #1 a discharge notice. There was no documentation from the physician indicating the facility could not meet the Resident's needs. This failure could place residents at risk of unnecessary transfer or discharge causing their needs to go unmet. Findings included: Record review of Resident #1's face sheet dated 09/24/2024 revealed a [AGE] year-old female who was admitted to the facility on [DATE] and discharged on 07/27/2024 at 12:36 PM. Resident #1's diagnoses included cerebral infarction, end stage renal disease, dependence on renal dialysis, ileostomy status, and mood disorder. Record review of Resident #1's admission MDS, dated [DATE] revealed a BIMS score of 14 indicating intact cognition. Further review of the MDS revealed the resident's hearing was highly impaired and hearing aid/appliance was used. Record review of Resident #1's care plan, revised 05/19/2024, revealed I AM REQUIRED TO RECEIVES DIALYSIS THREE TIMES A WEEK, BUT I WILL REFUSE TO GO AND WILL BE AT RISK FOR INCREASED: SOB, CHEST PAINS, BLOOD PRESSURE, ITCHY SKIN, NAUSEA/VOMITING, AND INFECTED ACCESS SITE. I HAVE BEEN EDUCATED REGARDING THE RISK WHEN I REFUSE. Record review of Resident #1's care plan, revised 06/12/2024, revealed On 4/30/24 I started to demonstrate aggressive behaviors. I CURSE AT STAFF WHEN IM UPSET, IN PAIN OR WANT MEDICAL ATTENTION. I AM COMBATIVE WITH STAFF, YELLS AT STAFF, CALL THE STAFF BITCHES, YELL ALL NIGHT, STAY ON THE CALL LIGHT EVEN AFTER THE STAFF ANSWERED THE CALL LIGHT, on 5/13/24 I spit on staff and used profanity. I (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 4 Event ID: 455748 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 455748 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Hall 2021 Shoaf Dr Irving, TX 75061 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)