Health inspection·April 9, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure the resident had a right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely for 5 of 26 residents (Residents #23, #35, #37, #46 and #52) reviewed for resident rights. The facility failed to maintain resident-use water to be above 100 degrees Fahrenheit. This deficient practice could place residents at risk of discomfort and unsanitary washing conditions . Findings include: Observation on 04/09/25 at 1:22 PM in resident room [ROOM NUMBER] revealed the hot water at the sink fixture measured 76.2 degrees Fahrenheit, when tested with a state-issued digital thermometer. Observation on 04/09/25 at 1:25 PM in resident room [ROOM NUMBER] revealed the hot water at the sink fixture measured 76.0 degrees Fahrenheit, when tested with a state-issued digital thermometer. Observation on 04/09/25 at 1:28 PM in resident room [ROOM NUMBER] revealed the hot water at the sink fixture measured 74.4 degrees Fahrenheit when tested with a state-issued digital thermometer. Observation on 04/09/25 at 1:31 PM in resident room [ROOM NUMBER] revealed the hot water at the sink fixture measured 74.1 degrees Fahrenheit, when tested with a state-issued digital thermometer. During a group interview on 04/08/2025, at 10:00AM, Resident #37 and Resident #35 said they did not have hot water in their room. Resident #37 said the water had been out for several weeks. She said she would let it run for a long time , but the water never got warm or hot. During interview on 04/09/25 at 2:21 PM, with the Maintenance Director, he said a water heater went out and a new one was installed . He said he thought the issues had been corrected and his maintenance assistant had been checking the water temperatures daily and recording the temperatures on the water temperature log. The Maintenance Director said it was his responsibility to adjust the water regulator, to provide the proper temperature water for resident-use water . During interview on 04/09/2025 at 2:28 PM, the Maintenance Assistant said the problem with the water heater started 2.5 weeks ago. He said they had a new water heater installed and he had been (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 3 Event ID: 455753 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 455753 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Brook Health Care Center 107 Stacy Whitehouse, TX 75791 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)