Inspection·May 3, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to implement a comprehensive care plan to meet the medical and nursing needs and the services to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being of 1 (Resident #1) of 5 residents reviewed for care plans. The facility failed to implement a comprehensive person-centered care plan for Resident #1 requiring weekly skin assessments. This failure could place residents of risk for not receiving appropriate care and treatment, worsening of skin issues, a delay in treatment, a decline in health, and hospitalization. Findings included: Record review of the face sheet, dated 05/02/2024, indicated Resident #1 was a [AGE] year old male initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including cellulitis (a common and potentially serious bacterial skin infection), and hemiplegia and hemiparesis (paralysis and muscle weakness on one side of the body) following cerebral infarction (a disruption in the brain's blood flow) affecting left non-dominant side. Record review of the Resident #1's physician orders, dated 05/03/2024, indicated Resident #1 had an active order to refer to [Wound Physician Group Name] physician for eval/treatment of all wounds until resolved per NP A, dated to start 10/05/2023. Record review of Resident #1's MDS, dated [DATE], indicated Resident #1 had a BIMS of 11, indicating he had moderate cognitive impairment and did not have a behavior history of rejecting care. The MDS indicated Resident #1 required extensive assistance with two or more persons physical assist for bed mobility and toilet use and was totally dependent with two or more persons physical assist for transferring to or from the bed, chair, or wheelchair. The MDS indicated Resident #1 did not have an unhealed pressure ulcer/injury or other wounds and skin problems, but did have a pressure reducing device for his bed and had ointments/medications applied to his skin, other than his feet. Record review of Resident #1's care plan, accessed 05/02/2024, indicated Resident #1 was at risk for impaired skin integrity, initiated and revised on 12/09/2021, with interventions including Conduct skin inspections / examinations weekly and as needed. Document findings., initiated 12/09/2021. Record review of Resident #1's Forms, labeled NURSING - Weekly Skin Evaluation, reviewed for the (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: 455796 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 455796 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/03/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Town and Country Nursing and Rehabilitation Center 625 N Main St Boerne, TX 78006 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)