Inspection·January 27, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for 1 of 5 Residents (Resident #27) reviewed for quality of care: Residents Affected - Few The facility failed to ensure Resident #27 was wearing compression stockings (a specialized hosiery designed to help prevent the occurrence of and guard against further progression of venous disorders such as swelling/inflammation and blood clots) as ordered by the physician. This failure could place residents of risk for not receiving appropriate care and treatment. The findings were: Record review of Resident #27's face sheet, dated 1/25/23 revealed a [AGE] year old male admitted on [DATE] with diagnoses that included dementia, muscle wasting and atrophy (wasting [thinning] or loss of muscle tissue), diabetes and heart failure. Record review of Resident #27's most recent quarterly MDS assessment, dated 12/30/22 revealed the resident was severely cognitively impaired for daily decision-making skills and required one-person physical assist with bed mobility and transfers. Record review of Resident #27's comprehensive person-centered care plan, revision date 1/4/23 revealed the resident had decreased cardiac output related to congestive heart failure with interventions that included, knee high compression stockings to bilateral lower extremities as ordered. Record review of Resident #27's Order Summary Report, dated 1/25/23 revealed the following order, KNEE HIGH COMPRESSION STOCKINGS TO BILATERAL LOWER EXTREMITIES. TO BE APPLIED AT 8am **MAY REMOVE FOR HYGIENE PURPOSES** one time a day for CHF (congestive heart failure), with start date 10/16/21 and no end date. Record review of Resident #27's Treatment Administration Record for January 2023 revealed documentation entered daily from 1/1/23 to 1/24/23 for, KNEE HIGH COMPRESSION STOCKINGS TO BILATERAL LOWER EXTREMITIES. TO BE APPLIED AT 8AM ***MAY REMOVE FOR HYGIENE PURPOSES** one time a day for CHF (congestive heart failure with start date 10/16/21 and no end date. During an observation and interview on 1/24/23 at 10:03 a.m., Resident #27 stated he was supposed to use compression socks but was unable to explain why he needed the compression socks or where they were. Resident #27 was observed with discoloration and swelling to the lower extremities and wearing (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 5 Event ID: 455797 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 455797 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearsall Nursing and Rehabilitation Center 169 Medical Dr Pearsall, TX 78061 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)