Inspection·December 12, 2023

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the television. She was positioned in front of the roommate's bed, which was closest to the door and a tray table was in front of her. Packaging from the morning breakfast was still on her tray table and her call light was placed across the room on her bed. In an interview on 12/12/2023 at 10:17 am, the surveyor knocked on Resident #1's door and she immediately screamed out in distress Help me! Please help me!! Resident #1 explained that she had went number two (had a BM) and she hated to sit in it after she had messed on herself. She stated that staff placed her in her wheelchair that morning after her shower and that was the last time she had been changed. Resident #1 stated that she was a stroke victim and was paralyzed and could not walk, which was why she was not able to move/transfer herself to the bed to reach her call light to ask for help. She revealed that she had fallen at the facility in the past and she was afraid to fall again and hit her head. The surveyor pressed the call light on the resident's behalf to summon assistance. In an interview on 12/12/23 at 10:22 am, CNA A entered the room to change Resident #1. She stated that she woke Resident #1 up that morning and changed her at 7:10 am. The resident finished her shower with the shower tech and was sitting in her wheelchair by 7:30 am to receive her morning breakfast tray. During incontinent care, CNA A said, ooh you pooped to Resident #1, who responded I know, I couldn't get anybody to change me. In an interview on 12/12/23 at 10:30 am, Resident #1 said that she felt much better now that she had been cleaned up. In an interview on 12/12/23 at 10:35 am, CNA A stated that residents are supposed to be changed every 2 hours or immediately if they have made a bowel movement. She explained that Resident #1 was normally in bed, which she preferred, but she took her out of the bed to switch things up. CNA A apologized to Resident #1 for getting her up out of bed. The CNA was not knowledgeable if Resident #1 was a fall risk or her diagnoses but admitted to having access to PCC (resident information portal). CNA A further explained that she normally worked on another hall, but she worked that hall on that day to fill in. In an interview with CNA B on 12/12/23 at 10:58 am, she explained that Resident #1 was allowed to sit up in her chair for 2-3 hours. She explained that as a safety precaution, the facility had to have someone watch Resident #1 at all times so that she would not aspirate due to her previous stroke and that she required multiple check-ins. CNA B also stated that Resident #1 could wheel herself around, but she would not, and the call light should be within reach of her. In an interview with the DON on 12/12/23 at 12:33 pm, she stated that rounds were ideally done every 2 hours, however this was a long-term care facility. She explained that Resident #1 would ask her roommate to press her call light on her behalf because she would often yell out for help, but she admitted that the call light should have been in reach of the resident. The DON stated that if a resident was not able to reach their call light, they were at risk of not receiving the assistance they need. Record review of the facility's policy titled Call Lights: Accessibility and Timely Response, (no date) stated: 1. All staff will be educated on the proper use of the resident call system, including how the system (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455800 If continuation sheet Page 2 of 3 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 455800 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Lev at Town Park 8820 Town Park Dr Houston, TX 77036 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)

F 0558 works and ensuring resident access to the call light. Level of Harm - Minimal harm or potential for actual harm 2. All residents will be educated on how to call for help by using the resident call system. Residents Affected - Few 3. Each resident will be evaluated for unique needs and preferences to determine any special accommodations that may be needed in order for the resident to utilize the call system. 4. Special accommodations will be identified on the resident's person-centered plan of care and provided accordingly. (Examples include touch pads, larger buttons, bright colors, etc.) 5. Staff will ensure the call light is within reach of resident and secured, as needed. 6. The call system will be accessible to residents while in their bed or other sleeping accommodations within the resident's room. 7. The call system must be accessible to the resident at each toilet and bath or shower facility. The call system should be accessible to a resident lying on the floor. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455800 If continuation sheet Page 3 of 3