Health inspection·May 16, 2025

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review the facility failed to ensure the assessment accurately reflected the resident's status for 1 (CR #1) of 5 residents reviewed for accuracy of assessments. Residents Affected - Few The facility failed to ensure CR#1's behavior was coded on the quarterly MDS dated [DATE]. This failure could place residents with behavior at risk of not receiving care and intervention that could meet their behavioral needs. Findings included: Record review of CR #1's face sheet dated 05/16/2025 reflected CR#1 was a [AGE] year-old male who was admitted to the facility on [DATE] and discharged on 5/15/2025. CR#1's diagnoses included muscle wasting and atrophy (decrease or wasting of tissue, muscle or organs), lack of coordination (pattern walking or moving on foot), non- Alzheimer's disease (a type of dementia/neurodegenerative disease that affects the brain causing memory loss, confusion, and changes in behavior), hypertension (high blood pressure), diabetes (high blood sugar) hyperlipidemia (high levels of fat in the blood), seizure (uncontrolled jerking, loss of consciousness and blank stares), unspecified dementia (memory loss), and psychotic disorder (severe mental disorder that causes abnormal thinking and perception, lose touch with reality). Record review of CR#1's nurse's notes revealed the following. 4/2/2025 at 10:16am Resident observed in the hallway yelling and screaming help, when resident was asked what he needed resident began yelling out curse words towards the staff. Resident upset because he wanted to put the dirty clothes back on after his shower, staff attempted to redirect resident. This resident continued to yell out curse words calling the staff out calling them derogatory names. Resident continued to wheel himself up and down the hall yelling curse words to the top of his lungs. 4/2/2025 at 9:45pm Assisted the patient to bed and met all needs. The patient continued to shout loudly. Attempted redirection, but the patient was difficult to reorient and continued shouting. 4/3/2025 at 09:42am. Patient up in w/c, able to make needs known, pt is verbally abusive towards staff during care, constantly cussing at staff for no reason. Pt at nursing station telling staff member he wished death to her kids and wished staff a car wreck. Pt not easily redirected, attempt to redirect, the more he cusses staffs. wheeled self to dining area at this time with no other concerns. (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: 455800 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 05/16/2025 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)