Health inspection·November 21, 2024

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interviews, the facility failed to ensure that equipment were secure and inaccessible to unauthorized staff and residents for 1 (second floor storage room) of 1 storage areas reviewed for equipment storage. The facility failed to ensure equipment supplies were all stored in locked compartments and permit only authorized personnel to have keys when the only storage room in the facility was on the second floor was left unlocked and unattended. This failure could result in resident access leading to a risk for harm and possible injury. Findings included: In an observation on [DATE] at 10:09 a.m. revealed an unlocked, unorganized and dirty storage room on the second floor. In the storage room revealed the following equipment: 1) Broken Wheelchairs, 2) a broken bed frame with sharp edges exposed on the frame, 3) a broken overbed table, with sharp edges where veneer was missing, 4) poles used for g-tube (feeding tubes for formula) and used for infusion of medications, 5) a bedside table with a drawer broken, 6) a suitcase, 7) repair parts for wheelchairs, 8) several mattresses stacked up almost to the ceiling, 9) one large bottle of mouthwash, 10) a bottle of unmarked white liquid, 11) a bottle of hand gel, (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: 455823 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 455823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treemont Healthcare and Rehabilitation Center 5550 Harvest Hill Rd Dallas, TX 75230 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)