Health inspection·August 29, 2025

F 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record reviews the facility failed to treat residents with respect and dignity for one of six residents (Resident #1) reviewed for resident rights. The facility failed to ensure RN A did not stand over Resident #1 while opening his brief and looking at his genitals with the door open and no curtain used, for anyone to see from the hallway on 08/29/25. This failure could affect residents who require assistance with ADLs of not wanting to get staff assistance if it were not done in private which could cause a decrease in the resident's self-esteem and psycho-social well-being resulting in embarrassment. Findings included: Observation on 08/29/25 at 2:40 PM, the door to Resident #1's room was open revealing RN A and CNA B in Resident #1's room. RN A had on gloves and was standing over Resident #1 with the resident's brief unfastened. RN A was looking at the resident's genital area, and the resident's legs was uncovered with his bedsheets at his ankles. When RN A saw the investigator, she quickly closed the brief back and pulled his bed covers up to his chest. CNA B walked out of the room with a bag of dirty wipes and brief. RN A then completed hand hygiene and walked out of the room. Record review of Resident #1's Annual MDS assessment dated [DATE] by RN Consultant reflected the resident was a [AGE] year-old male who admitted [DATE]. He had a Staff Assessment score of 00 and severely impaired cognition. And had no upper impairment and bilateral lower extremity impairment and used a walker. He was dependent and help did all ADL assistance. He required substantial/maximal assist with transfers and turning from side to side and always incontinent of bowel and bladder. He had progressive neurological conditions with diagnosis, anemia (low iron), HTN (high blood pressure), GERD (digestive disease/stomach acid), DM (diabetes mellites), hyperlipidemia (high fat particles), thyroid disorder (hormone gland disorder), osteoporosis (bone weakness), cerebral palsy (abnormal developed brain), seizure disorder (disruption in normal brain activity), malnutrition (lack of nutrients/digestive condition). Record review of Resident #1's Care Plan printed 08/29/25 reflected: Revision date 08/06/25 has potential impairment to skin integrity related to diabetes, incontinence of bowel and bladder and limited mobility. And had a communication problem and at increased risk for shears, and impaired skin integrity 2/2 (two muscle limbs tightening) contractures and impaired ADL's. Observation on 08/29/25 at 2:45 PM revealed Resident #1 was lying flat on his back with a blanket up to his chest. The resident was not able to communicate. There were no odors noted. Interview on 08/29/25 at 2:42 PM, CNA B stated Resident #1 was covered up after the nurse checked him. She stated she was not sure why Resident #1 did not have a privacy curtain and why his room door was not closed. She stated RN A checked to see if Resident #1 needed to be changed and was waiting for ADON C to come to the room for something (after several attempts she did not say what they were waiting for). Interview on 08/29/25 at 2:46 PM, RN A stated she had asked CNA B if she had changed Resident #1, and CNA B said she had. RN A stated she then went to check for herself because Resident #1 could not speak for himself. She stated the staff needed to give the residents privacy, and the only thing she forgot to do when Residents Affected - Few (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: 455872 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 455872 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arlington Residence and Rehabilitation Center 405 Duncan Perry Rd Arlington, TX 76011 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)