Inspection·November 4, 2023

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to assure that all nursing staff possessed the competencies and skill sets necessary to provide nursing and related services to meet the resident's needs safely and in a manner that promotes each resident rights, physical, mental, and psychosocial well-being for 1 of 4 residents (Resident #1) reviewed for nursing practices. The facility failed to ensure LVN A had the competency to retrieve a physician order before performing an invasive examination. The noncompliance was identified as PNC. The noncompliance began 10/18/23 and ended on 10/27/23. The facility had corrected the noncompliance before the investigation began. This failure could place the residents at risk of physical and psychosocial harm. Findings included: Record review of Resident #1's health record revealed a [AGE] year-old female, admission date 08/09/2022, Diagnoses: other intestinal obstruction unspecified as to partial versus complete obstruction (digested material is prevented from passing normally through the bowel), acute and chronic respiratory failure with hypercapnia (respiratory failure due to mechanical defects, central nervous system depression, imbalance of energy demands of central controllers), pleural effusion (fluid buildup between the lung and the chest), not elsewhere classified, unspecified diastolic heart failure (heart's main pumping chamber becomes stiff and unable to fill properly), hypertension (high blood pressure), fatty liver, unspecified cirrhosis of liver (chronic liver damage), hypokalemia (low potassium), edema (swelling caused by too much fluid trapped in body tissue), portal vein thrombosis (narrowing or blockage of the portal vein by a blood clot), unspecified abdominal pain, abdominal distension (bloating and swelling in belly area), muscular dystrophy (genetic diseases that cause progressive muscle weakness and loss of muscle mass), unspecified, Bells' palsy (muscle weakness on one side of face), dysphagia (difficulty swallowing), oropharyngeal phase (difficulty swallowing in mouth or throat), major depressive disorder (persistently low or depressed mood), recurrent, mild, aphonia, UTI (Urinary Tract Infection), anxiety disorder, GERD (Gastroesophageal reflux disease), pain, unspecified, constipation, other megacolon (abnormal dilation of colon), overactive bladder, difficulty in walking, lack of coordination, abnormal posture, muscle weakness, nausea with vomiting, stiffness to right shoulder, pain in right shoulder, and seasonal allergic rhinitis. Record review of Resident #1's health record revealed the most recent Care Plan dated 10/25/2023, page 15 of 35, stated Nutritional Status- [Resident #1] has a history of [NAME] and is at risk for (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 3 Event ID: 455901 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 455901 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Swan Health at Wichita Falls 1101 Grace St Wichita Falls, TX 76301 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)