Inspection·February 21, 2024

F 0908 Keep all essential equipment working safely. Level of Harm - Potential for minimal harm Based on observation, interview, and record review, the facility failed to maintain all mechanical, electrical, and patient care Residents Affected - Some Equipment in safe operating condition for 1 (Hot water heater) of 3 reviewed for essential equipment. The facility failed to repair or replace the hot water heater that supplied hot water for Halls 1, 2 and 3 for 7 days. This was determined to be past noncompliance because the facility took corrective actions prior to surveyor entry. This failure could place residents at risk for poor hygiene and health. Findings include: During an interview on 2/21/24 at 10:10am with the facility Administrator, Administrator stated on 1/31/24 the hot water heater which supplied hot water to Hall 1, 2 and 3 stopped working. The Administrator stated local plumbing was contacted. The blower motor on the water heater had failed and ordered a new blower. On 2/6/24 the blower motor was replaced by and hot water was restored to Halls 1, 2 and 3. The Administrator stated between 1/31/24 to 2/6/24 resident in Halls 1, 2, and 3 were able to take showers in rooms in Halls 4, 5 and 6. The Administrator stated residents residing in Halls 1, 2, and 3 were informed that showers will be taken in the Hall 4, 5 or 6 until repairs are made. The Administrator stated no showers for residents living in Halls 1, 2 and 3 were missed. During and interview on 2/21/24 at 10:34am, the Maintenance Director stated the hot water heater for Halls 1,2 and 3 went down on 1/31/24. The Maintenance Director stated he called immediately, and they arrived that day, 1/31/24. A Heater blower was needed, and the plumber ordered the part. Repairs were made on 2/6/24. Observation on 2/21/24 at 11:00am revealed hot water was being supplied to Halls 1, 2 and 3. Record review of invoices from revealed invoice 42671 dated 1/31/24 that blower was ordered and invoice #42656 dated 2/7/24 revealed replacement of blower on 2/6/24. During an interview on 2/21/24 at 1:54pm, Resident #3 stated that facility informed Resident #3 (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: 455931 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 455931 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Vernon 4401 College Dr Vernon, TX 76384 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)