Health inspection·March 4, 2024

F 0551 Give the resident's representative the ability to exercise the resident's rights. 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 allow the resident representative the right to exercise the resident's rights to the extent those rights were delegated to the representative for 1 of 1 resident (Resident #1) reviewed for resident rights. Residents Affected - Few The facility failed to provide Resident #1's medical records, when Resident #1's POA requested them on 02/07/24. This failure could place residents at risk of not having their preferred responsible party represent them in care decisions. The findings included: A record review of Resident #1's electronic Facesheet, dated 02/21/24, indicated Resident #1 was a [AGE] year-old male, who admitted to the facility on [DATE] with diagnoses which included pressure ulcer of sacral region, other chronic pain, non-pressure chronic ulcer, arthritis, muscle weakness, lack of coordination, and repeated falls. A record review of Resident #1's Quarterly MDS, dated [DATE], reflected Resident #1 had a BIMS score of 10, which indicated his cognition was moderately impaired. A record review of Resident #1's Care Plan, revised 12/04/23, reflected Resident #1 was in the facility for long-term care placement as a result of a continued need for the services of skilled nursing staff as evidenced by an inability to provide selfcare and discharge planning is not needed. Either the family or the resident has requested that questions regarding return to the community only be asked on comprehensive assessments. The goals for this concern included Resident and families wishes will be honored through next review date and the interventions included Observe for change in conditions that may affect long-term care goals and notify the physician and responsible party as needed. In an interview on 02/23/24 at 2:02 PM, Resident #1's POA stated on 02/07/23 she was in the BOM's office and requested Resident #1's medical records. The POA stated the BOM told her she would need to request the records from the MRC. She stated the MRC passed by the BOM office and the BOM told the MRC that she had requested the records. The POA stated the MRC said ok and rolled her eyes. She stated she went to speak to the ADMN about the incident and the ADMN told her it was a process to get the records and could take 3 days. The POA stated the ADMN told her once the request was made, she had to send it to corporate and wait for approval before they could provide the medial records. The POA stated she still had not received the records. She stated she was the POA for Resident #1 and there was no reason she should not have received the records. The POA stated she was at the facility 2-3 (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: 455996 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 455996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Renaissance at Kessler Park 2428 Bahama Dr Dallas, TX 75211 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)