Health inspection·April 9, 2023

F 0637 Assess the resident when there is a significant change in condition Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to complete a comprehensive assessment within 14 days after a significant change in the physical condition for 1 of 3 residents (Residents #1) whose records were reviewed for assessments. Residents Affected - Few The facility failed to recognize and assess Resident #1 after a significant weight loss and pressure ulcers were identified. This failure placed residents at risk for not being assessed for a change in condition and the need to revise their care plans to address changes in condition and develop interventions to meet their needs for care assistance and treatments. The findings included: Review of Resident #1's Face Sheet generated 4/09/2023, reflected Resident #1 was a [AGE] year-old female who was initially admitted to the facility on [DATE]. The resident had the following diagnosis: Aftercare following joint replacement surgery, other disorders of bone density and structure and age-related cognitive decline. Review of Resident #1's Nursing Notes noted the following: 1) On 3/16/2023 at 6:56 AM- During brief change and peri care resident states to be careful as she has a tear down there. Assessment performed noted 2 ulcers to the left inner groin area where foley catheter wraps under leg. Foley repositioned; wound care performed. Admin notified to notify Dr. and DON. 2) On 3/18/2023 at 4:56 PM- Resident has dark purple areas to sacrum related to resident having edema and not changing position frequently enough to circulation area. Dark purple area with red wound edges not open but tissue is delicate. Unable to determine depth and a suspected DTI from sheering and pressure and edema. Resident will be turning reposition every two hours around the clock by staff with pillows to support position. 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 3 Event ID: 675021 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 675021 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Electra Healthcare Center 511 S Bailey St Electra, TX 76360 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)