Health inspection·July 10, 2023

F 0641 Ensure each resident receives an accurate assessment. 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 ensure assessments accurately reflected the each resident's status for 2 of 6 residents (Resident #2 and Resident #6) reviewed for accuracy of assessment . Residents Affected - Few The facility failed to ensure Resident #2 and Resident #6's MDS assessment correctly noted their behaviors. This failure could place residents at risk for not receiving care and services to meet their needs. Findings include: 1. A record review of Resident #2's face sheet, dated 07/06/23, reflected a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #2's had diagnoses which included Chronic Diastolic Congestive heart failure (a condition where the lower left chamber of the heart is not able to fill properly with blood during the diastolic phase, reducing the amount of blood pumped out to the body), Schizophrenia (delusions (false beliefs), hallucinations (seeing or hearing things that don't exist), unusual physical behavior, and disorganized thinking and speech and Type 2 diabetes (a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel). Resident #2 was discharged to the hospital on [DATE]. A record review of Resident #2's admisson MDS , section E, dated 06/26/23, revealed no behaviors were exhibited in the 7-day look-back period. No behavior of rejection of care had occurred during that time. A record review of Resident #2 care plan, last revised on 06/20/23, revealed he required secure unit placement related to being an elopement risk. Resident #2 had poor impulse control, on 06/19/23. Resident #2 made a sexual comment to the aide and yelled loudly. On 06/20/23 Resident #2 refused incontinent care. The interventions included educating the resident regarding the outcome of not complying. Give Resident #2 a clear explanation of care activities and encourage Resident #2 to make his own choices and remain independent during care. 2. A record review of Resident #6's face sheet, dated 07/10/23, reflected an [AGE] year-old female who was admitted to the facility on [DATE]. Her diagnoses included Dementia (a group of symptoms affecting memory, thinking, and social abilities severely enough to interfere with your daily life), Delusional disorder, and Major depressive disorder . Resident #2 was located on the facility's secure unit. A record review of Resident #6's quarterly MDS, dated [DATE], revealed section E, for behaviors, (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: 675032 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 675032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedar Hill Healthcare Center 230 S Clark Rd Cedar Hill, TX 75104 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)