Health inspection·August 2, 2023

F 0755 07/13/23 AM Schedule: Resident Refused Level of Harm - Minimal harm or potential for actual harm 07/14/23 AM Schedule: Resident Refused 07/17/23 AM Schedule: Resident Refused Residents Affected - Few 07/18/23 AM Schedule: Resident Refused 07/19/23 AM Schedule: Resident Refused 07/21/23 AM Schedule: Resident Refused 07/24/23 AM Schedule: Resident Refused 07/25/23 AM Schedule: Resident Refused 07/26/23 AM Schedule: Resident Refused 07/27/23 AM Schedule: Resident Refused 07/28/23 AM Schedule: Resident Refused 07/31/23 AM Schedule: Resident Refused Interview with LVN O on 08/01/23 at 11:05 AM revealed she was the hall nurse for Resident #1. She stated the resident often refused a shower, but she was unaware the resident was refusing to take his medication because the Medication Aide did not advise her of this. She stated if a resident refused medication, the Medication Aide must notify the Hall nurse so that she can notify the physician, Responsible party, and attempt to persuade the resident into taking his medication. She advised the risk of the resident not taking his medication when scheduled could result in him having health complications. Interview with MA J on 08/02/23 at 11:15 AM revealed, She stated she had been at the facility for almost a year. She stated the resident refused medication since she had been there, and she stated she had told a nurse about him not taking medication and the last time when she told her nurse was in May 2023. She stated she mentioned it a lot before but stopped doing so because she thought it was care planned. She advised she could not remember who she had spoken with. She stated the risk to the resident not taking his medication is possible increase in his blood pressure and causing a heart attack or stroke. She was asked the process if a resident refuses medication, was that they had to notify the nurse. Interview with ADON on 08/01/23 at 11:20 AM revealed she was advised by the 100 Hall Nurse of the concerns regarding Resident #1's refusal of medication and it not being reported by the Medication Aide. She advised that staff are required to report to their Hall nurse anytime a resident refuses their medication. The ADON advised that this was the first-time hearing of the resident refusing to take medication. She advised the risk of residents not taking their medication when scheduled could result in the resident having a serious illness as a result of not taking the medication. She stated that the Medication Aide should have notified her nurse so that other attempts could be made to encourage the resident into taking the medication and they could also notify the Responsible party and his (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675033 If continuation sheet Page 2 of 3 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 675033 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Tree Nursing Center 434 Paza Dr Mesquite, TX 75149 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)

F 0755 physician. Level of Harm - Minimal harm or potential for actual harm Interview with Administrator of 08/01/23 at 11:30 AM revealed she was present when the ADON was advised of Resident #1 refusing to take his medication throughout the month of July 2023. The Administrator advised that anytime a resident refused medication, the Medication Aide must notify their Hall nurse every time a resident refused medication because the Resident had a good rapport with some of the staff and someone could have convinced him into taking his medication. She advised the risk of the resident not getting his medication could result in him having increased health issues, especially if it involved medication to treat illnesses such as diabetes and high blood pressure. The Administrator advised that she did some research and found that the resident was refusing his evening medication but taking his morning medications. She advised that she spoke with the Resident's physician and was advised that the blood pressure medication would be changed to the mornings, since the resident appeared more willing to take his medication in the mornings and for all other medications that are required to be taken at night, they will use interventions to encourage the resident to take his scheduled medication. Residents Affected - Few Review of the Facility's policy on Medication - Treatment Administration and Documentation dated 02/10/20 revealed, Circle initials for medication or treatment that were not administered and document reason for the non-administration on the back of the MAR or TAR. Review each MAR and TAR after each medication and treatment administration is completed and prior to the end of the shift to validate documentation is completed and supports services provided accorded to physician orders. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675033 If continuation sheet Page 3 of 3