Health inspection·March 20, 2025

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to establish and maintain an infection prevention and control program, designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections, for one resident (Resident #1) of 1 observed for incontinent care, in that: Residents Affected - Few CNA A did not use one wipe per swipe on the buttock area during incontinent care on Resident #1. This failure could place residents at risk for infections and cross contamination. The findings included: Record review of Resident #1's Face Sheet dated 03/18/25, reflected a [AGE] year old female admitted to the facility on [DATE], with diagnoses that included nontraumatic intracerebral hemorrhage (bleeding into the substance of the brain in the absence of trauma or surgery), anoxic brain damage (damage or death of brain cells due to lack of oxygen), spastic quadriplegic cerebral palsy (a movement disorder where the muscles of all four limbs are stiff). Record review of Resident #1's Quarterly MDS dated [DATE], revealed Resident #1's cognitive status was severely impaired, she was totally dependent with two-person assistance for bed mobility, dressing, toilet use, and personal hygiene. Record review of Resident #1's Care Plan dated 01/30/25, revealed, FOCUS: o Incontinence: I Resident #1 is incontinent of bowel/bladder related to Activity Intolerance Date Initiated: 09/03/2019 Revision on: 09/03/2019 GOAL: o I Resident #1 will remain free from skin breakdown due to incontinence and brief use through next review date. Date Initiated: 09/03/2019 Revision on: 06/13/2022 Target Date: 01/28/2025 o I Resident #1 will be clean and odor free through next review date. Date Initiated: 09/03/2019 Revision on: 06/13/2022 Target Date: 01/28/2025 INTERVENTIONS/TASKS: o INCONTINENT: Check frequently for wetness and soiling, and change as needed. Date Initiated: 09/03/2019 Revision on: 06/04/2021 C.N.A. CN o Briefs or incontinence products as needed for protection. Observation on 03/20/25 at 02:10 pm, CNA A and CNA B performed incontinent care on Resident #1. During incontinent care, CNA A wiped buttock area with one wipe per swipe four times. With fifth wipe, (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: 675044 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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)