Health inspection·March 4, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 based on the comprehensive assessment of a resident, that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for one of three residents (Resident #1) reviewed for quality of care. Residents Affected - Few The facility failed to ensure Resident #1 had a physician's order for suctioning, and order for monitoring for secretions, or an order for when to replace the suction machine's cannister and tubing. This deficient practice could place residents at risk of aspiration, aspiration pneumonia, or hospitalization. Findings Included: Review of Resident #1's undated face sheet reflected a [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses including aspiration (inhaling something into your airway) of fluid as the cause of abnormal reaction, cerebral infarction (stroke), anoxic (lack of oxygen) brain injury, dysphagia (difficulty in swallowing), and hypoxemia (abnormally low level of oxygen in the blood). Review of Resident #1's annual MDS assessment, dated 02/20/25, reflected a BIMS score of 99, indicating he was unable to complete the interview. Section K (Swallowing/Nutritional Status) reflected he had a feeding tube. Section O (Special Treatments, Procedures, and Programs) reflected he did not require suctioning as a respiratory treatment. Review of Resident #1's quarterly care plan, revised 01/28/25, reflected he was dependent on tube feeding/inadequate oral intake due to dysphagia and NPO with an intervention of providing oral care daily or PRN. Review of Resident #1's physician orders in his EMR, on 03/04/25, reflected no orders for suctioning, monitoring for secretions, or when to replace the suction machine's cannister or tubing. Review of Resident #1's physician order, dated 07/16/24, reflected provide oral care every shift. Review of Resident #1's hospital records, dated 02/21/25 - 02/24/25, reflected the following: . admitted with altered mental status and hypoxia. [Resident #1] has a history of recurrent aspiration pneumonia. [Resident #1] was admitted to the floor and started on IV antibiotics . (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: 675053 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 675053 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chisolm Trail Nursing and Rehabilitation Center 107 N Medina Lockhart, TX 78644 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)