Health inspection·March 8, 2024

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to provide treatment and services to prevent complications of enteral feeding for 1 (Residents #1) of 4 residents reviewed for tube feeding management. The facility failed to ensure Resident #1's Piston syringe for G tube flushing was changed daily. (A piston syringe is a small, cylindrical piece that fits inside the barrel of a syringe. It is typically made of plastic or metal and moves back and forth within the barrel to draw in or expel fluids for tube feedings.) These failures could place residents at risk un-sanitized treatment and infections. Findings included : Record review of Resident #1's face sheet dated 03/08/24 reflected a [AGE] year-old male admitted on [DATE] with dx dysphagia, oropharyngeal phase dysphagia (the inability to empty material from the esophagus i.e. stomach) following cerebral infarction. Record review of Resident #1's quarterly MDS assessment dated [DATE] reflected a BIMS score of 3 indicating he was severely impaired cognitively. Section K enteral feeding list. Record review of Resident #1's Care plan dated 01/12/24 reflected Will remain free of side effects or complications related to tube feeding through review date . Flush g-tube with 30-50 ml of water before and after medication administration flush tubing with 5ml-10ml water between each medication administration. Record review of Resident #1's Physician orders report dated 03/08/24 reflected, .Enteral Feed every shift rinse syringe after each use Enteral Feed .Enteral feed every shift change syringe. An observation on 03/07/24 at 08:45 AM revealed a piston syringe on the bed side table dated 03/05/24. Resident #1 was not interviewable. In an interview with DON on 03/07/24 at 9:31 AM she stated the piston syringe should be changed every shift. The nurses were expected to check the date and condition of the resident's Piston syringe during rounds to assure equipment for treatment was performed. In the event the syringe was not changed and dated, she expected the nurse to change and date the new one. The residents could get infections when syringes aren't changed daily or as needed. (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: 675111 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 675111 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Gardens Rehabilitation and Healthcare 2135 N Denton Dr Carrollton, TX 75006 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)