Health inspection·August 21, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to treat residents with respect and dignity for 1 of five (Resident #2) residents reviewed for dignity in that: The facility failed to ensure staff did not stand over Resident #2 while assisting the resident with her meal in the dining area on 08/21/2024 This failure could affect residents who require assistance with activities of daily living and placed them at risk for psychosocial harm due to a diminished quality of life. The findings were: Review of Resident #2's electronic face sheet printed 08/22/24 reflected a [AGE] year-old-female admitted on [DATE] with diagnoses including but not limited to senile degeneration of brain (cognitive decline in older people, particularly memory loss), dysphagia oropharyngeal phase (difficulty swallowing), and unspecified lack of coordination. Review of Resident #2's Quarterly MDS assessment, dated 06/09/2024 reflected the BIMS score was not completed. Review Resident #2's MDS section GG functional abilities and goals was not completed. Review of Resident #2's Care Plan revised 06/12/2024 reflected the following problems: The resident had potential for altered nutritional status regarding Dementia with interventions to include maintain adequate nutritional status and provide serve, diet as ordered and observe food intake. Review of Resident #2's physician order for diet dated 05/14/2024 revealed regular diet, pure texture. Observation and interview on 08/21/24 at 12:03 PM in the dining hall revealed LVN A was observed standing over Resident #2 and assisting her with feeding her the meal by placing food in her mouth with a utensil. There was no vacant chair. Interview with LVN A revealed she was assisting Resident #2 because she was not wanting to feed herself. LVN A stated there was no chair available which was why she decided to stand. Nurse A stated she was trying to get Resident #2 started with eating due to her putting her hands in the plate. LVN A stated Resident #2 did not normally need assistance with eating but she was not feeding herself. LVN A gave the spoon to Resident #2 and she began feeding herself. LVN A stated she was aware that she should have been sitting while assisting the resident with eating. (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 4 Event ID: 675113 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 675113 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/21/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Park IN Plano 3208 Thunderbird LN Plano, TX 75075 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)