Health inspection·June 17, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility staff failed to ensure residents received treatment and care in accordance with professional standards of practice, the comprehensive care plan, and the residents' choices for 1 resident of 17 residents (CR #1) reviewed for quality of care. Residents Affected - Some The facilities failure to assess CR#1 after she complained of pain during peri care at 5:00am on 06/06/24 but was not sent to the hospital until 06/07/24 at 12:06am which was over 18hours later. After being admitted into the hospital CR#1 was diagnosed with intertrochanteric fracture of the right femoral neck of indeterminate age. On 06/10/2024 at 3:46 p.m. an Immediate Jeopardy (IJ) was identified. While the IJ was removed on 06/14/2024, the facility remained out of compliance at a scope of pattern with the potential for more than minimal harm that was not immediate jeopardy, due to the facility continuing to monitor the implementation and effectiveness of their Plan of Removal. These failures placed residents who experience falls with injuries at risk of further injury, pain and delayed medical treatment. Findings include: Record review of CR#1 face sheet on 06/07/23 at 8:30pm revealed that she was an [AGE] year-old female that was originally admitted into the facility on [DATE]. She had diagnoses of cognitive communication deficit, contracture of muscle left ankle and foot, aneurysm of carotid artery (a bulge in the wall of one of these arteries), constipation, hemiplegia (one-sided muscle paralysis or weakness), hemiparesis (weakness or the inability to move on one side of the body), and insomnia. Record review of CR#1's Quarterly MDS, dated [DATE] revealed CR #1's BIMS score was determined to be 14 due to limited cognitive impairment. The MDS completed by the staff, which indicated CR#1 did not exhibit behavioral symptoms of wandering and required supervision. CR#1 was bed bound and must be encouraged to participate in activities as well as bathing. CR#1 was one-person physical assist for ADLs, but two- person assist when transferring. Record review of CR #1's care plan dated 05/30/24revealed that CR#1 had impaired visual functioning and was at risk for a decrease in ADLs and Injuries. CR#1's contractures did not affect the possibility of being able to perform her ADL's according to her cognitive and physical abilities. CR#1 had a splint in the past that she refused to wear and low motivation to participate with ADL care. Focus: I have an ADL self-care performance deficit r/t Left sided paralysis along with contracture (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 10 Event ID: 675127 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 675127 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Humble 93 Isaacks Rd Humble, TX 77338 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)