Health inspection·May 22, 2025

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure residents have the right to formulate an advance directive and determine the choice to receive or not receive CPR (cardiopulmonary resuscitation) for 1 of 8 residents (Resident #66) reviewed for advanced directives in that: 1. Resident #66 did not have his code status documented in the electronic record. This deficient practice could all residents as they may change their code status while being a resident at this facility. Findings: Review of Resident #66's face sheet dated [DATE] revealed he was admitted into the facility on [DATE] and readmitted on [DATE] with diagnoses including Acute respiratory failure, Chronic Obstructive Pulmonary Disease (COPD), Acute on chronic diastolic (congestive) heart failure, and Asymptomatic Human Immunodeficiency Virus (HIV) Infection. Resident is [AGE] years old. Record review of Resident #66's Electronic Medical Record (EMR) Point Click Care (PCC) revealed the Code Status was blank. Review of Resident #66's care plan revealed full code status. Interview on [DATE] at 11:45am with DON revealed the following. When asked how they would find the code status of a resident, DON stated they check the medical record tab at the top of the resident's EMR in PCC. Also, can check the code status book. If there's nothing there, he would be considered a full code. Stated the nurse or social worker places the code status into the chart during admission. DON logged on to PCC to look up Resident #66 code status. Stated it was not listed on his chart. Stated he was recently readmitted to this building from the hospital. Stated code status is for staff to know how to deal with residents appropriately in the event they stop breathing. DON informs SW that Resident #66 was missing a code status in PCC. Interview on [DATE] at 11:55am with SW revealed the following. When asked who puts the code status into the resident's chart, SW stated usually herself unless the resident comes in on the weekend, then the nurse who admits the resident will place it into the chart. Stated code status is used so the nurses will know what to do in the event of a code. They also have a code status book at the (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: 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 05/22/2025 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)