Health inspection·February 11, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to ensure each resident received adequate supervision and assistance devices to prevent accidents for 1 of 6 residents (Resident #13) reviewed for accidents hazards and supervision, in that: On 01/23/2025 Resident #13 was transferred by CNA C using standing pivot transfer x 1 staff instead of a mechanical lift. During transfer Resident #13 pivoted into the chair, her leg did not pivot well, and the knee twisted and popped which later caused swelling and pain to the left knee. This failure could lead to injury or death to residents. Findings include: Record review of Resident #13's face sheet dated 02/11/2025, revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included Multiple Sclerosis (a chronic, autoimmune disease that affects the central nervous system-brain and spinal cord, Muscle Weakness (a lack of muscle strength or the inability to control voluntary muscle force), and Unspecified Abnormalities of Gait and Mobility. Record review of Resident #13's Quarterly MDS assessment, dated 01/30/2025, reflected a BIMS of 15 which suggested the resident's cognition was intact. Section G revealed Resident #13 required extensive assistance with 2 persons for transfers. The prior Quarterly MDS assessment, dated 12/28/2024, in effect at the time of the event, revealed the resident was classified as requiring substantial/maximal assistance-Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. There was no designation for 2 person assist with a mechanical lift. Record review of Resident #1's Care Plan dated 03/27/2015 and revised on 02/03/2025, revealed Resident #13 required a mechanical lift X 2 staff assist for all transfers. The previous Care Plan dated 12/6/24 did not specifically address the resident's transfer needs. Record review of the Provider Investigation Report, dated 02/05/2025, related to the facility's self-report of Resident #13's injury on 01/23/2025, revealed on 01/23/2025 at 5:15 PM, [CNA C] performed a one person standing assist, as the resident pivoted into the chair the leg did not pivot well and the knee twisted and popped. At the time the resident denied any pain. X-ray results received on 01/24/2025 were negative with no acute fractures. On 01/24/2025 the resident did not communicate any pain. On 01/25/2025 the knee was found to be visibly swollen. The resident declined pain medications. An order for prednisone for inflammation was given and referral for an Orthopedic Physician (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: 675141 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 675141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Healthcare Residence 1400 Lake Shore Dr Waco, TX 76708 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)