Health inspection·March 8, 2023

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation, interview, and record review the facility failed to post the actual hours worked by the licensed and unlicensed nursing staff directly responsible for resident care and resident census on a daily basis for 3 of 3 days (03/06/23, 03/07/23, and 03/08/23) reviewed for March 2023 nursing staffing. Residents Affected - Many The facility failed to post the total number of hours worked for licensed nurses and certified nurse aides or the resident census on the staffing sheet for March 6th , 7th , and 8th of 2023. This failure could cause residents, families, and visitors to be unaware of the facility daily staffing requirements. Findings included: During an observation on 03/06/23 at 08:47 a.m., the total number of hours worked by licensed and unlicensed direct care staff and resident census was not posted on the staffing sheet. The staffing sheet was posted in the front lobby and dated 03/06/23. During an observation on 03/07/23 at 08:17 a.m., the total number of hours worked by licensed and unlicensed direct care staff and resident census was not posted on the staffing sheet. The staffing sheet was posted in the front lobby and dated 03/07/23. During an observation on 03/08/23 at 09:17 a.m., the total number of hours worked by licensed and unlicensed direct care staff and resident census was not posted on the staffing sheet. The staffing sheet was posted in the front lobby and dated 03/08/23. During an interview on 03/08/23 at 10:48 a.m., LVN D said she was the staffing coordinator and responsible for posting the staffing sheet daily. LVN D said she did not know the staffing sheets needed to include documentation of the actual staff hours worked each shift, and the resident census. LVN D said she had only worked in this positions for 3 weeks and was using the staffing sheet used by the person she replaced. LVN D said she would correct it. During an interview on 03/08/23 at 11:00 a.m., the DON said LVN D was the staffing coordinator, and she was responsible for posting the staffing sheet daily. The DON said he was unfamiliar with the posting requirements and did not know the staffing sheets needed to include documentation of the actual staff hours worked each shift, and the resident census. The DON said the staffing sheet needed to be corrected and updated with the total hours worked and resident census and would talk to LVN D about it. The DON said the staffing sheet will be updated and corrected today. (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 3 Event ID: 675142 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 675142 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Briarcliff Health Center 3403 S Vine Ave Tyler, TX 75701 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)