Inspection·July 7, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide the necessary services for residents who are unable to carry out activities of daily living to maintain good grooming and personal hygiene for 1 (Resident #1) of 4 residents reviewed for ADLs. Residents Affected - Few The facility failed to ensure Resident#1 had his fingernails cleaned and trimmed. This failure could place residents who were dependent on staff for ADL care at risk for loss of dignity, risk for infections, and a decreased quality of life. Findings include: A record review of Resident #1's Quarterly MDS assessment dated [DATE] reflected Resident #1 was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses included Alzheimer's disease (the most common type of dementia), and dementia (a progressive loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change, resulting from organic disease of the brain), type 2 diabetes Miletus. Resident #1 required extensive assistance of one-person with personal hygiene. A record review of Resident #1's Comprehensive Care Plan, revised 06/08/23, reflected Focus: [Resident #1] has an ADL self-care performance deficit related to Confusion, Disease Process, impaired balance. Goal: Resident will improve current level of function in SPECIFY ADLs through the review date. Interventions: PERSONAL HYGIENE/ORAL CARE: The Resident is totally dependent on (1) staff for personal hygiene and oral care. An observation on 07/07/23 at 09:59 am revealed Resident #1 was laying in his bed. His nails on both hands were approximately 0.3 centimeter in length extending from the tip of his fingers. The nails underside had a dark brown colored residue. Resident #1 was confused and unable to answer questions. Interview on 07/07/2023 at 10:43 AM, CNA K stated residents' fingernails care was provided by CNAs during the resident's' shower days. For Resident#1 shower days were Monday's, Wednesday's, Friday's, and he was due for shower today in the afternoon. She further stated Resident#1 likes to eat food with his fingers. Interview on 07/07/2023 at 10:58 AM, LVN N stated residents' nails care was provided regularly by LVNs, and CNAs during resident's' shower days or on daily basis. LVN N acknowledged Resident #1's fingernails were sharp looking, and dirty. LVN N stated she would clean and trim Resident #1's (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: 675196 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 675196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE North Park Health and Rehabilitation Center 1720 N McDonald McKinney, TX 75069 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)