Health inspection·July 30, 2025

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to coordinate the PASRR assessment for specialized services for 1 of 3 residents (Resident #1) reviewed for PASRR coordination and assessment. The facility failed to submit a NFSS request for nursing facility specialized services in the LTC Online Portal for Resident #1's specialized services by a specific deadline. This failure could place residents with intellectual and developmental disabilities at risk for not receiving specialized PASRR services which could contribute to a decline in physical, mental, psychosocial well-being and quality of life. Finding included: Record review of Resident #1's electronic face sheet dated 07/30/25 reflected he was a [AGE] year-old male, admitted to the facility on [DATE] and readmitted of 12/29/23. His diagnoses included Cerebral palsy, dementia, unspecified severity, psychotic disturbance, mood disturbance, and anxiety, schizoaffective disorder, bipolar disorder (A serious mental illness characterized by extreme mood swings). Essential hypertension (High Blood pressure), Muscle wasting and atrophy, Contracture, right knee, Contracture, left knee, and other lack of coordination., Record review of Resident #1's Annual MDS assessment dated [DATE] reflected Resident #1 was positive for serious mental illness, intellectual disability and other related condition. His cognitive patterns (BIMs) were coded as 9 out of possible 15, which reflected he was moderately impaired on cognition. Record review of Resident #1's care plan updated 05/18/23 with a start date of 05/03/25 reflected Resident #1 has been identified as PASRR Level II related to DX of: ID, Cerebral Palsy and Schizoaffective disorder, and Bipolar type. He will receive additional services through the State PASRR program at this time. Goal Resident will receive all specialized services related to positive PASRR through the next 92 days target date of 05/27/23.Record review of Resident #1's PASRR Comprehensive service plan dated 01/24/25 revealed there was a recommendation for a new custom wheelchair with positioning wedge. All specialized services were agreed on by the IDT team. Review of the Simple LTC-portal history spread sheet dated 04/11/25, reflected the NFSS form was not completed and submitted for customized wheelchair with wedge to PASRR office.During an interview with the MDS coordinator on 07/30/25 at 12:55PM, she said the therapy department usually completed the NFSS form. She said she does not do the NFSS forms.During an interview on 07/30/25 at 1:00PM, the Rehabilitation Director said she submitted the NFSS late because she had hard time getting Resident #1's Physician sign the necessary paperwork. She said the customized wheelchair was provided to Resident #1 about a month ago. She said the NFSS forms had been sent out as requested. She acknowledged that the NFSS was submitted late. During an interview on 07/30/25 at 2:00PM, the Administrator she said she remembered receiving an e-mail for PASRR office but might have overlooked it and would check again. Record review of the facility Provided policy did not address who was responsible for NFSS and time frame for submission.Record review of Facility provided policy titled Social Services, Policies and Procedure: subject: PASARR documentation policy indicated . PASARR CARE PLAN:3. Facility Nursing staff are trained in the Page 1 of 2 675214 675214 07/30/2025 Solidago Health and Rehabilitation 1720 N Logan St Texas City, TX 77590

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few roles and responsibilities to ensure the specializedservices are provided.4. Referrals/Notification of Significant Change:A. Facility staff will refer Level II residents and residents with newly evident or potentiallyserious mental disorder, intellectual disability, or a related condition for Level IIResident Review, upon a significant change in status assessment to the local MD or MI agency.5. The facility must notify the state-designated mental health or intellectual disability authoritypromptly when a resident with MD or ID experiences a significant change in mental or physical status.6. Any resident with newly evident or possible serious mental disorder, ID or a related conditionmust be referred, by the facility to the appropriate state-designated mental health or intellectual disability authority for review.Examples of individuals who may not have previously been identified by PASARR to have MD, ID ora related condition include NOTE: this is not an exhaustive list. (RAI Manual) A resident who exhibits behavioral, psychiatric, or mood related symptoms suggesting thepresence of a mental disorder (where dementia is not the primary diagnosis). A resident whose intellectual disability or related condition was not previously identified andevaluated through PASARR. A resident transferred, admitted , or readmitted to a NF following an inpatient psychiatric stayor equally intensive treatment. 675214 Page 2 of 2