Inspection·March 21, 2025

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to promote and facilitate resident self-determination through support of resident choice to including but not limited to the residents right to make choices about aspects of his or her life in the facility that are significant to the resident, healthcare and providers of healthcare services consistent with his or her interest, assessments, and plan of care and other applicable provisions of this part for 1 (Resident #4) of 8 residents reviewed for resident rights. The facility failed to honor Resident #4's request to be assisted to shower on Saturdays. This failure could place residents at risk for lack of choices/decision making resulting in depression, and diminished quality of life. Findings included: Record review of Resident #4's face sheet dated 03/20/2025 revealed a [AGE] year-old admitted to the facility on [DATE] and latest re-admission date of 02/28/2025. His diagnoses included Alzheimer's disease (a progressive brain disorder that slowly destroys memory and eventually the ability to carry out simple tasks)Parkinson's disease (a nervous system disorder), diabetes, Metabolic encephalopathy (a change in how the brain works due to an underlying condition), dementia, polyneuropathy (peripheral nerve disease) and history of fungal infection of the skin and nails. Record review of Resident #4's Quarterly MDS assessment dated [DATE] revealed a BIMS score of 12 out of 15 indicating moderate cognitive impairment. He had no rejection of care. He was feeling down, depressed, or hopeless for several days over a two-week period. He had functional limitations in range of motion to one side of lower extremity. He used a wheelchair for mobility. He required partial/moderate assistance from staff with showering self. He required supervision for personal hygiene and upper body dressing and substantial assistance with lower body dressing. He was always incontinent of bowel and bladder. Record review of Resident #4's undated care plan included Problem: the following tasks will be documented in POC (Point of Care) assist. Problem start date was 01/15/2025. -Goal: the resident will perform the following tasks at their highest practicable level. Target date was 05/28/2025. - Approach included: I prefer to take my bath/shower on Tuesday, Thursday, and Saturday. Last reviewed/revised on 3/04/2025. Problem: Resident #4 had refusals of ADL incontinent care, baths/showers, changing clothes and taking medications. Problem start date was 07/03/2023. Goal: maintain skin integrity issue. Target date was 05/28/2025. Approach included: educate as needed, explain benefits, explain risk, (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 7 Event ID: 675229 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 675229 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodland Manor Nursing and Rehabilitation 99 Rigby Owen Rd Conroe, TX 77304 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)