Health inspection·November 6, 2024

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, and record review, the facility failed to develop and implement a baseline care plan within 48 hours for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care for 1 (Resident #1) of 5 residents reviewed for baseline care plans. The facility failed to complete a baseline care plan within 48 hours of admission for Resident #1. This failure could place newly admitted residents at risk for not receiving the necessary care and services needed. The findings included: Record review of the face sheet, dated 11/06/2024, revealed Resident #1 was a [AGE] year-old female who admitted to the facility on [DATE] with the following diagnoses: vascular dementia (memory loss caused by impaired blood supply to the brain), unspecified sequelae of cerebral infarction (alteration of sensation following stroke), receptive-expressive language disorder (difficulty understanding and expressing self through language), type 2 diabetes mellitus (uncontrolled blood sugar), hypertension (elevated blood pressure), Crohn's Disease (bowel disease affecting the lining of the digestive tract). Record review of Resident #1's initial MDS, dated [DATE] revealed a BIMS score of 99, indicating the resident was unable to complete the interview. Section GG - Functional Abilities and Goals - admission revealed Resident #1 was independent with eating and transfers, required partial/moderate assistance to shower/bathe self and required supervision or touching assistance with tub/shower transfers, dressing and personal hygiene. 11/05/2024 Record review of Resident #1's electronic medical record revealed no baseline care plan. During an interview on 11/05/24 at 3:17 PM with the ADON/MDS-Care Plan Nurse, she stated each resident should have a baseline care plan in place within 48 hours of admission to the facility. She stated the DON and ADON were responsible for assuring baseline care plans were being completed. She stated the charge nurse was responsible for entering resident information into the baseline care plan during the admission process. The ADON stated the facility had been having issues with their electronic health system failing to prompt nurses to initiate the baseline care plan. She stated, we knew this was a problem and have been trying to fix it. She stated a potential negative outcome for failure to implement a baseline care plan was that it could lead to problems such as falls, or elopement (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 5 Event ID: 675291 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 675291 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crosbyton Nursing and Rehabilitation Center 222 N Farmer Crosbyton, TX 79322 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)