F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or
her rights.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review the facility failed treat each resident with respect and dignity in a
manner and in an environment that promotes maintenance or enhancement of his or her quality of life,
recognizing each resident's individuality for two of five residents (Residents #5 and #7) reviewed for
treatment with respect and dignity.
CNA A and HA B stood while feeding Residents # 5 and #7.
RN C was on her phone while monitoring the dining room with residents present.
HA B was texting while feeding Resident #5.
This failure placed residents at risk of feeling embarrassed, infantilized, dehumanized, or stigmatized due to
their need for assisted dining.
Findings included:
Record review of Resident #5's admission Record, dated 6/13/25, revealed he was a [AGE] year-old male
admitted to the facility on [DATE] with diagnoses including Parkinson's Disease (progressive neurological
disorder causing tremors, stiffness, and slow movement).
Record review of Resident #5's Annual MDS Assessment, dated 3/27/25, revealed: (the updated MDS was
in progress)
He had a mental status score of 3 of 15 (indicating severe cognitive impairment),
He needed supervision while eating.
Record review of Resident #7's admission Record, dated 6/13/25, revealed he was a [AGE] year-old male
admitted to the facility on [DATE] with diagnoses including multiple sclerosis (a progressive central nervous
system disease affecting the brain and spinal cord causing muscle weakness, balance issues and cognitive
issues).
Record review of Resident #7's Quarterly MDS Assessment, dated 4/10/25, revealed:
He had a mental status score of 10 of 15 (indicating moderate cognitive impairment)
(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:
675317
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
675317
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/13/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Deerings Nursing and Rehabilitation, LP
1020 N County Rd West
Odessa, TX 79763
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)
F 0550
He needed substantial or maximal assistance with eating.
Level of Harm - Minimal harm
or potential for actual harm
Record review of Resident #7's care plan, updated 2/15/24, revealed:
Residents Affected - Few
Resident #7 had an ADL Self Care Performance Deficit. Identified interventions included: The resident
required to be fed.
Observation on 6/12/25 at beginning at 12:07 p.m. of the lunch meal revealed: there were 27 residents
present.
At 12:08 p.m. Resident #7 was served a meal of a sandwich; CNA A fed him standing up. There was a chair
immediately behind CNA A, she kicked the chair out of way when CNA walked around Resident #7 to get
extra napkins.
At 12:23 p.m., HA B stood while feeding Resident #5. HA B had no interaction with Resident #5. She held a
roll up to Resident #5's mouth while Resident #5 took bite after continuous bite. Eventually the
Administrator promoted HA B to sit. After sitting, HA B's phone went off and she held it under the table
while answering it. HA B got up and walked away from Resident #5 to answer the phone without saying a
word to him and returned.
An observation at 12:44 p.m. on 6/12/25 revealed RN C stood to the side of the room scrolling on her
phone while she was supposed to be monitoring the dining room.
Interview on 6/12/25 at 1:09 p.m. CNA A stated she worked at the facility off and on for three years, but this
was her second day back. CNA A stated she was trained to sit while feeding residents and talk to them at
eye level and talk to them so you could if there were any choking issues instead of standing like I was and
it's more comfortable for the residents. CNA A stated she usually sat while feeding residents but she just
wanted to stand on 6/12/25.
Observation on 6/12/25 at 3:23 p.m. revealed RN C behind the nurse's station scrolling on social media.
Interview on 6/12/25 at 5:01 p.m. HA B stated she was trained to feed residents sitting down. HA B did not
know the reason. HA B said the reason she stood was because it was more work to sit to feed Resident #5.
HA B said she did not talk to Resident #5 because her English was very limited.
Interview on 6/12/25 at 5:58 p.m. the DON stated her expectation for feeding residents was that aides sat
down at eye level because it was patient centered care. The DON said the staff were not to have phones
out, staff were to have all their attention on the resident. The DON stated she monitored for that when she
was in the dining room. The DON stated she told CNA A to sit down at lunch. The DON said she felt the
aides were not giving the residents the attention they needed when they were not sitting. The DON stated
giving unrestricted bites while the staff was on the phone was not ok because residents needed to be
taking one bite at a time. The DON stated nurses were responsible for monitoring for cell phone use while in
the dining room. The DON stated she had in-serviced staff on phone use and every time she caught staff
on phones she did an in-service. The DON said she did not notice RN C on the phone during lunch and
said she was not doing a good job of monitoring if she was on the phone. The DON stated nurses were
allowed to be on the phone if they were trying to get a hold of the doctor. The DON stated they were not
supposed to be on social media because that took away from their job.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675317
If continuation sheet
Page 2 of 3
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
675317
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/13/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Deerings Nursing and Rehabilitation, LP
1020 N County Rd West
Odessa, TX 79763
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)
F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Interview on 6/12/25 at 6:39 p.m. the Regional RN stated the corporate expectation was staff sit down and
assist residents who needed help eating. The Regional RN said this was supposed to be monitored by the
charge nurse and administrative staff routinely. The Regional RN stated routinely meant any time they
passed by, there was no set number of times the staff needed to check. The Regional RN said it was in the
employee handbook to not be on the phone. The Regional RN stated they told staff to step outside if they
needed to take a phone call and it was not ok to be at the table and on the phone at the same time
because it sent the message the phone was more important. The Regional RN said he would be upset if he
was the resident.
Interview on 6/13/25 at 1:11 p.m. a random resident interview stated they were the only person who noticed
staff were on their phones all the time. The resident said they were afraid to approach staff when staff were
on their phone because they did not want to interrupt the staff and ask for what the resident needed.
Record review of the facility's Guidelines for Dining Room Etiquette, undated, revealed:
Do not carry on conversations with coworkers that do not pertain to residents and their dining experience,
do not shout across the dining room or elevate your voice. Do not use a cell phone while assisting residents
in the dining room. Try to keep the dining room [NAME] and minimize noise.
If you assist residents by feeding them, make sure that you are sitting at eye level with them, not standing
over them.
Record review of the Employee Handbook, undated, revealed:
Personal Communication devices: use of personal communication devices during scheduled work hours is
not permitted at the facility.
Record review of the facility's policy and procedure on Resident's Rights, revised 11/28/16, revealed.
The resident has a right to a dignified existence, self-determination and communication with and access to
persons and services inside and outside the facility, including:
A facility must treat each resident with respect and dignity and care for each resident in a manner and in an
environment that promotes or maintenance or enhancement of his or her quality of life, recognizing each
member's individuality.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675317
If continuation sheet
Page 3 of 3