Inspection·November 17, 2025

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to maintain medical records on each resident that are accurately documented for 1 (Resident #1) of 9 residents reviewed for resident records.Resident #1's Medication Administration Record showed medications were administered on 11/6/25 and 11/8/25 after Resident #1 left the faciity on [DATE]. The failure could place residents at risk of an inaccurate medical record.Findings include:Record review of Resident #1's face sheet dated 11/17/25, revealed the resident was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses including Unspecified Sequelae of Cerebral Infarction (Stroke).Record review of Resident #1's admission MDS dated [DATE], section C revealed a BIMS score of 13 that indicated cognition was intact. Section N revealed Resident #1 was taking an antidepressant and an anticoagulant. Record review of Resident #1's nursing progress note dated 11/3/25 at 6:26 p.m. written by LVN A revealed Resident Out of facility with family. Record review of Resident #1's nursing progress notes 10/23/2025 to 11/10/2025 revealed no notes regarding Resident #1 returning to the facility after leaving on 11/3/25. Record review of Resident #1's physician orders revealed orders for Cholecalciferol 1000 units, Isoniazid 300 mg, Aspirin 81 mg, Cyanocobalamin 1000 mcg, Ezetimibe 10 mg, Isoniazid 300 mg, Metoprolol Succinate ER 50 mg, Pyridoxine 50 mg, Brimonidine Tartrate, Polyethylene Glycol 3350 Oral Powder 1 scoop, Sennosides 8.6 mg, Polyethylene Glycol 3350 Oral Powder, Sennosides 8.6 mg, Latanoprost Ophthalmic Solution 0.005%, Pravastatin 20 mg and Trazodone 50 mg 0.5 tablet. Record review of Resident #1's November 2025 MAR revealed the following:MA A documented the following medications were administered: 11/06/25 at 8:00a.m.*Cholecalciferol 1000 units 11/06/25 at 9:00 a.m.*Aspirin 81 mg *Cyanocobalamin 1000 mcg, *Ezetimibe 10 mg *Isoniazid 300 mg *Metoprolol Succinate ER 50 mg, *Pyridoxine 50 mg, *Polyethylene Glycol 3350 Oral Powder, *Sennosides 8.6 mg*Brimonidine Tartrate11/06/25 at 1:00p.m.*Brimonidine Tartrate. MA B documented the following medications that were administered: 11/08/25 at 8:00a.m.*Aspirin 81, *Cyanocobalamin 1000 mcg, *Ezetimibe 10 mg, Isoniazid 300 mg, *Metoprolol Succinate ER 50 mg, *Pyridoxine 50 mg, *Brimonidine Tartrate *Polyethylene Glycol 3350 Oral Powder*Sennosides 8.6 mg11/08/25 at 1:00p.m.*Brimonidine Tartrate11/08/25 at 5:00p.m.*Brimonidine Tartrate*Polyethylene Glycol 3350 Oral Powder *Sennosides 8.6 mg 11/08/05 at 6p.m.*Latanoprost Ophthalmic Solution 0.005% was administered 11/08/25 at 8:00p.m.* Pravastatin *Trazodone 50 mg 0.5 tabletDuring interview on 11/12/25 at 10:46 a.m., Resident #1's family member said Resident #1 was picked up from the facility on 11/3/25 and did not return to the facility. During interview on 11/13/25 at 2:24 p.m., LVN B said Resident #1 left the faciity on a pass with a family member on 11/3/25 around shift change which was 6 p.m. and did not return to the facility. During interview on 11/17/25 at 9:46 a.m., MA A said they would not know if a resident was not at the facility until they asked the nurse and that residents were never taken out of the electronic medical system. MA A said they could not remember if Resident #1 was at the facility on 11/6/25 when they documented that (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 2 Event ID: 675321 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 675321 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at Faith Memorial 811 Garner Rd Pasadena, TX 77502 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)