Inspection·July 11, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to immediately inform the resident; consult with the resident's physician; and notify, consistent with his or her authority, the resident representatives when there is an accident involving the resident which results in injury and has the potential for requiring physician intervention or a significant change in the resident's physical, mental, or psychosocial status for 1 (Resident #1) of 5 residents reviewed for notification. The facility failed to ensure Resident #1's resident representative was immediately notified when the resident had a change in condition that required he be transported via ambulance to the hospital. This failure could result in residents not having the comfort and company of their families during traumatic times. Findings included: Record review of Resident #1's face sheet revealed that Resident #1 was a [AGE] year-old male, who was originally admitted into the facility on [DATE], with an updated admission date of 07/01/24. Resident #1 had diagnoses that included but were not limited to: cellulitis of unspecified part of limb (common, potentially serious bacterial skin infection), repeated falls, muscle weakness, and reduced mobility. Updated diagnoses on 07/01/2024 documented encounter for other orthopedic aftercare. The admission record further revealed Resident #1's family member was his emergency contact. Record review of Resident #1's quarterly MDS completed on 05/10/24. Section C revealed a BIMS of 13 which indicated cognition was intact. Record review of Resident #1's care plan completed on 05/22/24 revealed resident was a risk for falls, with unsteady gait balance and required moderate assistance with his personal needs. Record review of Provider Investigation Report dated 06/28/24 revealed Resident #1 had an unwitnessed fall in the front lobby of the facility on 06/21/2024 which required x-rays and resulted in Resident #1 having a displaced sub capital femoral neck fracture of right hip (hip fracture). Record review of Resident #1's progress note dated 06/21/24 revealed Resident #1 left the facility by ambulance on the same day in stable condition. Record review of Resident #1's progress note dated 06/26/24 and written by LVN B revealed that an attempt to contact Resident #1's family member, regarding resident's fall and transfer to hospital (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: 675336 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 675336 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kirkland Court Health and Rehabilitation Center 1601 Kirkland Dr Amarillo, TX 79106 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)