Inspection·September 27, 2023

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to implement written policies and procedures to prohibit and prevent abuse and neglect for 1 of 4 staff (CNA-B) reviewed for background screenings. Residents Affected - Few The facility failed to provide evidence of completion of an annual EMR for CNA-B. These deficient practices could place residents at risk for abuse and neglect. The findings were: Review of the personnel file for CNA-B with a hire date of 06/06/2022 revealed last EMR was verified on 06/03/2022. During an interview on 09/26/2023 at 10:27 a.m., ADMN stated that EMR's were not verified. He was not aware the facility was supposed to verify EMRs yearly until new company took over the first of September. The failure was that EMR verification did not occur. ADMN stated that the affect on residents would be that not completing annual EMR's could result in staff working in the building that should not be allowed to work. Review of Human Resources Policy and Procedures Manual titled HR-103 TEXAS Background Screening Procedures Effective Date: 4-27-2021 - Supersedes all previous policies on 09/26/2023 revealed Texas Health and Human Services (HHSC) Employability Status Check i. https://emr.dads.state.tx.us/DadsEMRWeb/emrRegistrySearch.jsp ii. This verifies the following information iii. Misconduct Registry iv. CNA Certification (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: 675350 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 675350 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Willowcreek Rehab and Nursing 4934 S 7th St Abilene, TX 79605 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)