Health inspection·August 7, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to develop and implement a comprehensive, person-centered care plan for each resident that included measurable objectives and time frames to meet, attain, and/or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 6 of 6 residents (Residents #3, Resident #10, Resident #16, Resident #17, Resident #25, and Resident #30) reviewed for care plans. 1.The facility failed when Resident #3 did not have a comprehensive care plan dated 05/13/2025 that included measurable goals related to therapeutic diet, PASRR positive status, medication use, risk for seizures and contractures, or food intake. 2.The facility failed when Resident #10 did not have a comprehensive care plan dated 07/29/2025 that included measurable goals related to nutritional needs, roommate, PASRR status, communication, medication use, falls, pain and altered comfort. 3.The facility failed when Resident #16 did not have a comprehensive care plan dated 07/29/2025 that included measurable goals related to behaviors, medication use, and antipsychotic medications. 4.The facility failed when Resident #17 did not have a comprehensive care plan dated 06/17/2025 that addressed physician ordered fluid restrictions. 5.The facility failed when Resident #25 did not have a comprehensive care plan dated 06/17/2025 that included measurable goals related to pain management, physical functioning, medication use, and nutrition. 6.The facility failed when Resident #30 did not have a comprehensive care plan dated 07/29/2025 that included measurable goals related to physical functioning, medication use, falls, edema, and hospice care. This failure could affect residents by placing them at risk of not receiving individualized care and services to achieve their goals.The findings included the following: 1. Review of Resident #3's Resident Face Sheet, dated 08/05/25, revealed he was a [AGE] year-old male admitted to the facility on [DATE] with medical diagnoses including cerebral palsy, anxiety, epilepsy, major depressive disorder, history of falls, edema, weakness, urinary tract infection, depression, and problems with swallowing. Review of Resident #3's Annual MDS Assessment, dated 04/12/2025 Section C Cognitive Patterns, subsection C0500 BIMS Summary Score revealed he had a BIMS score of 3 out of 15, indicating severe cognitive impairment. Review of Resident #3's Comprehensive Care plan reviewed/revised 05/13/2025 revealed the following: Focus: [Resident] is receiving a therapeutic or altered consistency diet and is at risk for nutritional impairment. Goal: [Resident] will have adequate fluid intake . Focus: Resident has been identified as having PASRR positive status related to an intellectual disability/developmental disability. Goal: Resident will maintain his/her highest level of practicable wellbeing . Focus: Black Box warning: This medication/s has a black box warning, the strongest warning mandated by the FDA, which indicates a need to closely evaluate and monitor the potential benefits and risks of the medication. Black box warning sign due to drug use of Furosemide (diuretic or water pill), Tramadol (opioid pain medication), Linzess (used to treat irritable bowel syndrome), Depakote 9anticonvulsant), Citalopram (antidepressant), Seroquel (antipsychotic), Lorazepam (antianxiety), IBU Page 1 of 4 675377 675377 08/07/2025 Bangs Nursing and Rehabilitation 1105 Fitzgerald Bangs, TX 76823

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some (non-steroidal anti-inflammatory). Goal: Facility to educate him/her/representative about the risk and benefits of drug and safety measures will be maintained to prevent or lessen any adverse reactions or injury from the drug use. Focus: [Resident] has Dx of Cerebral Palsy and is at risk for seizure activity and worsening of contractures. Goal: [Resident] will be able to function at the fullest potential possible . Focus: Potential for altered comfort r/t GERD. Goal: Resident will maintain adequate intake . Goals: continued review of Resident #3's comprehensive care plan dated 05/13/2025 did not included measurable goals related to therapeutic diet, PASRR positive status, medication use, risk for seizures and contractures, or food intake. 2. Review of Resident #10's Resident Face Sheet, dated 08/05/2025, revealed she was a [AGE] year-old female admitted to the facility on [DATE] with medical diagnoses including anxiety, epilepsy, quadriplegia, malnutrition, difficulty swallowing, intellectual disabilities, weakness, repeated falls, impulse disorder, incontinence of bowel and bladder, inability to speak, contracture of both hands, and a vitamin deficiency. Review of Resident #10's Quarterly MDS Assessment, dated 07/22/2025 revealed she had a BIMS score of 00 out of 15, indicating severe cognitive impairment. Review of Resident #10's Comprehensive Care Plan reviewed/revised 07/29/2025 revealed the following: Focus: [Resident] is receiving a therapeutic or altered consistency diet and is at risk for nutritional impairment. Goal: [Resident] will have adequate fluid intake . Focus: Per responsible party may room with life long room mate. Goal: Provide privacy for all ADLs initiated 07/25/2022. Focus: Resident has been identified as having PASRR positive status related to an intellectual disability/developmental disability. Goal: Resident will maintain his/her highest level of practicable wellbeing . Focus: [Resident] has a communication problem r/t Profound Intellectual Disabilities. Dx of aphasia. Rarely understood/Rarely understands. Goal: [Resident's] needs will be anticipated and met through nursing judgement . Focus: Black Box warning: This medication/s has a black box warning, the strongest warning mandated by the FDA, which indicates a need to closely evaluate and monitor the potential benefits and risks of the medication. Black box warning sign due to drug use of montelukast (used to treat asthma), linzess, IBU, depakene (used to treat seizures), carbamazepine (anticonvulsant), clonazepam (antianxiety/antiseizure), medroxyprogesterone (synthetic hormone). Goal: Facility to educate him/her/representative about the risk and benefits of drug and safety measures will be maintained to prevent or lessen any adverse reactions or injury from the drug use. Focus: [Resident] is at risk for falls r/t: Hx of falls and is at risk for future falls. Impaired Safety Awareness. Constant moving and squirming in bed and chair. Rolled out of bed - no injuries. Goal: [Resident's] risks and injury potential will be minimized . Focus: At risk for pain r/t chronic disease processes. Goal: Will report reduction in pain with interventions . Focus: Potential for altered comfort r/t GERD. Goal: Resident will maintain adequate intake . Goals: continued review of Resident # 10's comprehensive care plan dated 07/29/2025 did not included measurable goals related to nutritional needs, roommate, PASRR status, communication, medication use, falls, pain and altered comfort. 3.Review of Resident #16's Resident Face Sheet, dated 08/05/2025, revealed she was a [AGE] year-old female admitted to the facility on [DATE] with medical diagnoses including chronic obstructive pulmonary disease (lung disease that makes breathing difficult), high blood pressure, type 2 diabetes mellitus, paranoid schizophrenia(a subset of schizophrenia characterized by delusions and hallucinations), major depressive disorder (mental illness characterized by persistent sadness), chronic pain, repeated falls, weakness, low thyroid function, heartburn, insomnia, Review of Resident #16's Quarterly MDS Assessment, dated 07/22/2025 revealed she had a BIMS score of 00 out of 15, indicating severe cognitive impairment. Review of Resident #16's Comprehensive Care Plan reviewed/revised 07/29/2025 revealed the following: Focus: [Resident] requires psychological services provided by. 675377 Page 2 of 4 675377 08/07/2025 Bangs Nursing and Rehabilitation 1105 Fitzgerald Bangs, TX 76823

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Goal: [Resident] will exhibit less behaviors and needs will be met . Focus: Black Box warning: This medication/s has a black box warning, the strongest warning mandated by the FDA, which indicates a need to closely evaluate and monitor the potential benefits and risks of the medication. Black box warning sign due to drug use of tramadol, metformin (used to treat Type 2 Diabetes), Zyprexa (antipsychotic), haloperidol (antipsychotic), Wellbutrin (antidepressant), losartan (used to treat high blood pressure), metoprolol (used to treat high blood pressure). Goal: Facility to educate him/her/representative about the risk and benefits of drug and safety measures will be maintained to prevent or lessen any adverse reactions or injury from the drug use. Focus: [Resident] receives antipsychotic medications (Zyprexa, Haldol) r/t Disease process (Schizophrenia). Goal: [Resident] drug related complications, including movement disorder, discomfort, hypotension, gait disturbance, constipation/impaction or cognitive impairment through review date. Goals: continued review of Resident # 16's comprehensive care plan dated 07/29/2025 did not included measurable goals related to behaviors, medication use, and antipsychotic medications. 4.Review of Resident #17's Resident Face Sheet, dated 08/05/2025, revealed she was an [AGE] year-old female admitted to the facility on [DATE] with medical diagnoses including cardiomyopathy (heart disease), cerebral infarction (stroke), weakness, history of falling, high blood pressure, tremor, and anemia (low red blood cell count). Review of Resident #17's admission MDS Assessment, dated 06/11/2025 revealed she had a BIMS score of 15 out of 15, indicating intact cognition. Review of Resident #17's Comprehensive Care Plan reviewed/revised 06/17/2025 revealed the following: Focus [Resident] gets nervous and anxious at times dx anxiety. Goal [Resident] will have fewer outbursts of yelling/calling out . Record review of Resident #17's Comprehensive care dated 06/17/2025 plan did not have fluid restrictions addressed. 5.Review of Resident #25's Resident Face Sheet, dated 08/05/2025, revealed she was an [AGE] year-old female admitted to the facility on [DATE] with medical diagnoses including cardiomyopathy, cerebral infarction (stroke), weakness, history of falling, high blood pressure, tremor, and anemia. Review of Resident #25's admission MDS Assessment, dated 06/11/2025 revealed she had a BIMS score of 15 out of 15, indicating intact cognition. Review of Resident #25's Comprehensive Care Plan reviewed/revised 06/17/2025 revealed the following: Focus Need for pain management and monitoring related to. Goal: Will achieve acceptable pain level goal . Focus Impaired physical functioning and ADLs r/t debility/weakness, fatigue. Goal Will increase physical functioning level . Focus Black Box warning: This medication/s has a black box warning, the strongest warning mandated by the FDA, which indicates a need to closely evaluate and monitor the potential benefits and risks of the medication. Black box warning sign due to drug use of clopidogrel (prevents blood clots). Goal: Facility to educate him/her/representative about the risk and benefits of drug and safety measures will be maintained to prevent or lessen any adverse reactions or injury from the drug use. Focus Potential for alteration in nutrition . Goal Will achieve and maintain a healthy weight and nutritional status . Focus At risk for or actual pain. Goal Will have reduction in pain . Goals: continued review of Resident #25's comprehensive care plan dated 06/17/2025 did not included measurable goals related to pain management, physical functioning, medication use, and nutrition. 6.Review of Resident #30's Resident Face Sheet, dated 08/05/2025, revealed she was a [AGE] year-old female admitted to the facility on [DATE] with medical diagnoses including chronic kidney disease, adult failure to thrive, heart disease, low thyroid function, high blood pressure, myocardial infarction (heart attack), history of falls, weakness, chronic pain, rhabdomyolysis, shortness of breath, difficulty swallowing, and malnutrition. Review of Resident #30's Quarterly MDS Assessment, dated 07/21/2025 revealed she had a BIMS score of 14 out of 15, indicating intact cognition. Review of Resident #30's Comprehensive Care Plan reviewed/revised 07/29/2025 revealed the following: 675377 Page 3 of 4 675377 08/07/2025 Bangs Nursing and Rehabilitation 1105 Fitzgerald Bangs, TX 76823

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Focus [Resident] has physical functioning deficit related to . Goal Resident will improve current level of physical functioning. Focus Black Box warning: This medication/s has a black box warning, the strongest warning mandated by the FDA, which indicates a need to closely evaluate and monitor the potential benefits and risks of the medication. Black box warning sign due to drug use of tramadol, levothyroxine (thyroid hormone), Lasix (diuretic or water pill), voltaren gel (used to treat inflammation associated with arthritis), and Losartan (used to treat high blood pressure). Goal: Facility to educate him/her/representative about the risk and benefits of drug and safety measures will be maintained to prevent or lessen any adverse reactions or injury from the drug use. Focus . is at risk for falls/injuries r/t arthritis, cardiac compromise, depression, fall history, gait and balance. Goal Noncompliance with safety needs. Focus Potential for complications r/t edema Edema. Goal Resident will have not significant increase of weight r/t edema . Focus Hospice Care due to diagnosis of Heart Disease. Goal Will be kept comfortable with reduced pain . Goals: continued review of Resident #30's comprehensive care plan dated 07/29/2025 did not include measurable goals related to physical functioning, medication use, falls, edema, or hospice care. During an interview on 08/07/2025 at 08:36 AM, the dietary cook stated Resident #17 had a fluid restriction of 1.5 liters per day. The cook had a paper showing how much fluid to serve at each meal to comply with fluid restrictions. The cook stated if fluid restriction was not followed the resident could have more swelling in her feet. During an interview on 08/07/2025 at 09:40 AM, LVN A stated leadership was responsible for care plans. She stated the ADON or DON will ask the staff for input prior to care plan meetings. During an interview on 08/07/2025 at 09:58 AM, the ADON stated she runs care plan meetings and was responsible for creating the baseline care plans. She explained everybody could update a care plan as changes occur. During an interview on 08/07/2025 at 10:07 AM, the DON stated the ADON/MDS Coordinator was responsible for care plans. She explained the system prepopulated a resident's care plan based on data entered from the MDS assessment. The DON stated the prepopulated selections were editable. The DON stated monitoring care plans occurred during quarterly audits performed by a corporate nurse. She stated training on the system and creating care plans was on the job. The DON explained training was also provided when the corporate nurse performed quarterly care plan audits. She stated there was no effect on the residents when the goals were not measurable because of the information included in the interventions and physician's orders provided guidance. During an interview on 08/07/2025 at 10:30 AM, Resident #17 stated did not care that the staff told her she could only have so much to drink. Resident #17 stated she got enough and did not feel thirsty. Review of facility policy titled Care Plans, Comprehensive Person-Centered dated Quarter 3, 2018, revealed in the Policy Statement A comprehensive, person-centered care plan that includes measurable objectives . The Policy Interpretation and Implementation section revealed 8. The comprehensive, person-centered care plan will: a. Include measurable objectives ., k. Reflect treatment goals, timetables and objectives in measurable outcomes 675377 Page 4 of 4