Health inspection·October 23, 2024

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure that residents' environment remained free of accident hazards as was possible for 1 (Resident #2) of 3 residents reviewed for accident prevention. The facility failed to ensure Resident #2's bed was placed in the lowest position to assist in fall prevention. This failure could prevent residents from having an environment that was free and clear of accidents and hazards. Findings included: Record review of Resident #2's Face Sheet, dated 10/23/2024, reflected he was an [AGE] year-old male admitted on [DATE]. Relevant diagnoses included muscle spasms, lack of coordination, and muscle weakness. Record review of Resident #2's Quarterly Minimum Data Set (MDS) assessment dated [DATE] reflected, he had a Brief Interview for Mental Status (BIMS) score of 5 (severe cognitive impairment) and for ADL care it reflected assistance for transfers, toileting, and bathing and the resident was totally dependent for assistance. Record review of Resident #2's Comprehensive care plan dated 09/28/24 reflected the resident was care planned for falls, and one of the interventions was to have the bed in a low position. In an observation on 10/23/24 at 08:00 AM, Resident #2 was observed laying in his bed sleeping. The bed was raised and not lowered to the lowest position. In an interview and observation on 10/23/24 at 08:17 AM, the DON was shown Resident #2's bed area. She stated that the resident was care planned as a fall risk and was required to have his bed place in the lowest position, except when he was eating. She stated that the resident had just finished his breakfast. However, she was advised that the resident was observed for over 15 minutes and the bedside table was still in the same location, and there was no staff observed on the floor. She stated the floor nurse was running late, so she was the floor nurse. She had the bedside table moved away from the bed and lowered the bed to its lowest position. She stated the resident had not had a fall in quite some time. She agreed that the bed should be placed in the lowest position to limit the residents from injuring themselves if they fell out of the bed, and Resident #2's sleep area should be (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 6 Event ID: 675417 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 675417 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fair Park Health & Rehabilitation Center 2815 Martin Luther King Jr Blvd Dallas, TX 75215 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)