Health inspection·June 1, 2023

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of 1 resident (Resident #12) of 6 residents observed and reviewed for medication administration. -MA A dispensed five medications for Resident #12 and presented them to the resident for administration. Resident #12 had already received the medications. -LVN B had administered Resident #12's medications earlier but did not document in the MAR. The failures placed residents at risk for overmedication and the complications related to overmedication. Findings include: Record review of the admission Record for Resident #12 (printed 05/31/2023) revealed he was [AGE] years old, admitted to the facility on [DATE]. He was listed as being his own Responsible Party. Diagnoses included, but were not limited to, chronic kidney disease with dependence on renal dialysis and hyperlipidemia (high volumes of water-insoluble molecules). Record review of the quarterly MDS dated [DATE] revealed Resident #12 scored 15 of 15 on the BIMS, indicative of intact cognition. Record review of the Care Plan dated 10/27/2022 revealed one 'Focus' reflected Resident #12 had chronic renal/kidney failure. The 'Goal' was reflected as the resident would not have any complications related to fluid deficit or overload. One 'Intervention' was reflected as administering medications as ordered by the physician. Record review of the Physician's Order Summary Report (printed 05/31/2023) revealed Resident #12 was to receive dialysis treatments on Mondays, Wednesdays, and Fridays. The Orders reflected the resident was to receive one tablet of enteric coated aspirin (81 mg) daily related to high blood pressure. He was to receive three tablets of Sevelamer Carbonate (800 mg) on dialysis days for his kidney disease. The Orders reflected he was to receive Clopidogrel Bisulfate (75 mg) daily related to the acquired absence of one of his left fingers. The Orders reflected he was to receive Midodrine Hydrochloride (10 mg) on dialysis days to address low blood pressure during dialysis. In addition, Resident #12 was to receive one tablet of Multivitamin with minerals. (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 4 Event ID: 675420 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 675420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Brazos 2127 Preston St Richmond, TX 77469 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)