Health inspection·May 6, 2025

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure a resident who is fed by enteral means receives the appropriate treatment and services to prevent complications of enteral feeding for 1 of 4 residents (Resident #35) reviewed for gastrostomy tube management. The facility failed to ensure Resident #35 was provided with the correct feeding administration set up (no name, date or feeding being administered) through gastrostomy tube (g-tube, feeding tube). This failure could place residents who received feedings by gastrostomy tube at risk for injury, aspiration into the lungs (fluid or food enter the lungs accidently), decreased quality of life, hospitalization and decline in health, weight loss and poor wound healing. Findings: Record review of Resident #35's face sheet, dated 05/5/2025, revealed a [AGE] year-old-male was admitted to the facility on [DATE] with and readmitted on [DATE] with diagnoses to include Cerebral infarction affecting right dominant side, Dysphagia (or difficulty swallowing), subsequent encounter, Aphasia(is a communication disorder that results from damage to the brain's language centers, usually due to a stroke or brain injury), type 2 Diabetic Mellitus, alcohol abuse, other seizure, Chronic Respiratory Failure with Hypoxia(is a condition where the body or a specific region of the body doesn't receive enough oxygen at the tissue level), Subsequent encounter, and gastrostomy status (g-tube). Record review of the comprehensive MDS assessment dated [DATE] revealed Resident #35's, BIMS score of 9(score of 9 falls within the range indicating moderate cognitive impairment. This suggests the individual may need some extra assistance with daily activities or specific tasks and may be experiencing cognitive decline). The MDS further documented Resident #35's Nutritional Approach While a Resident was feeding tube. Attempt interview 5/4/2025 at 10am, with Resident #35 who could not describe his feeding set up that was hanging on pole beside his bed was unaware tube feeding. Record review of physicians' orders of Resident #35 reflected he requires a tube feeding r/t (related to) dx (diagnosis) of dysphagia; Focus: The resident requires tube feeding r/t dysphagia. Observations for of Resident #35's feeding revealed: (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: 675460 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 675460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Highlands Nursing & Rehabilitation Center 711 Lucas St Athens, TX 75751 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)