Inspection·September 27, 2023

F 0558 when he needed it. Resident #73 stated he could get up and get the call light if he needed to. Level of Harm - Minimal harm or potential for actual harm Resident #25 Residents Affected - Some Record review of Resident #25's admission record, dated 07/27/23, reflected a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #25 had diagnoses which included: type 2 diabetes mellitus (a chronic condition that affects the way the body processes the blood sugar), muscle wasting and atrophy (wasting [thinning] or loss of muscle), history of falling, need for assistance with personal care, and dysphagia (difficulty swallowing). Record review of Resident #25's quarterly MDS assessment, dated 09/07/23, reflected the resident had a BIMS score of 02, which indicated the resident was cognitively impaired. The resident required extensive assistance for dressing and supervision in various areas of activities of daily living such as bed mobility, transfer, locomotion on and off unit, eating, toilet use, and personal hygiene. Record review of Resident #25's care plan, initiated 02/21/20 and revised 09/24/23, reflected Resident #25 was care planned for at risk for falls r/t confusion, gait/balance problems, poor communication/comprehension, psychoactive drug use, unaware of safety needs, vision/hearing problems with a goal of [Resident #25] will be free of falls through the review date and had an intervention of be sure [Resident #25's] call light is within reach and encourage the resident to use it for assistance as needed. The resident needs prompt response to all requests for assistance. In an observation on 09/26/23 at 11:59 AM, observed Resident #25's call light not in reach and on the floor beside his bed. In an interview on 09/26/23 at 12:01 PM, Resident #25 stated the staff come quick when needed. Resident #51 Record review of Resident #51's admission record, dated 09/26/23, reflected an [AGE] year-old male who was admitted to the facility on [DATE]. Resident #51 had diagnoses which included: type 2 diabetes mellitus (a chronic condition that affects the way the body processes the blood sugar), dementia (general decline in cognitive abilities), muscle wasting and atrophy (wasting [thinning] or loss of muscle), need for assistance with personal care, cognitive communication deficit (difficulty thinking and using language) Record review of Resident #51's Annual MDS assessment, dated 07/21/23, reflected Resident # 51 required extensive assistance for dressing and supervision in various areas of activities of daily living such as bed mobility, transfer, locomotion on and off unit, eating, toilet use, and personal hygiene. Record review of Resident #51's care plan, initiated 02/21/20 and revised 09/24/23, reflected Resident #51 was care planned for at risk for falls r/t confusion, gait and balance problems, unaware of safety needs, wandering, Dementia with a goal of [Resident #51] will be free of falls through the review date and had an intervention of be sure [Resident #51's] call light is within reach and encourage the resident to use it for assistance as needed. The resident needs prompt response to all requests for assistance. In an observation 9/25/23 1:41PM Resident #51 was lying in bed sleeping with call light on floor (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675501 If continuation sheet Page 2 of 3 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 675501 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy at Corsicana Rehabilitation and Healthcare 3300 W 2nd Ave Corsicana, TX 75110 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)

F 0558 rolled up next to head of the bed on the floor. Level of Harm - Minimal harm or potential for actual harm In an observation 09/26/23 10:22 AM Resident #51 observed resident lying in bed, call light remains rolled up next to the head of the bed on the floor Residents Affected - Some In an interview on 09/27/23 10:34 AM with Resident #51 she stated I do not know how to call for help if needed. Resident #51 appeared confused. In an Interview on 09/27/23 10:47 AM CNA B stated call lights needed to be within reach in case the resident's needed assistance. Everyone that works should have made sure the call light was within reach of the resident. Staff were educated to keep them within reach. Risk to the resident for not having call light in reach is the resident would not be able to get help if needed. In an interview on 09/27/23 10:38 AM LVN A stated call lights should be attached to beds and within reach for safety. Staff are educated on keeping the call lights within reach in the form of reminders and in-services from DON and ADON. The Certified Nurse's Aides were responsible for making sure the call lights are attached. The risk to the resident for not having access to their call light is the inability to obtain staff assistance when needed. In an interview on 09/27/23 11:41AM with DON stated all residents should have had access to a call light while in bed. All staff are responsible and should have placed call lights within reach of the residents . In an interview on 09/27/23 at 10:38 AM, the ADM stated the purpose of a residents call light was for residents to notify staff that they needed assistance. He stated if a residents call light was out of reach and the resident needed help, the time could be extended for staff to provide assistance to residents. He stated staff should have made sure residents call lights were in reach when they did their rounds because residents could knock it off the bed or something. He stated they did angel rounds every morning and they checked for the call lights being in reach. The ADM stated the staff has not been in-serviced since he had been there, and they had not had the need to in-service staff because there had been no issues with call lights. Record review of the facility's Answering the Call Light policy dated 10/2010 revealed General Guidelines bullet #5 When the resident is in bed or confined to a chair be sure the call light is within easy reach of the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675501 If continuation sheet Page 3 of 3