Health inspection·August 28, 2025

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure the assessment accurately reflected the resident's status for 1 (Resident #2) of 12 residents reviewed for accuracy of assessments. On Resident #2's MDS the facility inaccurately coded Resident #2 as receiving anticoagulant medication. This failure could place residents at risk of not receiving necessary care. Findings Included: Record review of Resident #2's admission record dated 08/27/25 revealed a [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included, but were not limited to, hyperlipidemia (high cholesterol), orthostatic hypotension (form of low blood pressure that happens when standing after sitting or lying down), dysphagia (difficulty producing speech), and chest pain. Record review of Resident #2's quarterly MDS assessment revealed a completion date of 08/25/25. Section C (Cognitive Patterns) revealed a BIMS score of 15 which indicated the resident's cognition was intact. Section N revealed Resident #2 was receiving anticoagulant medication. Record review of Resident #2's care plan completed on 8/21/25 revealed Resident #2 was on anticoagulant therapy.Record review of Resident #2's active order summary report dated 08/26/25 revealed no order for anticoagulant medication. The report did reveal the following order: Aspirin Tablet EC (enteric coated) 81 MG Give 1 tablet by mouth one time a day for Preventative .During an interview on 08/28/25 at 09:54 AM, the MDS LVN stated she was responsible for completing MDS assessments. She stated she used the RAI manual as her policy when completing MDS assessments. When asked if aspirin should be coded as an anticoagulant in section N of the MDS she said yes it should. When she was shown a passage in the RAI which indicated aspirin was not to be coded as anticoagulant, she said, Huh, well ok! I did not know that. The MDS LVN could not think of a negative outcome for residents if aspirin was inaccurately coded as an anticoagulant. During an interview on 08/28/25 at 10:06 AM, the DON stated that the MDS LVN was responsible for MDS assessments. She stated a negative outcome of an inaccurate MDS could be reduction in funding and it could impact improper care for residents because the care plan was based on the MDS.During an interview on 08/28/25 at 10:08 AM, LVN A stated that she was the charge nurse for hall where Resident #2 resided. LVN A stated that the MDS LVN was responsible for MDS assessments and if a MDS was incorrectly coded, a resident's care plan could be affected which could negatively impact the residents' medications. During an interview on 08/28/25 at 10:10 AM, the ADM stated the MDS LVN was responsible for completing MDS assessments. She stated MDS assessments affected facility funding as well as direct resident care plans. The ADM stated having an inaccurate MDS could therefore negatively impact the care a resident received.Record review of the Long-Term Care Facility RAI 3.0 User's Manual Version 1.18.11 dated October 2023 revealed the following: . N041 5: High-Risk Drug Classes: Use and Indication . N041 5E1. Anticoagulant (e.g., warfarin, heparin, or low-molecular weight heparin): Check if an anticoagulant medication was taken by the resident at any time during the 7-day look-back period (or since admission/entry or reentry if less than 7 days). Coding Tips and Special Populations . Do not code antiplatelet medications such as aspirin/extended Residents Affected - Few (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: 675534 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 675534 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wheeler Nursing & Rehabilitation 1000 S Kiowa St Wheeler, TX 79096 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)