Inspection·August 16, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record reviews, the facility failed to ensure a resident received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 1 (Resident #1) of 5 residents reviewed for showers/baths. Residents Affected - Few -Resident #1 did not receive showers as scheduled. This failure affected one resident and placed 88 residents requiring assistance with baths and showers at risk of not having the assistance with personal care which could cause skin breakdown and low self-esteem. Findings include: Record review of the admission Record (printed 08/16/2023) for Resident #1 revealed she was [AGE] years old, andold and was admitted to the facility on [DATE]. Diagnoses included, but were not limited to, encephalopathy (disease that alters brain function), muscle weakness, and dementia. Record review of the quarterly MDS assessment dated [DATE] revealed no entry for Resident #1's cognitive status. The MDS reflected the resident required extensive assist of two persons for bed mobility, transfers, toilet use, and personal hygiene. She required physical help in part of the bathing activity. The resident weighed 244 pounds at the time of the assessment. Record review of the Care Plan (revised 04/05/2023) revealed Resident #1 required extensive to total assist with bathing. The Care Plan reflected the resident was to receive a sponge bath when a full bath or shower could not be tolerated. Observation on 08/16/2023 at 10:10 p.m. revealed Resident #1 to be in her room. She was lying in her bed. She was not interviewable. Observation on 08/16/2023 at 11:00 a.m. revealed CNA A and CNA B provided incontinent care for Resident #1. Observation revealed the resident required extensive assist from both staff to reposition. Interview on 08/16/2023 at 12:30 p.m. Resident #1's family member revealed the resident was not receiving showers or baths. She said one night she stayed and asked a CNA to give Resident #1 a shower. She said the CNA did not know which chair to use. She said she told the DON her concern that the resident was not receiving showers. Observation and interview on 08/16/2023 at 2:35 p.m. the DON said the shower sheets were kept in a (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: 675538 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 675538 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sugar Land Health Care Center 333 Matlage Way Sugar Land, TX 77478 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)