Inspection·November 29, 2023

F 0825 Provide or get specialized rehabilitative services as required for a resident. 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 provide specialized rehabilitative services for 1 of 4 residents reviewed for specialized rehabilitative services. (Resident #1) Residents Affected - Few The facility failed to ensure Resident #1 received speech therapy per the PASRR Comprehensive Service Plan January 2023 to March of 2023. This failure could place residents who require specialized rehabilitative services at risk of decline in health status and a decreased quality of life. Findings included: Record review of a face sheet dated 11/28/2023 indicated Resident #1 was an [AGE] year-old female who had a initial admit date of 01/16/2014 readmission to the facility on [DATE]. Her diagnoses included cerebral palsy (a group of disorders that affect movement, muscle tone, balance, and posture), hypertension (high blood pressure), and depressive disorder. Record review on 11/28/2023 of Resident #1's Order Summary dated 11/28/2023 indicated no order for speech therapy. Record review of the MDS dated [DATE] indicated Resident #1 was understood and understood others. The MDS indicated a BIMS score of 15 which indicated cognitively intact. The MDS indicated Resident #1 required limited assistance from staff for activities of daily living. The MDS did not indicate Resident #1 was receiving speech therapy. Record review of a care plan revised on 07/07/2023 indicated Resident #1 had cerebral palsy (muscle weakness or partial paralysis on one side of the body that can affect the arms, legs, and facial muscle). The Care Plan did not indicate/address speech therapy. Record review of the MDS - Resident Assessment and Care Screening Nursing Home Quarterly dated 09/08/2023 Record review on 11/28/2023 of Resident #1's electronic health record indicated no speech therapy notes for January 2023 through March of 2023. Record review on 11/29/2023 of PASRR (Pre-admission and Resident Review) Comprehensive Service Plan dated 01/17/2023 indicated a continuation of speech therapy services. (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: 675553 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 675553 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Quitman Wellness & Rehabilitation 1026 E Goode St Quitman, TX 75783 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)