Health inspection·June 12, 2025

F 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to transmit encoded, accurate, and complete MDS data to the Center for Medicaid/Medicare System (CMS) System for 1 of 3 closed records (CR #83) reviewed for Minimum Data Set (MDS) transmission. Residents Affected - Some CR #83's discharge MDS assessment was not completed and transmitted within 14 days of CR's discharges. This failure could place residents at-risk of not having their assessment and care plan completed timely, which could result in denial of services and or payment for services. Findings Include: Record review of CR #83's Face sheet dated 06/12/25 revealed a 63-years old male who was admitted to the facility on [DATE]. His diagnoses included but were not limited to Acquired absence of left leg below knee, infection, homelessness, iron deficiency anemia, peripheral vascular disease (Slow and progressive disorder of the blood vessels), type 2 diabetes mellitus with diabetic neuropathy (Insulin resistance and elevated blood sugar level), unspecified open wound, right foot, muscle wasting and atrophy (Thinning or wasting of muscle tissue), other lack of coordination, muscle weakness, and generalized anxiety( a mental condition characterized by excessive uncontrollable worries). Record review of CR #83's nurses note was dated 02/18/25 and read in part-2/18/2025at 01:39 , revealed Patient c/o chest pain, states it has been going on since earlier but didn't tell anyone because they wouldn't do any, states pain is 9/10 all day. VS stable, no history of heart condition. Patient tells me to call ambulance don't call doctor. I followed protocol. EMS arrives, patient states he is not going anywhere without 300-400 dollar clothes (banana republic clothes) and wheelchair. He threatens to call the police because someone stole his things. He said roommate took his name out and put his name in and stole his clothes. We attempted to put his things in a bigger bag, and he refused. He carries his two bags of things. He says he is not going to recommended local Hospital because he doesn't know anything about that hospital and requesting to go to a hospital in city. He argued with EMS about where they are going to take him and his things. He finally agreed to go and they put him on the stretcher. Then asked about WC and attempted to jump off stretcher grabbing doorway. EMS grabs his so he doesn't fall off and resident swung his arms at EMS and cursed them stating he is not going anywhere unless wheelchair comes with. Patient states he will just have to die here because he not going anywhere with his things. WC goes with. Patient refuse to leave until police arrived to verify all his things are with him. (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 10 Event ID: 675557 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 675557 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oasis at Pearland 3400 E Walnut Pearland, TX 77581 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)