Health inspection·August 18, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide pharmaceutical services, including procedures that assure the accurate dispensing and administering of all drugs and biologicals to meet the needs of each resident and determines that drug records are accurate to meet the needs of each resident, for 1 of 2 residents (Resident #1) reviewed for medication administration.The facility failed to ensure Resident #1 had an order for Acetaminophen/Tylenol 650 mg every 4 hours as needed for pain/fever in the Electronic Medication Administration Record per the facility's standing orders. The facility failed to ensure LVN A documented the administration of Acetaminophen/Tylenol 650 mg every 4 hours as needed for Resident #1 on 07/17/2025. These failures could place residents at an increased risk for inaccurate drug administration and not receiving the care and services to meet their individual needs.Findings included:Record review of a face sheet dated 08/18/2025 indicated Resident #1 was a [AGE] year-old female initially admitted to the facility on [DATE] with diagnoses which included sepsis (life threatening complication related to infection), diabetes mellitus (too much sugar in the blood), dependence of renal dialysis (life sustaining treatment for kidney failure) and hypertension (high blood pressure).Record review of the Discharge MDS assessment dated [DATE], indicated Resident #1 was able to make was able to make herself understood and understood others. The MDS assessment indicated Resident #1 had a BIMS summary score of 11, which indicated her cognition was moderately impaired. The MDS assessment indicated Resident #1 rarely had any pain that interfered with sleep, therapy or ADLs. Record review of Resident #1's Order Summary Report dated 08/18/2025 indicated she had an order for Acetaminophen/Tylenol 325 mg, two tablets by mouth every 4 hours as needed for pain started on 07/20/2025 and discontinued on 07/25/2025.Record review of Resident #1's care plan did not address pain.Record review of Resident #1's electronic medication administration record dated 07/17/2025 - 07/18/2025 did not indicate Acetaminophen/Tylenol had been administered.Record review of Incident Case Report dated 08/13/2025 documented by the DON, indicated Resident #1 alleged she had received her roommate's medication the evening of 07/17/2025. The report indicated, as LVN A walked into Resident #1's room, LVN A said to Resident #1's roommate that her Seroquel had been delivered as she walked through the room to administer Resident #1's medication. The report indicated that LVN A stated Resident #1's roommate mistook the information and thought LVN A had gave Resident #1 the (recently delivered from the pharmacy) Seroquel (medication used mental and mood conditions). The report indicated that Resident #1 and the roommate continued to insist LVN A had given the Seroquel to Resident #1. The report indicated LVN A told Resident #1 she would monitor her throughout the night for peace of mind and assured Resident #1 if she had given her the wrong medication .it would not cause her harm and would possibly make her sleepy. The report indicated, the DON had completed an assessment the next morning on 07/18/2025 and noted Resident #1 was somnolent but easily rousable and coherent. The report indicated, Resident #1 stated she felt sleepy, but not bad.During (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: 675561 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 675561 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Plaza Nursing Center 600 W 52nd St Texarkana, TX 75501 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)