Health inspection·February 23, 2023

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 interview and record review, the facility failed to ensure a MDS assessment was electronically completed and transmitted to the CMS System within 14 days after completion for 2 of 24 residents (Residents #31 and #61) reviewed for transmitting assessments, in that: Residents Affected - Few 1. Resident #4's discharge MDS assessment was not completed and transmitted within 14 days of completion. 2. Resident #40's discharge MDS assessment was not completed and transmitted within 14 days of completion. This deficient practice could place residents at risk of not having records completed and submitted in a timely manner as required. Findings include: 1. Review of Resident #4's face sheet, dated [DATE], revealed an admission date of [DATE] with diagnoses that included COVID-19, heart disease, kidney disease, gastro-esophageal reflux disease, hypertension (high blood pressure), and dementia. Resident #4 was discharged to home on [DATE]. Review of Resident #4's electronic quarterly MDS assessment revealed that there was no discharge MDS assessment available at the time of survey. 2. Review of Resident #40's face sheet, dated [DATE] revealed an admission date of [DATE]with diagnoses that included Gastro-Esophageal Reflux Disease without Esophagitis and Hypothyroidism. Resident #40 died in the facility on [DATE]. Review of Resident #40's electronic quarterly MDS assessment revealed that there was no discharge MDS assessment available at the time of survey. Interview on [DATE] at 3:30 p.m. with the MDS Coordinator, the MDS Coordinator confirmed Resident #4 and Resident #40's discharge MDS assessment was not started. When asked why these reports were not started, the MDS Coordinator stated, I do not know if it was a glitch, but sometimes it [MDS alert] does not come out for us. and, [Resident #40] was a death in the facility and private pay, but we are not sure why he [his MDS alert] didn't come out. When questioned about the consequence of not submitting records within the 14 days, the MDS Coordinator stated that there would be no consequence. When questioned about the facility policy regarding MDS assessments, the MDS Coordinator stated that (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: 675617 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 675617 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eagle Pass Nursing and Rehabilitation 2550 Zacatecas Dr Eagle Pass, TX 78852 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)