Inspection·May 16, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to provide a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely and housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior for 10 out of 10 residents in the secure unit reviewed for environment. The facility failed to ensure housekeeping and maintenance services were provided for Resident #4. The facility failed to clean and lock an in-wall storage cabinet in Resident #4's room. The facility failed to ensure the air conditioning was working properly to provide comfortable and safe temperature levels for residents in the secure unit and failed to keep cabinets secured and clean. Temperatures in resident rooms were above 81 degrees F. These failure could place residents at risk of being uncomfortable and being in an institutional environment versus a homelike environment. Findings included: Record review of Resident #4's admission record, dated 05/16/2024, revealed an [AGE] year-old female who admitted on [DATE] and readmitted on [DATE] with diagnosis that included Alzheimer's Disease. Record review of Resident #4's Quarterly MDS assessment, dated 04/02/2024, revealed a BIMS score of 3, indicating severe cognitive impairment. Observation on 05/14/24 at 9:22 AM in Resident #4's room revealed resident was not in the room, bed was made, and room was clean. Upon entry to the room, the wall on the left had an in-wall cabinet with a latch. The cabinet was not locked and contained 2 black wires going through the ceiling into the side of the wall on the left side, dust, a sleeve of plastic cups, a white plastic mouse trap, what appeared to be rodent droppings, and rolls of wrapping paper. Observation and interview on 05/15/2024 at 3:41 PM in Resident #4's room, revealed the in-wall cabinet was not locked. The Maintenance Supervisor opened the cabinet doors, stated it was dirty, and it looked like there were pest droppings inside. He said it should be locked and he would put a lock on the cabinet. He stated they used to have old records stored in there. He stated he would get it cleaned and the risk was the residents could catch something from the droppings. Observation and interview on 05/15/224 at 4:05 PM in Resident #4's room, the Administrator looked (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 9 Event ID: 675620 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 675620 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaumont Nursing and Rehabilitation 1175 Denton Dr Beaumont, TX 77707 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)