Health inspection·March 26, 2025

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure that a resident who needed respiratory care, was provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, the residents' goals, and preferences for 3 of 6 resident (Residents #11, #13, #14) reviewed for respiratory care. Residents Affected - Few 1. The facility failed to ensure Resident #11, #13, #14's nebulizer/Mask and tubing were kept in a bag while not in use. These failures could place residents at risk for infections and transmission of communicable diseases. Findings include: Record review of Resident #11's face sheet, dated 3/26/25, reflected an [AGE] year-old female, who was admitted to the facility on [DATE]. Resident #11 had diagnoses which included, cerebral infarction (stroke), diverticular disease of intestine (abnormal pouches form in the bowl wall), dementia (cognitive decline), encephalopathy (disease of the brain), asthma (inflammatory disease in the lungs). Record review of Resident #11's MDS quarterly assessment dated [DATE], reflected a BIMS score of 3 which indicated severe cognitive impairment. Section O of the MDS reflected: respiratory therapy. Record review of Resident #11's Physician Orders, revealed, 3 ML INHALE ORALLY EVERY 4 HOURS AS NEEDED FOR SHORTNESS OF BREATH OR WHEEZING VIA NEBULIZER. Record review of Resident #11's MAR date 3/26/25 revealed the last breathing treatment was 3/26/25 at 10:50am. Record review of Resident #11's quarterly Care Plan, dated 2/2/25, revealed Resident #11 had a diagnosis of asthma and to give nebulizer treatments and oxygen therapy as ordered. In an observation on 3/26/25 at 12:55pm, revealed Resident's #11 was lying in bed, and sleeping. Observed the nebulizer/mask and tubing sitting on the bedside table with the tubing touching the floor, and the nebulizer and tubing not bagged. Record review of Resident #13's face sheet, dated 3/26/25, reflected a [AGE] year-old female, who was admitted to facility 9/2/23, with diagnoses which include, Fracture of right femur (thigh bone), (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: 675633 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 675633 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Holland Lake Rehabilitation and Wellness Center 1201 Holland Lake Dr Weatherford, TX 76086 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)