Inspection·March 2, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure residents were treated with respect, dignity and cared for in a manner and in an environment that promoted maintenance or enhancement of his or her quaility of life, recognizing each resident's individuality for 1 of 17 Residents (Resident #4) reviewed for resident rights in that: The facility failed to promote care in a manner to enhanced dignity for Resident #4 when staff changed out her mattress with a scoop mattress. This deficient practice could place residents at risk to feelings of poor self-esteem and decreased self-worth. The findings were: Record review of Resident #4's face sheet, dated 03/02/2023, revealed the resident was re-admitted to the facility on [DATE] with diagnoses which included: history of falling, heart failure, and diabetes. Record review of Resident #4's quarterly MDS, dated [DATE], revealed a BIMS score of 14, which indicated borderline cognitive impairment. Record review of Resident #4's care plan, revised 03/01/2023, revealed a scoop mattress was not listed as an intervention under risk for falls. Record review of Resident #4's physcians orders, dated 03/02/2023, revealed a scoop mattress was not listed as an entered order. During an observation and interview on 02/28/2023 at 11:45 a.m., Resident #4 stated she did not like her mattress and was not aware of why it was switched out. When Resident #4 found out it was a scoop mattress, she stated she did not know why because she had not fallen out of her bed. Resident #4 stated no one told her why it was switched and that it was switched out not long ago. Resident #4 stated she liked the mattress she had before, and she was not able to sleep on the scoop mattress. During an interview on 03/02/2023 at 02:03 p.m., LVN B stated Resident #4 had a scoop mattress, however LVN was unable to recall for how long. She stated she had not seen anything previously on the 24 hour report that discussed when or why her mattress was switched. LVN B agreed Resident #4 was a fall risk, however, she was unable to recall a recent fall out of her bed. (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 8 Event ID: 675677 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 675677 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Del Rio Nursing and Rehabilitation Center 301 W Martin St Del Rio, TX 78840 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)