Health inspection·October 2, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 staff failed to ensure residents received treatment and care in accordance with professional standards of practice, the comprehensive care plan, and the residents' choices for 1 of 5 (Resident #1) reviewed for quality of care. Residents Affected - Few The facility failed to document, monitor, and assess Resident #1's abnormal skin discoloration prior to and upon return of Resident #1's outing (on pass) to her home after RP reported the discoloration to staff. This failure could affect residents by placing them at risk of delay medical treatment, hospitalization, decline in condition, and death. Findings included: Record review of Resident #1's admission Record dated 9/25/23 revealed a [AGE] year-old female, admitted to facility on 9/8/23 with a diagnosis of Hemiplegia (paralysis of one side of body) and Hemiparesis (weakness or inability to move one side of body) following cerebral infraction (stroke) affecting left non-dominant side, Contracture left knee, contracture left ankle. Record review of Resident #1's MDS assessment dated [DATE] showed Resident#1 had a BIMS score of 4 indicating severe cognitive impairment. Record review of the facility's Sign Out / Sign In Log revealed Resident #1 was signed out of facility by RP on 9/23/23 at 12:45 pm initialed by RN D and Signed in on 9/23/23 at 4:45 pm initialed by LVN T. In an interview on 9/24/23 at 6:07 pm, the RP said he told RN D before taking Resident #1 out on pass to their home, that he noticed bruising on Resident #1's left leg. He said that LVN D looked at the leg and asked if she had any pain and Resident #1 said no. In an interview on 9/24/23 at 5:22 pm RN D stated RP voiced a concern on 9/23/23 at approximately 12:35 pm stating that Resident #1 had discoloration to her leg area. RN D said she assessed the resident and found no cause for concern. She said the resident did not complain of pain. RN D also said she did not document at the time or at that day when it happened and she could not say why. She said she should have documented but did not. She also said she did not relay this information to the oncoming afternoon nurse or the DON. She said she didn't document it at the time because it wasn't any cause of concern. In a follow up interview RN D said the discoloration was Resident #1's baseline (that was her norm). She said she could not remember the exact color so she could not answer what color (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: 675689 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 675689 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Village Healthcare and Rehabilitation 615 N Ware Rd McAllen, TX 78501 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)