Health inspection·July 18, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 reviews the facility failed to ensure residents had the right to a safe, clean, comfortable, and homelike environment including but not limited to receiving treatment and supports for daily living safely for 1 out of 2 residents (Resident #3) reviewed for environment. - The facility failed to ensure Resident #3's room was clean and a homelike environment. There was sheetrock debris and dust on the resident's floor and on her windowsill. - The facility failed to relocate Resident #3 to another room while sheetrock repair work was actively being performed in her room. This deficient practice could place residents at risk of environmental hazards such as airborne dust, construction debris, noise and physical risk which could lead to a decreased quality of life. Findings included: Record review of Resident #3's Electronic Health Record revealed a [AGE] year-old female with diagnoses including Dementia, Protein Calorie Malnutrition and Paralytic Syndrome (loss of muscle function, causing weakness or inability to move). Record review of the Resident #3's Quarterly MDS revealed a BIMS score of 03, which indicates severely impaired. Section GG of the MDS revealed the resident did not use any mobility devices and she required supervision or touching assistance (Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently) with chair/bed-to-chair transfer. On 07/18/25 at 10:45am, surveyor observed Maintenance staff conducting Sheetrock repairs in Resident #3's room. The work included sanding drywall. There were larges pieces of debris observed on the windowsill of the room as well as on the floor beneath the window. The resident was present in the room and sitting in bed, within close proximity (about 4 feet) to the work area. In an interview on 07/18/25 at 10:50am, Resident #3 stated, It's loud and they usually have a fan. Due to the resident's cognition level, she was unable to answer additional questions that was asked by the surveyor. In an observation on 07/18/25 at 1:01pm, Maintenance staff were observed continuing to do repairs in Resident #3's room while the resident was in her room; pieces of debris and dust was located on the floor near the resident's window and on the windowsill. In an interview on 07/18/25 at 2:11pm, the ADON stated she was unaware of the exact work that was being completed in Resident #3's room but stated that work was active on only one side of the room and reported that the roommate that was closer to the repairs was moved to another room. When asked why both residents were not relocated to another room, she reported that they relocated the roommate that was on the side with the repairs and stated the administrator recommended when residents should be removed. The ADON stated they tried to keep residents out of their rooms when repairs were being completed but stated it was sometimes difficult because the residents were on the memory care unit. In an interview on 07/18/25 at 2:31pm, the Maintenance Director stated he was completing repairs in Resident #3's room. He stated the sheetrock was replaced, windowsill was taken out and he went in to start sanding the wall. He stated he began completing work (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 3 Event ID: 675700 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 675700 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Brookshire 710 Hwy 359 S Brookshire, TX 77423 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)