Health inspection·June 27, 2024

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observations, interviews, and record reviews, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for 4 of 4 (Resident # 2, 7, 8, &9) rooms reviewed for environment. The facility window blinds in Resident #2, 7, 8, &9's rooms were inoperable and damaged. This failure could place residents at risk for diminished quality of life due to the lack of a well- kept environment. Findings included: Observation on 6/26/24 at 9:10 am revealed that in 4 rooms (Resident #2, 7, 8, 9's room) observed during initial rounds the white 1-inch vinyl blinds being used for window covering were damaged, had broken blades, missing blades, cords in knots, inoperable. Interview on 6/26/24 at 10:45am Resident #2, stated that the broken window blinds were already damaged when she arrived. Resident #2 stated it made the room look junky and cheap. Resident #2 stated she did not mention the damaged blinds to any staff but wished they would replace them. Interview on 6/26/24 at 1:30pm Resident #7, stated blinds were damaged when she admitted , and it makes the room look junky. Resident #7 stated that the facility has known about the blinds but has done nothing. Resident #7 stated staff are nice and respectful, food is good, and she likes the facility but wishes they would fix the blinds. Resident #7 stated she did not ask or tell anyone about the blinds because they can see they are broken themselves. Interview on 6/26/24 at 1:40pm Resident #8, stated the blinds were broken when she arrived at the facility, and they let too much light in. Resident #8 said she knows the facility knows about the blinds, and she wished they would repair them. She said she has not asked anyone to fix the blinds and thinks they should know to do this. Interview on 6/27/24 at 1:10pm Resident #9, stated the blinds have been broken since she has been here. Resident #9 stated she has told them she would like them to be replaced or fixed to keep out the light. Resident #9 stated she thinks she has told the nurse and maintenance man about the blinds. Interview on 6/27/24 at 10:05am CNA L stated she has noticed broken blinds in resident's rooms and (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: 675722 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 675722 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Fort Stockton 501 N Sycamore Fort Stockton, TX 79735 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)