Inspection·August 7, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure that the comprehensive person-centered care plan described services that are to be furnished to maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 of 5 residents (Resident #1) reviewed for care plans, in that: Resident #1's care plan, undated, did not indicate that Resident #1 was on a regular diet consisting of mechanical soft texture and regular liquids as of 6/18/2024. Resident #1's care plan inaccurately indicated Resident #1 was NPO status, onset date 05/29/2024. This deficient practice could affect residents who had a diet order change by serving a resident the wrong diet. The findings included: Record review of Resident #1's face sheet, undated, reflected Resident #1 was a [AGE] year-old male who admitted to the facility on [DATE] with diagnoses of traumatic subdural hemorrhage (type of bleeding in which a collection of blood gathers between parts of the brain usually caused by a severe head injury) and dysphagia (difficulty speaking). Record review of Resident #1's admission MDS assessment, dated 06/03/2024, reflected Resident #1 had a BIMS score of 8, indicating moderate cognitive impairment. Record review of Resident #1's June 2024 administration record, reflected Resident #1 had an enteral feed order: six times a day for provide 2130kcal, 91g pro, 2280ml total water [brand name] 1.5 bolus feeding x 6 cans/day + 100ml flush before and after q feed, start date 06/03/2024 and discontinued date, 06/19/2024. Resident #1 had an enteral feed order: three times a day bolus 2 cans of [brand name] 1.5 after meals if PO intake is < 50%, start date 06/19/2024. Record review of Resident #1's physician order summary for June 2024, reflected Resident #1 had an order for regular diet: mechanical soft texture and regular liquids, start date 06/18/2024. Record review of Resident #1's nutrition/dietary note, dated 06/19/2024, reflected, Diet: regular diet, mech soft texture, regular liquids. Noted diet started 06/18/2024 per ST recommendations. PO intake 75%-100% no supplements ordered. Record review of Resident #1's care plan, undated, reflected Resident #1 has a care plan [Resident #1 first name] has a swallowing problem r/t dysphagia. He is NPO and received g-tube feedings, dated (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: 675736 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 675736 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Yoakum Nursing and Rehabilitation Center 1300 Carl Ramert Dr Yoakum, TX 77995 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)