Health inspection·April 11, 2024

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure for 1 of 3 residents (Resident #1) who needed respiratory care was provided care consistent with professional standards of practice reviewed for respiratory care, in that: Residents Affected - Few Resident #1 was observed to be administered oxygen PRN, but nurses did not document the times PRN oxygen was given . LVN D reported Resident #1's oxygen dipping low at times but did not document change of conditions and times in which PRN oxygen was needed. This failure placed Resident #1 at risk of not receiving adequate respiratory care. Findings included: Record review of Resident #1's face sheet revealed a [AGE] year-old female who was admitted into the facility on [DATE] and was diagnosed with cerebral palsy, shortness of breath, epilepsy, dementia and muscle wasting atrophy. Observations on 04/09/2024 at 10:34AM, revealed Resident #1 lying in bed with her nasal cannula on receiving oxygen from her oxygen concentrator set on 2L/min. The humidifier attached was labeled with date 04/07/24. Resident was observed have unlabored breathing. Record review of Resident #1's comprehensive MDS, dated [DATE], revealed the resident was not noted to have oxygen therapy while a resident. Record review of Resident #1's care plan, not dated, revealed the resident was at risk for shortness of breath and coughing up yellow phlegm due to acute diagnosis of acute bronchitis, resolved 05/05/2021 status post COVID and intervention listed included to administer oxygen as ordered. Record review of Resident #1's vital signs revealed from 03/29/2024 - 04/10/2024, the resident was documented to have O2 sat% of at least 95% or above. Record review of Resident #1's physician's orders revealed the resident had an order to: (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: 675739 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 675739 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381 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)