Health inspection·September 28, 2023

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to develop and implement a baseline care plan for each resident that included instructions needed to provide effective and person-centered care of the resident that met professional standards of quality care within 48 hours of the resident's admission for one of eight residents (Residents #177) reviewed for baseline care plans. The facility failed to complete a baseline care plan for Residents #177 within 48 hours of admission which included the minimum required healthcare information which included physician orders, dietary orders, therapy services and social services. This failure could place residents at risk of not receiving effective and person-centered care. Findings include: Record review of Resident#177's faced sheet, dated 09/27/2023, reflected a 95 -years-old-male who was admitted to the facility on [DATE]. His diagnoses included: hemiplegia (paralysis of one side of the body) affecting left non-dominant side, hypertension, dysphagia (difficulty or discomfort in swallowing, as a symptom of disease) following cerebral infarction (type of ischemic stroke resulting from a blockage in the blood vessels supplying blood to the brain), muscle weakness, lack of coordination, and repeated fall. Record review of Resident #177's electronic clinical record, on 09/26/23, revealed no Baseline Care Plan. An incomplete baseline care plan was done on 09/27/2023. Interview on 09/27/23 at 02:06 PM with the DON revealed Resident #177's base line care plan was not done after 48 hours of admission and stated the care plan was posted today, 09/27/2023. The DON stated Resident # 177's admission paper was not reviewed, and she was not aware of the missing base line care plan. The DON stated baseline care plans should be completed by the nurses completing the residents' admission. She stated the baseline care plans were important because they captured the immediate care needs of residents coming into the facility. She stated they should be completed within 24 - 48 hours. she stated the facility's expectation was they be completed with 24 hours. She stated not having a baseline care plan could limit the facility's ability to meet the resident's care needs. She said would typically complete admission reviews to ensure all care plans were completed. Interview on 09/28/23 at 10:00 AM with MDS coordinator nurse D revealed she worked as the MDS coordinator nurse at a corporate level and was no longer assigned to the facility starting last Thursday 09/21/2023. She stated baseline care plans should be completed by the nurses completing the (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: 675822 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 675822 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beltline Healthcare Center 106 N Beltline Rd Garland, TX 75040 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)