Health inspection·February 10, 2024

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure allegations of abuse, neglect, or mistreatment, including injuries of unknown origin was reported immediately but not later than 24 hours after the allegations was made for residents reviewed for reporting alleged abuse and neglect, for 1/1 incident not reported to HHSC. The Facility failed to report to HHSC allegations of a weapon (gun) found in the public restroom in the facility with residents having access to this restroom. This failure could affect all residents by placing them at risk of abuse, physical harm, pain, mental anguish, emotional distress, and serious harm. Findings Include: During an interview with CNA B via telephone on 02/10/2024 at 12:09 pm. CNA B stated he had heard from staff talking that they had found a gun in the front restroom (north side), last Saturday 02/03/2024. CNA B stated he does know that the Administrator had done an investigation for the incident because she went around asking questions. CNA B stated the Administrator was aware of the incident. CNA B stated the incident was reported to the Administrator and the police. During an interview with the officer on 02/10/24 at 1:32 PM. The officer stated he responded to a call to the facility on [DATE] for a report of a gun found in the bathroom at the facility. The Officer stated when he arrived, the gun was found in the public restroom near the dining room. He stated he confiscated the gun and the police department will assign a detective to the case to further investigate. The Officer stated the call was received by LVN B from the facility. During an interview with LVN A via telephone on 02/10.2024 at 1:43 pm., LVN A stated CMA A had yelled at him to go to the public bathroom by the front because she had seen a gun in the restroom. LVN A stated when he went in the restroom, he did see the gun laying in there on the sink. LVN A stated he instructed CMA A to stay at the restroom and guard it so that no one would go into the restroom, while he went to call police. LVN A stated he called the police to reported the gun being in the restroom and while he waited for police to get there, he also called the Administrator and DON. LVN A stated the Administrator and DON both came to the facility. LVN A stated that police went to the facility to examine and take custody of the gun. LVN A stated that during the investigation process, the Administrator did call the police department to check on the status of the investigation, police told the administrator the gun was not a stolen gun. LVN A stated he did not think any of the residents knew about the gun because [NAME] had not heard them talk about it or question it. LVN A stated he (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: 675842 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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)