Health inspection·February 27, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life for 1 (Resident #1) of 5 residents reviewed for care in that: Resident #1 was left exposed in his room in an undignified manner. This failure could cause residents to feel uncomfortable and disrespected leading to feeling of isolation and deterioration in general health conditions. Findings include: Record review of Resident #1's face sheet dated 2-27-2024 revealed he was a [AGE] year-old male resident admitted to the facility on [DATE] with diagnoses to include congestive heart failure (a chronic condition in which the heart dose not pump blood as well as it should), hypertension(a condition in which the foresee of the blood against the artery walls is too high), malignant neoplasm of the bladder, (a fast-growing cancer of the bladder that spreads to other areas of the body), malnutrition(lack of proper nutrition), myocardial infarction (heart attack), and aftercare following survey of the genitourinary system. Record review of Resident #1's last MDS revealed a Medicare 5-day assessment completed on 2-23-2024 with a BIMS of 13 indicating he was cognitively intact, and he had a functional status of requiring partial to moderate assistance with most of his activities of daily living. Section H-Bladder and Bowel: HO100 Appliances-C. Ostomy (including urostomy, ileostomy, and colostomy)-Resident #1 was listed as having an ileostomy. HO300 Urinary Continence-Resident #1 is marked as 1. Occasionally incontinent (less than 7 episodes of incontinence). HO400 Bowel Continence-Resident #1 is marked as 2. Frequently incontinent (2 or more episodes of bowel incontinence, but at least one continent bowel movement). Record review of the Physician Order Report for Resident #1 with active orders as of 2-27-2024 revealed the following physician's order: (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: 675851 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 675851 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Georgia Manor Nursing Home 2611 W 46th Ave Amarillo, TX 79110 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)