Inspection·April 15, 2024

F 0839 Employ staff that are licensed, certified, or registered in accordance with state laws. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure professional staff were licensed for 1 of 41 nursing staff (Staff A) reviewed. Residents Affected - Few Staff A's LVN license had not been renewed as of [DATE] causing her LVN license to be delinquent. This deficient practice could place residents at risk of having receiving care from unlicensed staff to provide proper medical care. Findings included: Record review of personnel files indicated Staff A (LVN) nursing license expired on [DATE]. Hire date [DATE]. Staff A had no disciplinary actions against her from the facility. Record review of the License from Texas Board of Nurse Examiners Staff A had an original licensure issue date of [DATE] with a delinquent effective [DATE], with no previous disciplinary actions. Record review Daily Assignment Sheets from [DATE] to [DATE] indicated 21 days in [DATE] days in February 2024, 19 days in [DATE], and 7 days in [DATE]. Staff A was 1 of 4 nurses present on the floor during those times. In an interview on [DATE] at 2:10 pm, the Human Resources Manager (HRM) stated that it was her responsibility for checking the nurses' licenses monthly, stating I'm responsible and just somehow missed this one. In an interview on [DATE] at 4:50 pm the Director of Nursing (DON) stated that the person responsible for checking licensed staff licensure was HRM. The DON stated there was no risk to the residents other than staff having a delinquent license, further expressing that DON believed Staff A was competent in her skills of assessment, medication administration and other nursing duties. The DON said that Staff A told her that she thought her license was expiring next year. In an interview on [DATE] at 7:15 pm, the Administrator (ADM) revealed that the HRM was responsible for checking for expired licenses each month and giving a report to the DON. Record review of facility policy labeled Abuse, Neglect and Exploitation dated [DATE] revealed: Background checks: For any licensed professional applying for a position that may involve direct contact with resident, his/her respective licensing board will be contacted to determine if any sanctions have been assessed against the applicant's license. The policy did not indicate that 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 2 Event ID: 675852 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 675852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Wichita 4810 Kemp Blvd Wichita Falls, TX 76308 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)