F 0656
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Develop and implement a complete care plan that meets all the resident's needs, with timetables and
actions that can be measured.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interviews, and record review the facility failed to develop and implement a comprehensive
person-centered care plan for each resident, consistent with the resident rights, that included measurable
objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that
were identified in the comprehensive assessment for 1 of 6 residents (Resident #1) reviewed for
comprehensive care plans.
Resident #1's comprehensive care plan did not reflect Resident #1's mechanical soft texture diet.
This deficient practice could place residents at risk for not receiving proper care and services due to
inaccurate care plans.
Findings include:
A record review of Resident #1's face sheet dated 04/30/2025, reflected a [AGE] year-old male who was
re-admitted to the facility on [DATE]. Resident #1's diagnoses included: unspecified dementia (a condition
that causes a decline in thinking, memory, and reasoning abilities), seizures (sudden, temporary disruption
of the brain's normal electrical activity, resulting in changes in behavior, movement, feelings, or
consciousness.), muscle wasting and atrophy (the muscles are shrinking and losing strength), lack of
coordination (having difficulty controlling your movements and making them work together smoothly) and
muscle weakness (reduced ability of the body to contract muscle properly, resulting in a lower strength in
one or more muscle).
A record review of Resident #1's Quarterly MDS assessment, dated 04/10/2025, reflected the resident had
a BIMS score of 99, which indicated the BIMS interview was not completed. Resident #1's Quarterly MDS
reflected Resident #1 was dependent in the following areas: toileting hygiene, shower/bathe self, and
personal hygiene. Resident #1 required substantial/maximal assistance with eating, oral hygiene, and
putting on/taking off footwear. Resident #1's Quarterly MDS also reflected he received a mechanically
altered diet.
A record review of Resident #1's care plan, dated 04/30/2025, reflected Resident #1's care plan did not
reflect Resident #1's mechanical soft diet.
A record review of Resident #1's physician orders dated 04/30/2025, reflected Resident #1 had a physician
order dated 12/08/2023 for regular diet, mechanical soft texture, regular consistency.
During an observation on 04/30/2025 at 12:10 pm., Resident #1 was observed eating a mechanical soft
(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:
675867
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
675867
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/30/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Kerens Care Center
809 NE 4th St
Kerens, TX 75144
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)
F 0656
diet during lunch in the dining area with the assistance of LVN A.
Level of Harm - Minimal harm
or potential for actual harm
Attempted to interview Resident #1 on 04/30/2025 at 12:10 pm., Resident #1 could not be interviewed due
to his severe cognitive impairment.
Residents Affected - Few
During an interview with LVN A on 04/30/2025 at 12:50pm, LVN A stated that Resident #1 received a
mechanical soft diet. LVN A stated Resident #1 has a physician order for his mechanical soft diet. LVN A
stated during the dining times she reviews the meal tickets to ensure residents are receiving the correct
texture diet. LVN A was not aware that Resident #1's care plan did not reflect his mechanical soft diet.
During an interview with the MDS Coordinator on 04/30/2025 at 3:00pm, the MDS Coordinator stated that
Resident #1's mechanical soft diet should have been reflected on his care plan. The MDS Coordinator
stated she and other department heads were responsible for ensuring that care plans were up to date and
accurate. The MDS Coordinator stated if a resident's care plan was not accurate then the resident would
not receive the appropriate care needed.
During an interview with the ADM on 04/30/2025 at 3:50pm, the ADM stated Resident #1's mechanical soft
diet should have been reflected on his care plan. ADM stated it was the MDS Coordinator's responsibility
for ensuring care plans have the most accurate information for the resident's care. ADM stated that
Resident #1 could have received the wrong texture diet because of his care plan not reflecting his
mechanical soft diet.
A record review of the facility's Comprehensive Care Planning policy, not dated, reflected The facility will
develop and implement a comprehensive person-centered care plan for each resident, consistent with the
resident rights that includes measurable objectives and timeframes to meet a resident's medical, nursing,
and mental and psychosocial needs that are identified in the comprehensive assessment.
The comprehensive care plan will describe the followingThe services that are to be furnished to attain or maintain the resident's highest practicable physical,
mental, and psychosocial well-being
Each resident will have a person-centered comprehensive care plan developed and implemented to meet
his other preferences and goals, and address the resident's medical, physical, mental, and psychosocial
needs .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675867
If continuation sheet
Page 2 of 2
