Health inspection·April 25, 2024

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure that respiratory care was provided, consistent with professional standards of practice for 2 of 2 residents (Resident #1 and Resident #2) reviewed for respiratory care and services. Residents Affected - Few The facility failed to ensure Resident #1's oxygen tubing was dated. The facility failed to ensure Resident #2's oxygen tubing was dated and properly stored when not in use. These failures could place residents at risk for respiratory infections. Findings included: Record review of Resident #1's admission record, dated 04/25/2024, revealed a [AGE] year-old female with an original admission date of 09/04/2021 and readmitted on [DATE] with diagnoses that included heart failure, shortness of breath, obstructive sleep apnea, and chronic obstructive pulmonary disease. Record review of Resident #1's most recent MDS assessment, dated 03/15/2024, revealed a BIMS score of 12 indicating moderate cognitive impairment. Further review of the MDS revealed Resident #1 received oxygen therapy while not a resident and while a resident. Record review of Resident #1's care plan, revised on 03/21/2024, revealed the resident has oxygen therapy r/t CHF, ineffective gas exchange, and CPAP r/t to sleep apnea. Record review of Resident #1's physician orders, dated 03/04/2024, revealed Oxygen: Change Mask, O2 tubing, water bottle, and clean concentrator filter every night shift every Sun Initial & date tubing & bottle. Record review of Resident #2's admission record, dated 05/03/2024, revealed an [AGE] year-old female with an original admission date of 04/19/2022 and readmitted on [DATE] with diagnoses that included Alzheimer's Disease, heart failure, and chronic obstructive pulmonary disease. Record review of Resident #2's quarterly MDS assessment, dated 04/16/2024, revealed a BIMS score of 10, indicating moderate cognitive impairment. Further review of the MDS revealed Resident #2 did not receive oxygen therapy while a resident. (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: 675891 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 675891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeport Medical Lodge 2108 15th Street Bridgeport, TX 76426 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)