Health inspection·July 16, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of Resident #1's progress note completed by nursing staff, dated 06/30/24 at 01:33 AM revealed Resident #1 had fall with injury when attempting to get up from wheelchair resulting in resident being transported to the hospital for further evaluation. Record review of Resident #1's progress note dated 06/30/24 at 08:21 AM as a late entry and written by nursing staff revealed that resident's family member was notified at 08:21 AM regarding her fall and transfer to hospital. During a telephone interview on 07/16/24 at 08:44 AM, family member stated he was not contacted by the facility when Resident #1 had fallen in the middle of the night. He stated he felt there was a miscommunication because two nurses had thought the other had contacted him. The Family member stated he did not find out until 06/30/24 at 08:21 AM that Resident #1 had fallen and was transferred to the hospital, but that there were extensive apologies from staff and a lot of follow up calls after that. During an interview on 07/16/24 at 11:06 AM, LVN A stated if a resident falls, the protocol was to assess the resident, take vitals, call family, notify nursing supervisors, and notify provider. She stated a possible negative outcome of family not being made aware of a family member falling would be terrible, and if it were her family member, she would want to be notified. During an interview on 07/16/24 at 11:09 AM, RN B stated if a resident falls, the protocol was to assess the resident, take their vitals, assess what might have contributed to the fall, notify family, physician, and nursing supervisor. He stated a possible negative outcome for not calling the family it might take them by surprise especially if the resident had a bad injury resulting from the fall. He stated the family deserve to be in the loop just as much as everybody else. He stated it was a part of the facilities protocol to notify the family immediately. During an interview on 07/16/24 at 11:13 AM, LVN C stated if a resident falls, the protocol was to assess the resident, take vitals, call family, physician, and let nursing supervisors know. She stated if she did not reach the family, she would keep calling them back until she spoke with them, and not just leave a message. She stated the importance of calling the family would be that family members need to know what was going on and that if it were her family, and she was not notified, she would be mad. During an interview on 07/16/24 at 11:15 AM, the DON stated the fall protocol for the facility was to first notify the physician, then notify the family immediately or as soon as possible. She stated the charge nurses are responsible for calling the family and physician. Stated there was a report in the health records that are sent to her when family and physician are contacted, but DON could not find that report of when the family member was called or what time it happened. The DON stated a possible negative outcome for not calling the family was they would be upset. During an interview on 07/16/24 at 11:26 AM, Surveyor requested from DON the facility policy regarding protocol for reporting falls. During an interview on 07/16/24 at 11:35 AM, RN D stated she did not call the family of Resident #1. She stated she was waiting with Resident #1 for the ambulance to arrive and she thought another nurse was going to call the family. She stated she did call the physician and it was her responsibility to call the family but there was a miscommunication, and it did not happen. RN D stated the DON called the family member about 7 or 8 the next morning. She stated a possible negative outcome for not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 2 of 3 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 675904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/16/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windflower Health Center 5500 SW 9th Ave Amarillo, TX 79106 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 0580 Level of Harm - Minimal harm or potential for actual harm calling the family was that something bad could have happened to Resident #1 and the family would not have known about it. During an interview on 07/16/24 at 11:51 AM, the DON stated they did not have a policy regarding protocol for notification or reporting falls. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 3 of 3