Health inspection·September 20, 2023

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review the facility failed to ensure residents were free from abuse for 1 of 7 residents (Res #1) reviewed for abuse. The facility failed to ensure CNA A did not verbally and physically abuse Resident #1 during ADL care. This failure placed residents at risk of abuse, decreased feelings of dignity, self-worth, and humiliation. Findings include: Record review on 9-20-2023 of the facility's face sheet reflected Res # 1 was born on [DATE] and was admitted to the facility on [DATE]. Res # 1 was diagnosed with dementia and cognitive communication deficit. Record review on 9-20-2023 of a ring doorbell video clip, date stamped 6-22-2023 at 7:32:06 AM, reflected two CNAs, CNA A and CNA B, in Res # 1's room having performed ADL care. The video showed CNA A having stood over Res # 1 and having spoken to Res # 1 in an aggressive manner in response to Res # 1 attempted touching of CNA B's body. CNA A was viewed having restricted both of Res # 1's forearms and having aggressively told Res # 1 not to touch women like that. CNA A continued to speak to Res # 1 in an aggressive tone about touching people. CNA A stated that people don't like that. Res # 1 was heard telling CNA A to be quiet, which sparked CNA A having responded with you be quiet! CNA A then leaned forward towards Res # 1, which prompted Res # 1 to having raised their left arm to a defensive position. In response to Res # 1's arm being raised, CNA A threatened Res # 1 having stated, I wish you would, I wish you would, I want you to! When CNA A stated, I want you to, she raised her right hand in the air and shook their first 4 times in unison with the syllables, I want you to! CNA A continued to state, come on; do it! Res # 1 was overheard telling CNA A that she would be on the floor. In response to Res # 1's response, CNA A stated, no I won't, you're going to be on the floor. CNA A told Res # 1 they would call the police if Res # 1 struck them. CNA B was overheard having told Res #1 that the police would take him to jail. Interview on 9-20-2023 at 12:55 PM with the DON revealed a family of Res # 1, LAR # 1, contacted the facility on 6-22-2023 after LAR # 1 viewed the incident on the ring camera. LAR # 1sent the video to the DON and the previous ADM. The DON stated that they substantiated the abuse and non-reporting based on the video. The DON stated, the ADM and the DON, brought both CNA A and CNA B into the office and terminated them both. The DON stated she assessed Res # 1 to find no injuries. (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: 675924 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 675924 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Rehabilitation and Healthcare Center 7801 Woodway Dr Waco, TX 76712 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)