Health inspection·June 14, 2025

F 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure each resident had a right to personal privacy which and confidentiality of his or her personal and medical records, which included included accommodations, medical treatment, written and telephone communication, personal care, visits, meetings of family, resident groups, for 1 (Resident #1) of 2 residents reviewed for resident privacy. Residents Affected - Few The facility failed to keep Resident #1's catheter bag covered in a privacy bag. This failure could place residents at risk of experiencing feelings of shame and/or embarrassment as well as having their right to privacy violated. Findings included: Record review of Resident #1's face sheet dated 06/14/2025 revealed an [AGE] year-old female who was admitted to the facility on [DATE]. Resident #1 had diagnoses which included, but were not limited to, hypertensive heart disease without heart failure (hypertension, with or without enlargement of the heart (left ventricular hypertrophy) is usually symptomless), edema-unspecified (swelling), chronic kidney disease, state 4 (severe) (severe loss of kidney function), retention of urine (a condition in which you are unable to empty all the urine from your bladder), pain, other reduced mobility, cognitive communication deficit (trouble participating in conversations), localized swelling, mass and lump, lower limb, bilateral, essential (primary) hypertension (elevated blood pressure), peripheral vascular disease (the reduced circulation of blood to a body part other than the brain or heart), muscle weakness. Record review of Resident #1's quarterly MDS, dated [DATE] revealed Resident #1 had a BIMS score of 10, which indicated Resident #1 had a moderate cognitive impairment. Functionality for Resident #1 revealed required moderate assistance with bathing/showering. Supervision was required with toileting, dressing lower half of body, taking off and putting on footwear, and personal hygiene. Resident #1 was able to perform eating and oral hygiene independently. Section H of MDS revealed no need for a foley catheter. Record review of Resident #1's significant change MDS, dated [DATE], revealed Resident #1 was on Hospice and required a foley catheter. Record review of Resident #1's care plan with a revision date of 06/10/2025, revealed the following: Focus (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 11 Event ID: 675945 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 675945 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Care Center 1506 Childress St Wellington, TX 79095 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)