Health inspection·May 12, 2024

F 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure residents were treated with dignity and respect for 3 (Resident #1, #5, and #7) of 10 residents reviewed for residents' rights in that: -Resident #1 was found to have soiled (feces) wipes left in her brief until her scheduled shower time. -Residents #5 and #7 did not have their briefs changed in a timely manner according to the facility's policy and procedures. These deficient practices could place residents at risk for impaired dignity, loss of self-worth, and a decline in psychosocial well-being. Findings included: Resident #1 Record review of Resident #1's face sheet revealed a [AGE] year-old female admitted on [DATE] with diagnoses of Lymphedema (define), Rheumatoid Arthritis (define), Primary Hypertension (high blood pressure), and Generalized Muscle Weakness. Observation and Interview on 5/11/2024 at 1:57 PM revealed Resident #1 alert and oriented to person, place, time, and event. Her daughter was at her bedside. Staff transferred Resident #1 from the bed to her wheelchair. She was waiting to be discharged from the facility. The resident said the facility was short staffed, so the level of care was inadequate and unacceptable . She said she was incontinent to bowel and bladder. She said the CNA left soiled (feces) wipes in her brief before bringing her to take her scheduled shower. She said knowing a soiled wipe had been left in her brief made her feel uncomfortable and upset. She said she told her daughter, spoke with the administrator, and filed a grievance. She said the treatment and conditions were unacceptable, and she could not wait to leave the facility. She said she felt dehumanized when they left the soiled wipe in her brief. She said she was embarrassed and worried about potential infection from the fecal contact with her private parts. Resident #5 Record review of Resident #5's face sheet revealed a [AGE] year-old female admitted on [DATE] with diagnoses of schizoaffective disorder (combination of symptoms of schizophrenia and mood disorder, (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: 675991 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 675991 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Manor of Humble 19424 McKay Dr Humble, TX 77338 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)