Inspection·May 25, 2023

F 0839 Employ staff that are licensed, certified, or registered in accordance with state laws. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure that professional staff were licensed, certified, or registered in accordance with applicable State laws for one of one staff (Administrator A) reviewed for staff qualifications. Residents Affected - Many The facility failed to ensure the Administrator had a license. This failure could place residents at risk of a diminished quality of care and being supervised by unqualified personnel. Findings included: Record review on 05/25/23 of the facility census revealed 61 residents were present in the facility Interview on 05/25/23 at 2:55 PM the Administrator A stated she began working at the facility on 01/16/23 under the previous licensed administrator, she took on the role of administrator on 02/03/23 working under the license of Administrator B. Administrator A stated she had tested on [DATE] to become a licensed Administrator in Texas but had not received official notification of her license. Administrator A stated there was no risk involved to the residents because she worked closely with Administrator B and communicated with her regarding all issues and concerns. Review of the Nursing Facility Administrator Licensing System on 05/25/23 revealed the status of Administrator A and Administrator B were Prospective. Record review of the facility's Licensure, Certification, and Registration of Personnel policy, revised April 2007, reflected: .Employees who require a license, certification, or registration to perform their duties must present such verification with their application for employment. 1. Personnel who require a license, certification, or registration to perform their duties must present verification of such license/certification/registration to the Human Resources/Director designee prior to or upon employment. .6. Should the background investigation reveal that the employee/applicant does not hold current unencumbered or valid license/certification/registration, the employee will not be employed (or discharged if employed) and appropriate stated and federal officials will be notified 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: 676004 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 676004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Hills Nursing & Rehabilitation 201 E Thompson St Decatur, TX 76234 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)