Inspection·November 20, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure each resident was treated with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life for 1 of 6 residents (Resident #3) reviewed for dignity. The facility failed to allow Residents #31 to keep his electric wheelchair when he admitted to the facility. This failure could place residents at risk for a loss of dignity, decreased self-worth and decreased self-esteem. Findings included: Record review of Resident #31's quarterly MDS, dated [DATE], reflected the resident was a [AGE] year-old male admitted to the facility on [DATE]. His diagnoses included heart disease, end stage renal disease (a terminal illness that occurs when the kidneys can no longer function properly), and stroke. Resident #31 had a BIMS of 12 which indicated his cognition was moderately impaired. The MDS further indicated the resident had impairment on one side to his upper and lower extremities and used a wheelchair. Record review of Resident #31's care plan revised on 07/19/24 reflected the resident had an ADL self-care performance deficit and required limited assistance of one staff member for ADLs. Observation and interview on 11/19/24 at 9:11 AM revealed Resident #31 was in a manual wheelchair. The resident said when he was admitted to the facility he had an electric wheelchair and was told by someone, whom he could not recall, that it was against the rules to have the electric wheelchair unless he was given a test so he was given a manual wheelchair. Resident #31 said he did not believe it was fair that he did not get to keep his electric wheelchair and was never given a test to see if he could keep it. He stated he was just told they did not have room for it. The resident said he was able to get around good with the manual wheelchair, but he preferred to have his electric one. Record review of a progress note for Resident #31, dated 07/05/24, and documented by the previous DON reflected the following: Resident arrived to the facility in electric wheelchair. Wheelchair is not a necessity and resident has not been approved for use. Manual w/c offered to resident and he is able to move w/c using legs. W/C seat added for additional height for legs. Explained reason electric w/c is not allowed and (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 6 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 11/20/2024 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)