Inspection·November 16, 2023

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident #3's prior level of functioning (before his current illness or injury) was documented as independent in self-care, mobility, and cognitive function. Review of Resident #3's care plan, initiated 10/28/23, reflected the resident was at risk for falls, with the intervention of Be sure the call light is within reach and encourage to use it to call for assistance as needed. ( .) Needs a safe environment: floors free from spills and/or clutter; adequate, glare-free light; a working and reachable call light, ( .) Review of Resident #4's face sheet, dated 11/16/23, reflected he was a [AGE] year-old male, admitted on [DATE], with diagnoses of acute respiratory failure, schizophrenia, generalized muscle weakness, and other abnormalities of gait and mobility. Review of Resident #4's admission MDS, dated [DATE], reflected he was able to understand others, and be understood by others, and had a BIMS score of 12, indicating potential moderate cognitive impairment. Resident #4 had no behavioral issues, or indicators of psychosis. He required supervision to limited assistance of one person for ADL's. Review of Resident #4's care plan, revised on 10/02/23, reflected he was at risk of falls, with the intervention of Be sure the call light is within reach and encourage to use it to call for assistance as needed. ( .) Needs a safe environment: floors free from spills and/or clutter; adequate, glare-free light; a working and reachable call light, ( .) Review of Resident #5's face sheet, dated 11/16/23, reflected she was a [AGE] year-old woman, admitted to the facility on [DATE], with diagnoses of Alzheimer's, new daily persistent headache, and restlessness and agitation. Review of Resident #5's Quarterly MDS, dated [DATE], reflected the resident was rarely or never understood. The document reflected staff were unable to assess her cognitive function. Resident #5 used a wheelchair. Review of Resident #5's care plan, revised on 09/27/23, reflected the resident was at risk of falls, with an intervention of Needs a safe environment: floors free from spills and/or clutter; adequate, glare-free light; a working and reachable call light, ( .) Observation on 11/16/23 at 9:31 AM revealed Resident #1 and Resident #2 both in bed, sleeping soundly. Resident #1's call button cord was hanging over itself where it was plugged into the wall, and not within her reach. Resident #2's call button was not in reach, but was clipped to the call light cord, near where it was plugged into the wall. An interview and observation on 11/16/23 at 9:35 AM with RN A revealed she did not think Resident #1 would ever be able to use her call light, because she was not alert, and they had to anticipate all of her needs. She thought Resident #2 might use hers though, because she was alert and went around in her wheelchair. She was new, so she was not sure. She then went into the room, roused Resident #2, placed her call button on her bed next to her hand, and told the resident where it was. The resident did not say anything. An observation on 11/16/23 at 9:43 AM of Resident #5 revealed her to be sleeping soundly. Her call light was hanging over the headboard of her bed, with the button between the headboard and mattress, and the level of the mattress was higher than the top of the headboard, placing the button out of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676023 If continuation sheet Page 2 of 3 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 676023 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Keller Oaks Healthcare Center 8703 Davis Blvd Keller, TX 76248 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)

F 0558 sight for a person at the level of the mattress. Level of Harm - Minimal harm or potential for actual harm An interview and observation on 11/16/23 at 9:46 AM revealed Resident #3 and Resident #4 to be alert, and able to speak with the surveyor. Both of their call buttons were visible beneath their beds, near the center of the bed. He said he did not know his call button was under his bed, and he had not ever used it, and was not really aware of it. He said he did not need it, because the staff came and checked on him so much. Resident #3 said he had once tested his call light out of curiosity and unplugged it. He said it was plugged in now. He said he was not aware it was under his bed, but he had not used it, and had not missed it, because the staff checked on them, and he got up and did whatever he wanted to do. Residents Affected - Some An interview on 11/16/23 at 9:54 AM with CNA B revealed the rooms where the call lights were not in place were the part of the hallway he was responsible for, and he was responsible for making sure the buttons were in place. He said he was new at the facility but had been a CNA for a long time, and the facility went through all of the training with him when he started, which included call lights. He said he checked on his residents frequently and was not aware any of the lights were out of reach of the residents. He said that if they could not use them, they could possibly fall or not be able to get someone's attention. An observation on 11/16/23 at 9:57 AM revealed Resident #2 to be awake, but non-interviewable. An interview on 11/16/23 at 11:07 AM with ADON C revealed all staff were responsible for checking call lights when they were in the rooms, but the CNAs were at the forefront, because they went into the rooms so often. She said the call lights were important because they were the residents' lifeline. An interview on 11;16/23 at 11:29 AM with ADON D revealed the hall where the call light concern was noted was one of the halls she was responsible for, and when she heard there was an issue with call lights, she went to check. She said Residents #1, #2, and #5 would be able to use a call light, but in the room Resident #3 and Resident #4 shared, one of the lights was still under the bed when she checked, and one was clipped to the bed. She said that even residents who were confused should have call lights within reach. She said it was both a dignity and a safety issue, and the lights enabled residents to let staff know if they needed help, or were in pain or distress, or even just needed some ice. An interview on 11/16/23 at 2:49 PM with the Administrator revealed her expectation to be that call lights were within reach of all residents. She said Residents #1, #2, and #5 would not be able to use a call light and some of them were on hospice. She said they made accommodations for any resident who would be able to use one, like using the touch pad type of button. The Administrator said Resident #3 and Resident #4 both were very independent and able to walk and talk. She said there were many risks for a resident in not being able to get assistance as needed, including falls. She said the call lights were part of the angel rounds the staff did every morning, and in the section of the hall where the problem was found, she thought the person responsible for those rounds had not done them yet, due to finishing up helping with breakfast. Record review of facility policy Routine Procedures: Call Light/ Bell, revised 07/2015, reflected POLICY: It is the policy of this facility to provide the resident a means of communication with nursing staff. PROCEDURES: ( .) 5. Leave the resident comfortable. Place the call device within resident's reach before leaving room. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676023 If continuation sheet Page 3 of 3