Inspection·April 23, 2024

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some cognitive impairment. Resident #2's MDS further revealed Resident #2 had total dependence with bathing, occasional urinary incontinence, and frequent bowel incontinence. Record review of Resident #2's care plan, dated 4-10-2023, indicated Resident #2 had an ADL self-care deficit in bed mobility, transfers, eating, dressing, grooming, and hygiene stating Encourage to use bell to call for assistance. Resident #2's care plan further stated Resident #2 had an actual fall on 7-28-2023 and stated 7/28/23 educated on using call light Date Initiated: 07/31/2023. In an observation/interview on 4-23-2024, at 1:10 PM, revealed Resident #2 laying in her bed with her call light out of reach, hanging 1 inch above the floor, next to the wall. Resident #2 spoke in a very soft voice to the point; that one needed to get within 2 feet of the Resident's mouth to hear her. Resident #2 stated she did not know where her call light was, and she used it. Record review of Resident #3's face sheet, dated 4-23-2024, indicated a [AGE] year-old female admitted to the facility on [DATE]. Resident #3 had a primary diagnosis of Alzheimer's disease, history of falling, chronic obstructive pulmonary disease (a group of diseases that cause airflow blockage and breathing-related problems), and orthopedic joint implants. Record review of Resident #3's MDS, dated [DATE], indicated a BIMS score of 00 indicating severe cognitive impairment. Resident #3's MDS further indicated Resident #3 ambulated in a wheelchair and was always urinary incontinent and always bowel incontinent. In an observation/interview on 4-23-2024, at 1:50 PM, revealed Resident #3 lying on her bed with her call light out of reach, underneath her bed. Resident #3 had a communication challenge but stated she needed her call light. Record review of Resident #4's face sheet, dated 4-23-2024, indicated an [AGE] year-old female admitted to the facility on [DATE]. Resident #4 had a primary diagnosis of dementia without behavioral disturbance, congestive heart failure, osteoarthritis of hip, and lack of coordination. Record review of Resident #4's MDS, dated [DATE], indicated a BIMS score of 02, indicating severe cognitive impairment. Resident #4's MDS further indicated the need for extensive assistance for bed mobility, movement in her bedroom, dressing, personal hygiene, and toilet use. Record review of Resident #4's care plan, dated 8-13-2023, revealed Resident #4 had an injury of an unknown origin related to osteoarthritis (degeneration of joint cartilage and the underlying bone) and osteopenia (lower than normal bone mass) with fracture to left fifth digit stating that facility staff need to Be sure call light is within reach and respond promptly to all requests for assistance. Resident #4's care plan further stated Resident #4 is bilingual and at times is at risk for a communication barrier as her dementia will cause her to speak in Spanish and staff should ensure/provide a safe environment, call light in reach, adequate low glare light, bed in lowest position, wheels locked, and avoid isolation. In an observation/interview on 4-23-2024, at 1:55 PM, revealed Resident #4 did not speak English and did not respond to my questions. Resident #4 was lying in her bed and her call light was not in reach touching the floor. (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 04/23/2024 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an interview with CNA/CMA A, on 4-23-2024, at 2:05 PM, it was revealed that when call lights were not within reach of residents, there was a risk they could fall and get hurt. In an interview with LVN A, on 4-23-2024, at 2:48 PM, it was disclosed that she worked the 200-hall area and expected her CNAs to make rounds every two hours; making sure call lights were within reach. LVN A stated the risk to residents who could not reach their call light was a high risk and they may not get the care they need. In an interview with the DON, on 4-23-2024, at 4:20 PM, it was revealed that the risk to residents not having their call lights within reach was the residents might not get the help or care they needed. The DON stated that the facility needed to anticipate the needs of residents who unclipped their call lights and let them drop to the ground. In an interview with the Administrator, on 4-23-2024, at 5:22 PM, revealed that her expectations were for call lights to be within reach and for staff to make rounds ensuring they are in place. The Administrator stated the nurses were responsible to ensure the CNAs placed the call lights within reach of the residents. The Administrator stated the risk, to the residents, of call lights not being within reach, was their needs might not be met. Record review of the facility's call light policy, dated August 2020, stated: It is the policy of this facility to provide the resident a means of communication with nursing staff by .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