Health inspection·December 1, 2023

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 promote care for resident in a manner and in an environment that maintained or enhanced each resident's respect and dignity for 1 (Resident #1) of 3 residents reviewed for dignity in that: The facility failed to provide dignity and respect for Resident #1 by leaving the resident on the floor face down with his buttocks exposed. This failure could place residents at risk for embarrassment. Findings include: Record review of Resident #1's face sheet dated 11/30/23 revealed he was a [AGE] year-old male admitted to the facility on [DATE]. Resident #1's diagnoses included: hypoglycemia (low blood sugar), Parkinson Disease, Depression, Heart Failure, Dysarthria and Anarthria, Secondary Malignant Neoplasm, Anemia, Morbid Obesity, Chronic Atrial Fibrillation, Cognitive Communication Deficit, Type 2 Diabetes, Unspecified Dementia, Peripheral Vascular disease, Muscle Weakness, Dysphagia Edema, Hypertension, Vitamin Deficiency, Presence of Coronary angioplasty implant and Graft, and Muscle Weakness, Muscle weakness and atrophy. Record review of Resident #1's Comprehensive MDS dated [DATE] revealed Resident #1 had a BIMS of 10 which indicated moderately impaired cognition. Section H noted the resident had bowel continence and urine continence. Record Review of Resident #1's care plan dated 07/13/23 revealed Resident #1 had a plan for assistants with ADL due to declining physical status. Resident needs help with bathing, dressing, incontinence care, and transfer. Resident was also care planned for falls. Precautions to prevent falls were bed in lowest position fall matt and during transfer two person assist and Hoyer lift. Observation of a photo on 11/30/23 at 10:45 am. that was obtained from CNA-A revealed Resident #1 was lying on the floor in his room face down with his buttocks exposed. Resident #1 brief was position in a manner to where his buttocks was completely exposed for anyone to see. In an interview on 11/30/23 at 6:36 p.m. with CNA-A revealed that she went into Resident #1 room at the beginning of her shift to check on the residents on her assigned hall when she discovered him lying on the floor face down and his buttocks exposed. CNA-A said she took a photo of the resident to show administration what condition the resident was in because the facility's Nursing staff refused (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 4 Event ID: 676050 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 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 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)