Health inspection·February 15, 2024

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 of 11 residents reviewed for infection control. (Resident #1). Residents Affected - Few The facility failed to place Resident #1 in contact isolation following a wound culture ( a test to determine if microorganisms that cause infections are in the wound) indicating the resident had staphylococcus aureus (a bacteria that causes infections) in her wound. This failure could place residents at risk for being exposed to health complications and infectious diseases. Findings included: Record review of Resident #1's face sheet printed on 02/14/24 indicated Resident #1 was a 66 -year-old female and admitted on [DATE] with diagnoses including heart disease, dementia, and hereditary ataxia (degenerative changes in the brain and spinal cord which affects walking, coordination, and speech). Record review of the MDS dated [DATE] indicated Resident #1 indicated she had BIMS score of 11 which indicated moderate cognitive impairment. Resident #1 required assistance of 1 staff with bathing grooming and eating. Record review of Resident #1's care plan dated 02/06/24 indicated for the wound infection the interventions were to give the resident medications per physician's orders, monitor labs and wound cultures and report abnormal results to the physician. Record review of Resident #1's wound culture laboratory report dated 02/09/24 indicated she had staphylococcus aureus (bacteria) in her sacral wound and was resistant to methicillin, tetracycline and macrolide antibiotics. Record review of Resident #1's physician orders dated 02/14/24 indicated to obtain a wound culture and sensitivity from her sacrum related to diagnoses of cellulitis on 2/7/2024. The orders included to place the resident in contact isolation related to bacteria in the wound that was resistant to macrolide, methicillin, and tetracycline (antibiotics used for skin infections) with start date of 02/14/2024. (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 2 Event ID: 676094 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 676094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Orange 4201 Fm 105 Orange, TX 77630 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)