Health inspection·July 18, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that included measurable objectives and time frames to meet a resident's medical, nursing and mental and psychological needs that were identified in the comprehensive assessment for 1 of 5 residents (Resident #1) reviewed for comprehensive care plans. The facility failed to implement an accurate individualized comprehensive care plan which identified Resident #1 would benefit from having quarter side rails applied to the bed to assist her with bed mobility. This failure could place residents at risk for injuries or illness associated with immobility. Findings include: Record review of Resident #1's face sheet dated 7/18/2023 revealed a [AGE] year-old female admitted to the facility on [DATE] with a re-admission of 4/25/2023. Record review of Resident #1's annual MDS assessment dated [DATE], revealed a BIMS score of 11, moderate cognitive impairment. Resident #1 had a diagnosis of stroke affecting the left side. Resident #1 was a one person assist for bed mobility, dressing, eating, toileting and personal hygiene and a 2 person assist for transfers, Record review of Resident #1's care plan, initiated 6/22/2023, Resident #1 was to have quarter side rails (right side rail) to bed to be used as safety/enablers. Interventions included quarter side rails up as per orders for safety during care provision to assist with bed mobility. In an observation on 7/18/2023 at 3:40 PM, the bed assigned to Resident had no quarter side rails on either side. In an observation on 7/18/2023 at 5:00 PM accompanied by the Admin and MDSC we walked into the room assigned to Resident #1, lifted the bedspread and observed the absence of quarter side-rails on either side of the bed. In an interview on 7/18/2023 at 3:30 PM, FM #2 stated sometime last month, they took the side-rails off her bed and now she was scared that she could fall out of bed. FM #2 had not talked to the physician about bed rails. FM #2 had not talked to Admin about Resident #1's fear of falling without the (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: 676098 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 676098 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Plaza at Richardson 1301 Richardson Dr Richardson, TX 75080 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)