Health inspection·May 13, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure that all alleged violations involving abuse, neglect, exploitation, or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately for 1 of 4 residents (Resident #1) reviewed for reporting, in that: The facility failed to report the allegation of neglect for Resident #1 to the State Agency within required reporting timeframes. This failure could place residents at risk ongoing abuse or neglect. Findings included: Review of Resident #1's face sheet dated 05/13/2025 revealed an [AGE] year-old female admitted to the facility on [DATE] with a readmission on [DATE]. Admitting diagnosis of other fracture of lower end of the left femur, subsequent encounter for closed fracture with routine Healing (bone breaks, but there is no break in the skin over the injury; cast change or removal of external or internal fixation device, medication adjustment, other aftercare, and follow-up injury treatment); unspecified dementia mild, with other behavioral disturbances (dementia that doesn't fit into a specific type by has a mild severity and presents with other behavioral issues); and essential (primary) hypertension (high blood pressure where the underlying cause is unknown). Record review of Resident #1's Annual MDS (Minimum Data Sheet) dated 04/12/2025 revealed Resident #1 BIMS (Brief Interview for Mental Status) score was noted to be 02/15 indicating severe cognitive impairment. Resident #1 required total assistance with all ADL care including bed mobility and transfers. Record review of Resident #1's progress notes revealed the following: * 01/09/2025 revealed Resident #1 c/o pain on the left knee to LVN A and upon assessment the knee looks swollen. 2 Tylenol 325 mg administered for pain, vital signs taken, physician was notified and gave an order for x-ray on the left knee. Order updated in the system and waiting for the technician. DON and ADON were notified. *01/10/2025 results of x-ray received and sent to NP for review. Orders given for Resident #1 to be transferred to hospital for further evaluation. *01/15/2025, Resident #1 returned to facility from hospital with diagnosis of unspecified fracture (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 3 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 05/13/2025 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)