F 0558
Reasonably accommodate the needs and preferences of each resident.
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 provide reasonable accommodation of
resident needs for 1 (Resident #138) of eight residents reviewed for call lights:
Residents Affected - Few
Resident #138's call light was not placed within reach and provided with a soft ball device for ease of use
by the resident.
This failure could place residents who used call lights for assistance in maintaining and/or achieving
independent functioning, dignity, and well-being.
Findings included:
Record review of Resident's #138's admission record face sheet, dated 05/17/23 indicated Resident #138
was an 88 -year-old male admitted on [DATE] with dementia (inability to remember, think, or make
decisions), hypertension (high blood pressure), diabetes (metabolic disorder in which body has high sugar
levels for prolonged periods of time, heart failure (heart disease that affects pumping of the heart muscles),
chronic ulcer of the other part of left foot (a perforation of the skin), spinal stenosis (spinal canal narrowing,
causing pain), dorsalgia (pain in the upper back), and hallucinations (sensory experiences that appear real
but are created in the mind).
Record review of Resident #138's admission MDS dated [DATE] revealed resident
-had a BIMS score of 09 with cognition moderately impaired.
-had other behavioral symptoms not directed toward others (physical symptoms such as hitting or
scratching self, pacing, rummaging, public sexual acts)
-required extensive assistance by two persons for bed mobility, dressing, toilet use, and personal hygiene.
-required extensive assistance by one person for transfers.
-used a wheelchair as mobility device.
Record review of Resident #138's care plans indicated resident was at risk for falls related to weakness and
debility, date initiated 04/27/23.
Interventions included Be sure the resident's call light is within reach and encourage the resident
(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:
676119
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
676119
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/18/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Rio Grande City Nursing and Rehabilitation Center
2530 Central Palm Dr
Rio Grande City, TX 78582
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 - Few
to use it for assistance as needed. The resident needs prompt response to all requests for assistance, date
initiated 04/27/23.
Observation and interview on 05/17/23 at 9:38 am revealed Resident #138 seated in his wheelchair in his
room next to his bed. Resident's call light cord was clipped to the pillow in his bed and the cord was lying
across his bed. The push button for call light was on the opposite side of the bed from where Resident #138
was sitting in his wheelchair. Resident #138 said he would use his call light to ask for help but he but could
not reach the call light where it was placed. Resident #138 said he would have to yell out if he needed help.
Interview on 05/17/23 at 9:40 am with CNA A revealed he had transferred Resident #138 into his
wheelchair and forgot to clip the call light cord to the resident's shirt so he could use his call light to ask for
help. CNA A said Resident #138 was able to use his call light, but he forgot to place it on his lap when he
had transferred the resident.
On 05/17/23 at 9:45 am Resident #138 demonstrated he could use the push button call light. Resident
#138 said his right shoulder and arm were hurting.
On 05/17/23 at 2:51 pm interview with LVN C revealed staff were in-serviced on placing resident's call lights
within reach so they could use when they needed assistance. A new call light with a soft ball or bulb was
placed for Resident #138 so he could use without pain or discomfort. LVN C resident had not voiced he felt
pain when using the push button call light.
On 05/17/23 at 2:55 pm, Resident #138 demonstrated he could use the soft ball bulb call light device
without pain or discomfort.
Interview on 05/17/23 at 3:20 pm with the DON revealed the staff should have placed Resident #138' call
light where he could reach even when he was seated in his wheelchair. The DON said a soft ball/bulb type
of call light should have been provided to the resident since he had recently had a seizure that affected his
right shoulder and arm. The DON said Resident #138 had not voiced he had pain when using his call light
button even after he had the seizureThe DON said if the resident didn't have his call light accessible and
within his reach, he would not be able to call for help or assistance.
Record review of the facility policy titled Answering the Call Light dated July 2015 indicated The purpose of
this procedure is to respond to the resident's requests and needs. When the resident is in bed or confined
to a chair, be sure the call light is within easy reach of the resident.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676119
If continuation sheet
Page 2 of 2
