Health inspection·December 4, 2024

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, and record review the facility failed to review and revise the person-centered comprehensive care plan to reflect the resident's current status, for 2 of 6 residents (Resident #37 and Resident #50) reviewed for care plans. The facility did not update Resident #37's care plan to reflect goals and interventions for Hospice. The facility did not update Resident #50's care plan to reflect goals and interventions for Hospice. This failure could place residents at risk for not receiving appropriate care and intervention to meet their current needs. The findings were: Review of Resident #37's MDS significant change assessment dated [DATE], reflected he was a [AGE] year-old female admitted on [DATE]. Her diagnoses included: Dementia (confusion), hypertension (high blood pressure), and diabetes (high blood sugar). She had a BIMS score of 2 which reflected his cognitive status was severely impaired. She required moderate to maximum assist of one staff member for activities of daily living. Section O of the MDS was marked for hospice. Record review of Resident #37's Care Plan initiated on 04/011/23 reflected, it had been edited/updated on 09/30/2024, [resident was on hospice services], further review reflected there was no goals and approaches for hospice. Record review of the consolidated physician orders dated 11/2024 reflected Resident #37 admitted to Hospice services on 09/18/2024. Review of Resident #50's MDS quarterly assessment dated [DATE], reflected she was a [AGE] year-old female admitted on [DATE] and readmitted on [DATE]. Her diagnoses included: Hypertension (high blood pressure), and dementia (confused). Her BIMS score of 3 reflected her cognitive status was severely impaired. She required moderate to maximum assist of one staff member for activities of daily living. Section O of the MDS was marked for hospice. Record review of Resident #50's Care Plan initiated on 06/24/24 reflected, the care plan had been edited/updated on 9/10/2024, [resident was on hospice services], further review reflected there was (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 6 Event ID: 676128 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 676128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Madison on Marsh 2245 Marsh LN Carrollton, TX 75006 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)