Health inspection·July 2, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure residents had the right to a safe, clean, comfortable, and homelike environment for 1 of 5 facility shower room and hallway (MU) were reviewed for environment. 1. The facility failed to ensure shower chairs and shower curtains were thoroughly cleaned and stored away from Memory care residents, staff, and visitors. 2. The facility failed to discard used water bottles located on shower chair on the memory unit. These failures could place residents at risk of living in an unclean and unsanitary environment which could lead to a decreased quality of life. An observation on 07/02/2025 at 12:06 PM the facility hydration cart was left open unattended with the ice exposed and the metal scoop. After waiting for approximately 4 minutes, CNA-M was observed coming out of a resident’s room [ROOM NUMBER] minutes later. An observation on 07/02/2025 at 12:39 PM of the memory unit, revealed 3 shower chairs shower chairs, stored in the hallway outside of the shower room where staff, residents, and visitors ambulated. Shower chair #1 was observed with light brown smear stains and shower chair #3 was observed with 1 large industrial size shower curtain and an empty 16.9-ounce clear water bottle. Another observation revealed an unattended housekeeping cart with used mop water and trash assessable to residents on the memory unit. In an interview on 07/02/2025 at 12:45 PM, LVN-B was advised about the 3 shower chairs located in the hallway with a large shower curtain tossed across the chair and an empty water bottle. LVN-B said that the chairs were stored in the hallway, due to recent construction on the shower room. She stated that facility staff have not used the shower on the unit for approximately 2 weeks. LVN-B-said there are residents that ambulate independently on the unit. LVN-B said the staff are sanitizing and cleaning the shower chairs before and after use, despite the stain on the chair. LVN-B said she had not reported the stains on the shower chair to leadership for cleaning or replacing. She stated housekeeping and the nursing staff were responsible for ensuring the residents environment was safe, clean, and sanitary as well as free of hazards. LVN-B did not provide a response when questioned about the potential risks to residents and visitors associated with storing large equipment in the hallway. In an interview on 07/02/2025 at 3:45 PM, the DON stated the shower room on the unit was under construction, however, the shower chairs, shower curtain should be stored in a safe location to prevent hazards for those walking through the hallway. The curtain observed tossed across the shower chair and empty water bottle placed with it was considered to be easy access for resident that ambulate and infection from cross contamination. The DON said the shower chairs, shower curtain, and housekeeping cart had been moved to a storage room on the unit away from residents and visitors, therefore, eliminating hazards. The DON said she was not made aware of the shower chair that was stained and would follow up with the ADMIN. (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 5 Event ID: 676135 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 676135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Presbyterian Village North Special Care Ctr 8600 Skyline Dr Dallas, TX 75243 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)