Health inspection·February 26, 2025

F 0694 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some was no date and no initials on the dressing. She stated Resident #1 had reported to her that the dressing had not been changed since before he was admitted to the facility. She reported she went and told the ADON (name unknown) and told her what she had found. She stated the ADON stated, thank you. RN B reported that Resident 1's IV antibiotics had completed yesterday. Review of physician order by Physician E dated 02/26/25 at 01:56 pm ordered the PICC line catheter to the left upper arm to be discontinued. In an interview and observation on 02/26/25 at 02:40 pm, Resident #1 reported his Veteran's Affair nurse was here today (02/26/25) and had noted that his PICC line dressing was dirty. He stated the dressing had never been changed since he was admitted to the facility and the dressing did not have a date on it. He reported that a facility nurse had discontinued the PICC line within the past two hours. A small round scab was noted to his left upper arm. He reported the Band-Aid had fallen off. In an interview on 02/26/25 at 04:27 pm, LVN C reported she had worked with Resident #1 for two weeks in the evenings on Monday through Fridays and had given him his IV antibiotic once each day. She reported she had never changed his PICC line dressing. She reported that PICC line dressings are supposed to be changed every seven days. She stated she does not remember what the date on his PICC line dressing was. She reported there was no order that prompted her to change the dressing. She reported she flushed the PICC line with normal saline before and after each medication administration. She reported that a risk of not changing the dressing would be a risk to the resident for infection and that the dressing could become loose and the PICC line possibly fall out. She reported that signs of infection including abnormal drainage, redness, tenderness/pain, swelling are some signs of infection at the sight. She reported that Resident #1 has not had any of those signs of infection at his PICC line sight since she has been providing his care. She reported she had not received any PICC line training at the facility since her hire two weeks ago In an interview on 02/26/26 at 005:00 pm, LVN D reported that she had provided Resident #1 with IV antibiotics on the weekends over the past two weeks through his left upper arm PICC line. She reported she did not remember what the date on the dressing was. She reported she had flushed the port with normal saline before and after the medication. She reported she had never done the dressing change because she did not see an order to do one and there was usually an order. She reported the policy was to change the dressing every seven days and that failing to do so could place the resident at risk of infection or embolism. She reported there was no redness, warmth, infiltration, or other sign of infection at the PICC line site of Resident #1. She reported she had previously received PICC line training at the facility including the need to change the dressing weekly. In an interview on 02/26/25 at 05:30 pm, the DON reported she was aware that a Veteran's Affair nurse had visited Resident #1 today (02/26/25) and had reported an issue with his PICC line dressing not being changed. She reported the physician ordered the PICC line discontinued because the resident had completed his IV antibiotics. She reported she had begun educating the nurses to make sure there are orders present for PICC line care. reported that not having the orders could increase the risk of nurses failing to provide the care. She stated her expectation is that nurses will add the orders for PICC line care in the the electronic medical record upon the admission of a resident, including flush orders, monitoring site orders, and dressing change orders. She did not state who was responsible for monitoring this. She reported the facility policy was that PICC line dressing were changed every seven days. She reported she expected that PICC line dressing changes were documented in the resident's electronic medical record. She did not discuss what training nurses had previously received for PICC line care. She She reported a resident would be at risk for infection if their dressing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676139 If continuation sheet Page 2 of 3 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 676139 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Green Oaks Nursing & Rehabilitation 3033 W Green Oaks Blvd Arlington, TX 76016 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 0694 was not changed. Level of Harm - Minimal harm or potential for actual harm Review of Resident #1's records did not reflect PICC line related infection or complications. Residents Affected - Some In an interview on 02/26/25 at 06:10 pm, Physician E reported that he was unaware that Resident #1's dressing was not being changed or that his orders for PICC line care had not been entered. He reported these orders are part of standing orders when a resident is admitted to the facility with a PICC line. He reported PICC line dressings are typically changed weekly. He reported that Resident #1 had not experienced any infection or adverse reaction related to the dressing not being changed, and that Resident 1's recent blood work showed his inflammatory markers had improved. He reported that today he gave an order to discontinue the PICC line as Resident #1 had completed his antibiotics. Review of the facility's policy (undated) titled, Central Venous and Midline Catheter Flushing reflected to, Flush catheters at regular intervals to maintain patency AND before and after the following: b. administration of medications . Review of the facility's policy (undated) titled, Central Venous Catheter Dressing Changes reflected to, Change transparent semi-permeaable membrane (TSM) dressings at least every 5-7 days and PRN (when wet, soiled, or not intact) . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676139 If continuation sheet Page 3 of 3