Health inspection·September 4, 2025

F 0697 Provide safe, appropriate pain management for a resident who requires such services. 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 ensure that pain management was provided to residents who required it for 1 of 8 residents (Resident #1) reviewed for pain. The facility failed to make sure that each resident's clinical record contains the physician's signed and dated orders that also were handled appropriately if any changes were made for 1 (Resident #1) of 8 Residents reviewed for physician orders in that: - Facility failed to obtain physician orders for [[NAME]] Cold Therapy Unit which was used to provide cold therapy to reduce pain and swelling for Resident #1. This failure could place residents at risk for incorrect treatment decisions, evaluation, and treatment plans compromising patient safety due to insufficient information and could cause confusion about the resident's care and place residents at risk for harm due to inaccurate records Findings included: Record review of Resident #1's admission record dated 09/04/25 revealed a [AGE] year-old female who was admitted to the facility on [DATE] with the diagnosis of unspecified hyperlipidemia (this is elevated lipid levels in the body without a clearly identifiable cause). admission record did not have other diagnoses. Record review of Resident #1's hospital discharge date d 08/29/25, revealed Resident #1 was a [AGE] year-old female who had Type II Diabetes mellitus [uncontrolled blood sugars], Atrial fibrillation [heart irregularity and arrhythmia], Hyperlipidemia, GERD [heart burn/irritation], and Chronic low back pain. [Resident #1] presents with a chief complaint of left knee pain. She has had the symptoms for 2 years. She was previously diagnosed with osteoarthritis in 2006 [(a degenerative joint diseases that primary affects the left knee joint causing pain. Stiffness, and reduced mobility)] and underwent an arthroscopic debridement [(this a surgical procedure that involves removing damaged tissue from a joint)]. She had relief for 1-2 years. She has had progressive pain in the knee over time. She has had multiple steroid injections with temporary relief. Her last steroid injection was in February 2025. She did not have any relief with [name] supplementation. She has been receiving home physical therapy, which has been helping her mobility and strength, but pain persists. She still has popping in the knee, as well as deep pain. She has been receiving Oxycodone [(pain medication)] and Lyrica [(nerve pain medication)] for chronic pain from [Physician name], a pain management specialist. Record review Resident #1's admission MDS on 09/04/25, revealed document was in progress status. Record review of Resident #1's active physician orders on 09/04/25 did not reflect physician order for ICTU therapy. Record review of Resident #1's care plan initiated on 09/03/25 did not reflect focus, goals, or interventions for use of ICTU therapy. Observation and interview with Resident #1 and Medication Aide on 09/04/25 at 07:50 AM, revealed Resident #1 was in bed with both legs uncovered. The left leg had a black knee immobilizer brace on and on top of her knee opening was a blue ice pad of the [[NAME]] Cold Therapy Unit in place connected. The ICTU cooler box was placed on the floor at the end of the bed. She said that she had the ICTU since she admitted [9/2/25], and the ice was only refilled yesterday [09/03/25] at 7 pm. Resident #1 stated that the nurse had already administered pain Residents Affected - Few (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: 676139 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 09/04/2025 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)