Health inspection·November 24, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for one (Resident #1) of five residents reviewed for care plans. The facility failed to ensure Resident #1's comprehensive care plan addressed their oral care and condition including the resident's risk and/or underlying causes (to the extent possible) of the resident's dental/oral condition and the impact upon the resident's function, mood, and cognition. This failure could place residents at risk of receiving inadequate interventions not individualized to their mental health and dental health care needs.Findings included: Record review of Resident #1's annual MDS dated [DATE], reflected the [AGE] year-old female resident was admitted to the facility on [DATE] with a BIMS score of 13, indicating the resident was cognitively intact but at risk for mild memory/recall difficulties. Diagnoses included: recurrent depressive disorder (persistent sadness, loss of interest, and low energy that affects daily life), anxiety disorder (ongoing excessive worry and nervousness that interferes with daily life), diabetes (a condition where the body can't properly use sugar for energy, leading to high blood sugar and possible complications), and heart disease (blood vessels that carry oxygen and nutrients to the heart get clogged or narrowed by fatty buildup also known as plaque). Resident #1 scored a 5 on the MDS Self-Performance for Oral Hygiene, indicating the resident required set-up or clean up assistance only. Record review of Resident #1's dental record dated 01/28/2025 reflected the resident was seen by the dentist for Step 3 of the denture process (refers to the multi-step phase in the multi-step process of creating custom dentures). The exam reflected the resident was edentulous (missing some or all natural teeth), with gingival inflammation (bleeding gums), and required a new upper partial and full lower denture. The note reflected that the dentist completed a bite registration (procedure to correctly align the new upper flexible partial denture and the new lower full denture). The dentist instructed nursing staff to provide oral hygiene twice daily, removing dentures at night, assist with cleaning, and encourage the resident to wear dentures. Record review of Resident #1' dental record dated 02/20/2025 reflected the resident was seen by the dentist for Step 4 of the denture process. The exam reflected a try-in was performed for the resident's new upper flexible denture and full lower denture. (This step allowed the dentist to verify the fit, comfort, and aesthetics of the dentures before the final versions were made). Record review of Resident #1's dental record dated 03/21/2025 reflected the resident was seen by the dentist for Step 5 of the denture process. The exam reflected the resident was provided with her upper flex partial and full lower dentures. The note reflected the bite, fit, and esthetics were good and the resident was pleased. The note reflected the dentist would return on 03/22/2025 for a follow-up visit and again on 08/20/2025 for her annual exam. Record review of Resident #1's dental record dated Page 1 of 5 676145 676145 11/24/2025 Prairie Estates 1350 Main St Frisco, TX 75034

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 04/04/2025 reflected that the resident was not seen by the dentist as scheduled. The reason why she was not treated stated Patient was Unavailable: hygiene and was signed by the dentist. Record review of Resident #5's Comprehensive Care Plan dated 07/17/2025 revealed there were no goals or interventions related to dental/oral health care needs. During an interview with Resident #1 on 09/23/2025 at 9:15 AM, she reported she was having issues with her dentures. She reported the dentures did not fit and they fell off. She stated the dentures didn't look like real teeth and they felt like plastic. Resident #1 stated she was not offered any adjustments, repairs, or replacements. She said it made it difficult to eat and talk when she had them in. She stated she has not worn them since she got them. She stated she had not seen the dentist since she got them and needed to see the dentist again for another pair. She reported she told the Social Worker about the problem and nothing had been done. She reported she also sent an email to the Social Worker about a month ago and the Social Worker never responded. Resident #1 stated a couple of weeks ago she was eating, and she broke a tooth. She reported the tooth was hurting at first, but it no longer hurt. She stated she told her nurse about the broken tooth and was told by the nurse she would relay that information to the Social Worker. She said her tooth broke because she could not wear her dentures. She reported the broken tooth had made her self-conscious because it had affected the way she talked and chewed. She reported that when she would eat, she had to mostly use her gums and what few teeth she did have. During an interview with LVN A on 09/23/2025 at 10:45 AM, she reported she did not recall any issues regarding Resident #1's dentures or broken tooth. She stated if a resident reported problems with dentures or teeth, she notified the social worker who scheduled dental care either within the facility or with an outside dentist, and she also informed the physician as appropriate. She reported she was unsure why Resident #1 did not wear her dentures and stated that the resident refused to wear them. During an interview with CNA B on 09/23/2025 at 11:00 AM, she reported she was not aware that Resident #1 wore dentures. She reported she had never seen her wearing her dentures. During an interview with the Regional Director of Clinical Services on 09/23/2025 at 2:30 PM, he stated he was unaware that Resident #1's care plan did not address dental needs. He stated it was something that would need to be in her care plan. He stated the risk to the resident was not receiving appropriate interventions. The facility's Care Plan, Comprehensive Person-Centered dated March 2022 reflected the comprehensive, person-centered care Plan includes the measurable objectives and time frame .includes the residents stated goals and desire outcome . the interdisciplinary team reviews and updates the care plan: when there has been significant change in the residents condition, when the desired outcome is not met; when the resident has been readmitted to the facility from a hospital stay; and at least quarterly. 676145 Page 2 of 5 676145 11/24/2025 Prairie Estates 1350 Main St Frisco, TX 75034

F 0790 Provide routine and 24-hour emergency dental care for each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to provide or obtain from an outside source, routine and 24-hour emergency dental services to meet the needs of 1 of 5 residents (Resident #1) reviewed for dental needs. The facility failed to obtain dental services for Resident #1, who had a broken tooth and oversized dentures. This failure could place the residents at risk for not having their dental needs met.Findings included: Record review of Resident #1's annual MDS dated [DATE], reflected the [AGE] year-old female resident was admitted to the facility on [DATE] with a BIMS score of 13, indicating the resident was cognitively intact but at risk for mild memory/recall difficulties. Diagnoses included: recurrent depressive disorder (persistent sadness, loss of interest, and low energy that affects daily life), anxiety disorder (ongoing excessive worry and nervousness that interferes with daily life), diabetes (a condition where the body can't properly use sugar for energy, leading to high blood sugar and possible complications), and heart disease (blood vessels that carry oxygen and nutrients to the heart get clogged or narrowed by fatty buildup also known as plaque). Resident #1 scored a 5 on the MDS Self-Performance for Oral Hygiene, indicating the resident required set-up or clean up assistance only. Record review of Resident #1's dental record dated 01/28/2025 reflected the resident was seen by the dentist for Step 3 of the denture process (refers to the multi-step phase in the multi-step process of creating custom dentures). The exam reflected the resident was edentulous (missing some or all natural teeth), with gingival inflammation (bleeding gums), and required a new upper partial and full lower denture. The note reflected that the dentist completed a bite registration (procedure to correctly align the new upper flexible partial denture and the new lower full denture). The dentist instructed nursing staff to provide oral hygiene twice daily, removing dentures at night, assist with cleaning, and encourage the resident to wear dentures. Record review of Resident #1' dental record dated 02/20/2025 reflected the resident was seen by the dentist for Step 4 of the denture process. The exam reflected a try-in was performed for the resident's new upper flexible denture and full lower denture. (This step allowed the dentist to verify the fit, comfort, and aesthetics of the dentures before the final versions were made). Record review of Resident #1's dental record dated 03/21/2025 reflected the resident was seen by the dentist for Step 5 of the denture process. The exam reflected the resident was provided with her upper flex partial and full lower dentures. The note reflected the bite, fit, and esthetics were good and the resident was pleased. The note reflected the dentist would return on 03/22/2025 for a follow-up visit and again on 08/20/2025 for her annual exam.Record review of Resident #1's dental record dated 04/04/2025 reflected that the resident was not seen by the dentist as scheduled. The reason why she was not treated stated Patient was Unavailable: hygiene and was signed by the dentist. Record review of Resident #1's dental record dated 05/05/2025 reflected that the resident was not seen by the dentist as scheduled. The reason why she was not treated stated Patient was Unavailable and was signed by the dentist. Record review of Resident #1's electronic health record reflected there were no further attempts, appointments scheduled, or treatment completed with the dentist between 03/21/2025 and 09/23/2025. During an interview with Resident #1 on 09/23/2025 at 9:15 AM, she reported she was having issues with her dentures. She reported the dentures did not fit and they fell off. She stated the dentures didn't look like real teeth and they felt like plastic. Resident #1 stated she was not offered any adjustments, repairs, or replacements. She said it made it difficult to eat and talk when she had them in. She stated she had not worn them since she got them. She stated she had not seen the dentist since she got them and needed to see the dentist again for another pair. She reported she told the Social Worker about the problem and nothing had Residents Affected - Few 676145 Page 3 of 5 676145 11/24/2025 Prairie Estates 1350 Main St Frisco, TX 75034

F 0790 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few been done. She reported she also sent an email to the Social Worker about a month ago and the Social Worker never responded. Resident #1 stated a couple of weeks ago she was eating, and she broke a tooth. She reported the tooth was hurting at first, but it no longer hurt. She stated she told her nurse about the broken tooth and was told by the nurse she would relay that information to the Social Worker. She said her tooth broke because she could not wear her dentures. She reported the broken tooth had made her self-conscious because it had affected the way she talked and chewed. She reported that when she would eat, she had to mostly use her gums and what few teeth she did have. During an interview with LVN A on 09/23/2025 at 10:45 AM, she reported she did not recall any issues regarding Resident #1's dentures or broken tooth. She stated if a resident reported problems with dentures or teeth, she notified the social worker who scheduled dental care either within the facility or with an outside dentist, and she also informed the physician as appropriate. She reported she was unsure why Resident #1 did not wear her dentures and stated that the resident refused to wear them. During an interview with the Medical Records Custodian on 09/23/2025 at 11:30 AM, she reported she was Resident #1's Angel meaning she would check on the resident every morning to ensure her room was in order and to see if she had any concerns. She stated she would take any concerns reported by the resident and provide them during the morning team meeting where all staff were present. She reported she could not recall the exact day of last week when Resident #1 reported to her that she was eating something and her tooth broke. The Medical Records Custodian stated the Social Worker was in the morning team meeting and was made aware of the concern. She stated the Social Worker reported in the meeting that she would make an appointment for Resident #1 to see the dentist.During an interview with the Social Worker on 09/23/2025 at 12:15 PM, she stated that the resident had expressed a desire to see the dentist after chipping or breaking a tooth and had informed the room Angel of this the prior week. She reported she contacted the dentist the day the resident reported the concern to her angel. She could not recall the exact date to request an appointment. She reported the appointment was anticipated during the first week of October. She was not aware of any issues with the resident's dentures or the reason they were not worn. The Social Worker confirmed the resident was already on the dental list to see the dentist. She explained that the in-house dentist treated a resident unless a resident was absent, ill, or refused. The Social Worker stated if a resident was receiving hygiene or incontinent care, the dentist would come back to them later but on the same day. The Social Worker did not know why Resident #1 was not seen for her denture follow up appointment, her annual cleaning, or the visits she was not seen on 04/04/2025 and 05/05/2025. During a phone interview with the [dental company] representative, on 09/23/2025 at 12:45 PM, she reported Resident #1 had a do not treat on her account since 05/23/2025 due to incomplete paperwork. She further explained that once a year each resident had to have a re-enrollment packet that was completed and submitted by the Social Worker of the facility. She stated if the packet was not received, the Resident could not be seen for services with the facility's contracted dentist through [dental company]. She reported they did receive part of the paperwork but never received the portion the resident's physician signed approving or disapproving of the resident's dental plan. She stated all the forms needed for the re-enrollment packet were sent all at once to the facility Social Worker to complete and send back for the resident to maintain dental coverage. She reported the packet was due at the same time each year. She reported the resident was placed on a list to see the dentist scheduled for 10/06/2025 but she would not be able to be seen until [dental company] received the needed paperwork signed by the physician. She stated the main point of contact they had for the facility was [Social Worker's Name]. During a follow-up interview with the Social Worker on 09/23/2025 at 1:15 PM, she reported she was made aware of 676145 Page 4 of 5 676145 11/24/2025 Prairie Estates 1350 Main St Frisco, TX 75034

F 0790 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the missing paperwork for Resident #1's re-enrollment for dental care today when she called [dental company] to confirm the residents' status of seeing the dentist in October. She reported she was not sure why the physician's form was not sent in. She further stated that the forms are not sent together by the [dental company]. She reported the forms were due at different times during the year so the forms were sent to her as they are due, which could have caused the physician form to not have been sent to her yet. The Social Worker stated she kept track of the forms by completing them as they were sent to her. During an interview with the Regional Director of Clinical Services on 09/23/2025 at 2:30 PM, he stated he was unsure why the resident was not seen per schedule by the dentist. He reported the resident should have been seen or rescheduled. He reported the resident was at risk of the broken tooth and ill-fitting dentures could affect her eating. Record review of the facility policy titled Dental Services, dated December 2013 reflected the following policies regarding dental services for residents: Oral health services are available to meet the resident's needs.Routine and emergency dental services are provided to our residents through:A contract agreement with a local dentist;Referral to the resident's personal dentist;Referral to community dentists; orReferral to other health care organizations that provide Dental Services.Our facility has a contract with a dentist that comes to the facility and provides dental services on a monthly basis.Residents are permitted to select dentists of their choice when dental care or services are needed.Selected dentists must be available to provide follow-up care.Failure of a dentist to provide follow-up services will result in the facility's right to use its Consultant Dentist to provide the resident's dental needs.A complete record of the resident's dental care and services are maintained in accordance with current regulations.Social Services personnel will be responsible for assisting the resident/family in making dental appointments and transportation arrangements as necessary. 676145 Page 5 of 5