Health inspection·February 15, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 reviews, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for 1 of 6 community bathrooms (shower #2) reviewed for physical environment in that: -Shower #2 on the second floor had mold on shower mattress and pillow. This failure could place residents at risk of infection leading to a diminished quality of life. Findings Included: Observation and interview on 02/13/2024 at 2:10 PM, LVN A accompanied surveyor to shower room [ROOM NUMBER] revealed shower #2 had a wedge pillow and the shower mattress covered with black and gray spots. LVN A said, That's mold. She said it was everyone's responsibility to keep the equipment clean. She said, housekeeping was in here earlier. Observation and interview on 02/13/2024 at 2:32 PM, revealed CNA A was in shower room [ROOM NUMBER], attempting to clean the spots off the shower pillow. She said the black and gray spots noted were mildew. She said she had to wait for more cleaning products to get them cleaned. Observation on 02/13/2024 at 3:16 PM, LVN B accompanied surveyor to shower room [ROOM NUMBER] revealed shower #2 still had a wedge pillow and the shower mattress covered with black and gray spots. LVN B said, they're just stains. LVN B attempted to scrape off the spots, but the spots would not disappear. LVN B said housekeeping was responsible for cleaning community bathrooms including the bed and pillows in the shower room after each resident use. LVN B said the staff called housekeeping to clean because they were always present on the floor. Observation on 02/15/2024 at 9:14 am revealed shower room [ROOM NUMBER] with no wedge pillow observed in the room or on the shower mattress. Shower #2 still had shower mattress covered with black and gray spots. Interview on 02/15/24 at 02:51 PM with the housekeeping director, he said housekeeping was only responsible for the upkeep of the shower room walls, toilet and floors. He said the pillows and shower mattress beds in the shower rooms used by resident were the nursing staff's responsibility for sanitizing them between each resident's use. He said housekeeping staff did not clean nor mop showers in between resident use of showers. The Housekeeping Director said community showers were cleaned and disinfected after all residents showered and/or at the end of each shift. (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: 676152 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 676152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Acres Jewish Senior Care Services 6200 N Braeswood Blvd Houston, TX 77074 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)