Health inspection·January 24, 2024

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure each resident received adequate supervision and assistance devices to prevent accidents for 1 (Resident #1) of 3 residents reviewed for accidents. The PT failed to ensure Resident #1's body, to include her lower extremities, were positioned properly during a transfer using a sliding board, which is a rigid board used to bridge the gap between two surfaces to assist with transferring from one surface to another. During set-up of the transfer, the PT lowered the bed on or against the resident's foot causing a laceration that required 13 sutures. This failure could place residents at risk for serious injury or harm, decline in health, and decreased quality of life. Findings included: Review of Resident #1's MDS, dated [DATE], revealed the resident was a [AGE] year-old female admitted to the facility on [DATE]. The resident's diagnoses included paraplegia, scoliosis, pressure induced deep tissue damage of right hip, spinal cord injury at C7 (cervical vertebrae), and colostomy status. The MDS further reflected the resident had intact cognition, and she had lower extremity impairment to both sides. Review of Resident #1's care plan, revised on 12/01/23, reflected she had limited physical mobility related to paraplegia. Interventions included to provide supportive care, and assistance with mobility as needed. Review of the facility's provider investigation report, dated 12/20/23, reflected the following: The facility's investigation revealed that on 12/13/23, during a sliding board transfer, a paraplegic patient, who requires a two-person transfer, was being assisted by both a physical therapist (PT) and an occupational therapist (OT). The patient, seated in a wheelchair, was being prepared for transfer with appropriate precautions As the PT lowered the bed to ease the transfer a laceration to the patient's lower left extremity was discovered resulting in immediate medical attention and a hospital visit for suture treatment Review of Resident #1's progress notes, dated 12/13/23, reflected the following entries: .upon entering resident room resident R leg observed propped on side of mattress. [PT] was (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 3 Event ID: 676176 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 676176 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crowley Nursing and Rehabilitation 920 E Fm 1187 Crowley, TX 76036 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)