Inspection·September 19, 2024

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review; it was determined the facility failed to ensure that in accordance with accepted professional standards and practices, the facility must maintain medical records on each resident that are complete, accurately documented, and readily accessible for 1 of 6 residents reviewed for clinical records (Resident #1) in that: The facility failed to ensure Resident #1's concerns about the prior administrator were documented and addressed in social services notes. The facility's failure to ensure medical records on each resident were complete, accurately documented, and readily accessible, placed all residents requiring care at risk for incorrect or omitted treatment, duplicated treatments, poor self-esteem and self-worth, and a failure to ensure continuity of care. Findings included: Record review of Resident #1's face sheet dated 09/19/2024 reflected a [AGE] year-old-female admitted to the facility on [DATE]. Resident #1's current diagnoses included but not limited to diffuse traumatic brain injury with loss of consciousness of unspecified duration, schizoaffective disorder (mood disorder), bipolar type (extreme mood swings), anxiety disorder, major depressive disorder, recurrent severe without psychotic features, and cognitive communication deficit (difficulty in communication). Record review of Resident #1's quarterly MDS assessment dated [DATE] reflected Resident #1 had a BIMS score of 15 out of 15 indicating she was cognitively intact. Record review of Resident #1's social services notes dated 09/11/2024 reflected a visit was conducted with Resident #1 by SW concerning Resident #1's boyfriend and their relationship, there was no documentation relating to the concerns Resident #1 stated in the visit about a past employee asking Resident #1 to go to bed with him. During an interview on 09/19/2024 at 10:55 AM, the SW who stated she and Resident #1 were having a conversation about intimacy due to Resident #1 having a relationship with another resident in the facility. During this conversation Resident #1 stated the PADM asked her to go to bed with him and got mad at her when she was holding hands with her boyfriend during dinner. The SW stated the PADM had been gone since December 2024 and Resident #1 could not tell her when this incident happened. The SW stated she immediately informed the current ADM about the allegation but did not document the (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: 676186 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 676186 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Castro County Nursing & Rehabilitation 1621 Butler Dimmitt, TX 79027 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)