Health inspection·May 25, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of 3 of 5 residents (Resident #1, Resident #2, and Resident #3) reviewed for medication administration, in that: LVN A failed to document the medications administered to Resident #1, Resident #2, and Resident #3, in the MAR. This deficient practice could place residents at-risk of Medication Administration Errors that leads to the danger of overdosing drugs. The findings included: Record review of Resident #1's face sheet, dated 05/25/24, revealed the resident was a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses that included: Alzheimer's disease, , Hypertension, Dysphagia (difficult to swallow), Encounter for palliative care, Psychotic disorder with delusions due to known physiological condition, Insomnia, Anxiety Disorder and constipation. Record review of Resident #1's MDS assessment, dated 05/20/24, revealed Resident #1 did not have a BIMS completed due to the resident rarely/ never understood. Record review of Resident #1's careplan dated 05/ 20/24 revealed: Resident/family has elected Hospice Care. Resident is at risk of complications related to dying process and the relevant intervention was: Observe for non-verbal S/S of pain to include but not limited to restlessness, agitation, facial grimacing, assess for cause and relieve as possible, provide ordered pain medications and notify MD, Hospice if not effective. Record review of Resident #1's Hospice Physician's Orders, revealed: Lorazepam Oral Tablet 0.5 MG (Lorazepam): Give 1 tablet by mouth every 2 hours as needed for agitation x2 doses and if still agitated call (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 7 Event ID: 676211 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 676211 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wesley Woods Health & Rehabilitation 1700 Woodgate Drive Waco, TX 76712 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)