Health inspection·August 16, 2023

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 observation, interview, and record review, the facility failed to provide pharmaceutical services, including procedures that assures the accurate acquiring, receiving, dispensing, and administering of medications for 1 of 4 residents (Resident #39) reviewed for pharmacy services. The facility did not ensure medications were properly administered to Resident #39. This failure could place residents at risk for the unsafe administration of medications and not receiving prescribed doses of ordered medications. Findings: Record review of facility face sheet dated 8/15/2023 indicated Resident #39 was admitted on [DATE] with diagnoses of respiratory failure with hypoxia (low oxygen level) and end stage renal disease. Record review of quarterly MDS dated [DATE] revealed Resident #39 had a BIMS of 12 indicating mild cognitively impairment. Record review of comprehensive care plan dated 06/28/2023 did not indicate Resident # 39 could safely self-administer medications. Record review of physician order dated 9/13/2020 indicated Resident #39 took Carafate 1 gram 1 tablet by moth four times a day. Physician order dated 6/12/2023 indicated Resident #39 took Sevelamer 800mg 1 tablet by mouth three times a day. During an observation on 08/14/23 at 09:50 am Resident # 39 had a medicine cup with 2 tablets present: 1 white imprinted with R789 and 1 pink imprinted with 1712. Resident #39 stated he was asleep, and the worker left the medicine for him to take. Resident #39 stated the staff handed him the medicine cup and did not watch him take his medicine. During an interview on 8/14/2023 at 12:36 pm MA A stated she had been a medication aide since 1995 and employed at the facility for 8 years. She stated she gave Resident # 39's medicine and she watched him turn the medicine cup up to his mouth before she walked out of the room but did not ensure he took them. She stated the medicines in the medicine cup were Carafate and sevelamer. She stated she had been trained on proper medication administration and ensuring residents took their medicine and by not doing so could affect the resident or other residents if they were to take medicine that was left in the room. (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: 676257 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 676257 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trucare Living Centers 2265 S Sycamore St Palestine, TX 75801 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)