Inspection·November 19, 2025

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some (inability to move the limbs due to severe disability or frailty), afib (heart beat is irregular), polyosteoarthritis (inflammatory joint disease in multiple joints), chronic pain, bilateral cataracts (clouding over both eyes), and muscle wasting and atrophy.Record review of Resident #17's Quarterly MDS assessment dated [DATE] revealed a BIMS score of 12 out of 15, which indicated the resident had moderately impaired cognition. Per the MDS, the resident did not reject care (e.g., bloodwork, taking medications, ADL assistance) that was necessary to achieve the resident's goals for health and wellbeing. The resident had impairment on both sides of his lower extremities and used a wheelchair for mobility. According to the assessment the resident was dependent (helper did all of the effort, resident did none of the effort to complete the activity) for showers/baths. Resident #17 was always incontinent of bowel and bladder. The resident had shortness of breath or trouble breathing with exertion (walking, bathing, transferring), when sitting at rest, and when lying flat, and was on oxygen.Record review of Resident #17's Care Plan dated 10/1/24 revealed the focus: The resident had an ADL self-care performance deficit r/t recent hospitalization for COPD exacerbation, generalized weakness, and afib (Initiated: 10/1/24, Revised: 10/8/24). The goal was to improve his level of function in ADLs through the review date (Target: 11/2/25). The interventions included: bathing/showeringThe resident required assistance by staff with showering and as necessary.Record review of Resident #17's Progress Notes from 9/17/25-10/15/25 revealed 2 notes that he refused a bath/shower, on 10/13/25 and 10/15/25.Record review of Resident #17's ADL - Bathing MWF Task, printed on 10/15/25 for the past 30 days revealed No Data Found. The task did not note any refusals. He missed a bath on 9/17/25, 9/19/25, 9/22/25, 9/24/25, 9/26/25, 9/29/25, 10/1/25, 10/3/25, 10/6/25, 10/8/25, and 10/10/25.In an observation and interview on 10/14/25 at 9:14am, Resident #17 was sitting up in bed. He said he did not get showers/baths often and was supposed to get one on Friday 10/10/25 but didn't. He said the staff would not offer it and say they were too busy. Record review of Resident #24's undated face sheet revealed she was a [AGE] year-old female admitted [DATE] with diagnoses of multiple sclerosis (chronic autoimmune disease that affects the brain and spinal cord), osteoarthritis, need for assistance with personal care, cognitive communication deficit, glaucoma (increased pressure in eye), neuromuscular dysfunction of bladder (bladder will not release urine), and muscle wasting and atrophy.Record review of Resident #24's Quarterly MDS assessment dated [DATE] revealed a BIMS score of 13 out of 15, which indicated normal cognition. Per the MDS, the resident did not reject care (e.g., bloodwork, taking medications, ADL assistance) that was necessary to achieve the resident's goals for health and wellbeing. The resident had impairment on both sides of her lower extremities and used a wheelchair for mobility. The assessment revealed the resident was dependent for showers/baths. Resident #24 had an indwelling catheter (tube into bladder to drain urine) and was always incontinent of bowel. The resident had shortness of breath when lying flat and had 1 Stage 4 (full thickness tissue loss with exposed bone, tendon, or muscle) pressure ulcer.Record review of Resident #24's Care Plan dated 10/24/24, had a Focus: Resident has an ADL self-care performance deficit r/t impaired mobility and needs assistance with personal care (Initiated: 5/28/25). The goal was that the resident would improve her level of function in ADLs through the review date (Initiated: 10/24/24, Revised: 10/30/24, Target: 12/2/25). The interventions included: The resident was totally dependent on staff for repositioning and turning in bed, the resident was bedfast all or most of the time, the resident was totally dependent on staff for personal hygiene and oral care.Record review of Resident #24's Progress Notes from 9/17/25-10/15/25, revealed 1 note from 9/22/25 stating she received a bed bath. There were no refusals noted in any of the Progress Notes.Record review of Resident #24's ADL - Bathing MWF Task, printed on 10/15/25 for the past 30 days revealed 1 bed bath on 9/29/25. The task did not note any (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676258 If continuation sheet Page 2 of 4 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 676258 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Memorial City Nursing and Rehabilitation Center 1341 Blalock Houston, TX 77055 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)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete refusals. She missed a bath on 9/17/25, 9/19/25, 9/24/25, 9/26/25, 10/1/25, 10/3/25, 10/6/25, 10/8/25, 10/10/25, 10/13/25, and 10/15/25.In an interview and observation on 10/14/25 at 9:41am, Resident #24 was sitting up in bed. She said she got maybe 2 baths a week, if that. She could not remember when her last bath was.In an interview on 10/15/25 at 11:13am, the SW said Resident #17 told her before that he was not receiving showers/baths. She said she would report it to the nurse.In an interview on 10/15/25 at 12:38pm, LVN H and LVN T, who worked the resident's hall, said the showers/baths were documented in the EMR, under tasks. Both LVNs gave the names of 2 different residents as the only residents they could think of who refused showers/baths, and not Resident #22, Resident #17, or Resident #24. LVN H and LVN T said the CNAs in the morning gave the baths/showers to the A beds and the CNAs at night gave the showers/baths to the B beds.In an interview on 10/15/25 at 12:54pm, CNA O said showers/baths were given to the even numbered rooms on MWF and odd numbered rooms on TTS. A beds were given their shower/bath in the morning and B beds were given theirs at night. She said they documented the shower/bath in the EMR, and they documented the refusal in the system as well. CNA O said if a resident refused, she told the nurse, and the nurse would talk to the resident.In an interview on 10/15/25 at 2:14pm, LVN F said she had received complaints from residents about not getting showers/baths. She said the only resident who refused showers/baths was a different resident than Resident #22, Resident #17, or Resident #24. She said she felt the CNAs had enough time for showers/baths and providing care. LVN F said the baths/showers were documented in the EMR, along with refusals. She said if residents did not get showers/baths, they could develop skin issues and body odor, and the residents would feel horrible if they did not get them.In an interview on 10/15/25 at 2:39pm, CNA R, who worked the resident's hall, said she had enough time to provide showers/baths and care to residents. She said she had received complaints from residents about not getting showers/baths, and one of the residents was Resident #17. She said she would report it to the nurse when he would report it to her. CNA R said the showers/baths were documented in the EMR, and the refusals were documented there also. She said if residents did not get showers/baths they could get skin breakdown or scabies.In an interview on 10/15/25 at 3:33pm, the DON said the baths/showers should be documented in the EMR in the tasks, along with the refusals. She said if the resident refused, the CNA should have informed the nurse and then the nurse documented the refusal. She said, then the nurse would call the family and see if they could convince the resident, or they would try other interventions. The DON said if residents did not receive baths/showers they could get skin infections.In an interview on 10/16/25 at 9:20am, Resident #22 said she had never refused a bath/shower.In an interview on 10/16/25 at 9:22am, Resident #24 said she had not gotten a bath/shower in the last few days, and she wanted a bed bath. She said no one had come in and offered her one.Record review of the facility's policy and procedure on Activities of Daily Living (ADLs) dated 5/26/23 read in part: The facility will, based on the resident's comprehensive assessment and consistent with the resident's needs and choices, ensure the resident's abilities in ADLs do not deteriorate unless deterioration is unavoidable. Care and services will be provided for the following activities of daily living: 1. Bathing, dressing, grooming, and oral care.A resident who is unable to carry out activities of daily living will receive the necessary services to maintain good nutrition, grooming, and personal and oral hygiene.Documentation shall be completed at the time of service, but no later than the shift in which care service occurred. Event ID: Facility ID: 676258 If continuation sheet Page 3 of 4 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 676258 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Memorial City Nursing and Rehabilitation Center 1341 Blalock Houston, TX 77055 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)

F 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to adequately equip to allow residents to call for staff assistance through a communication system which relays the call directly to a staff member or to a centralized staff work area from each resident's bedside for 1 (Residents #35) of 6 residents reviewed for call lights.-Residents #35 did not have her call light within reach while she was in bed.This failure could lead to residents not being able to request and receive prompt medical care and result in injury and harm.Record review of Resident #35's face sheet dated 10/16/2025, she was a [AGE] year-old female originally admitted on [DATE] with medical diagnoses including vascular dementia, bipolar disorder, generalized anxiety disorder, Alzheimer's Disease, hypertension, cognitive communication deficit and other abnormalities of gait and mobility.Record review of Resident #35's Quarterly MDS assessment dated [DATE], she had a BIMS score of 3 out of 15, indicating severe cognitive deficit related to memory and thinking. Resident #35 was coded for having a walker. Resident #35 required set-up/cleanup assistance with tasks such as toileting, oral hygiene and dressing, and mobility in bed.Record review of Resident #35's care plan dated 10/16/2025, she had an ADL self-care performance deficit r/t impaired mobility with resident requiring staff assistance for toileting, turning and re-positioning in bed as necessary. Resident #35 was at risk for falls r/t confusion, gait/balance problems with interventions including being sure the resident's call light was within reach and encouraging the resident to use it as needed, the resident needed prompt response to all requests for assistance. Observation and interview with Resident #35 on 10/14/2025 at 9:48am, revealed she was in bed and appeared well-groomed and in no distress. Resident #35 said staff took her call light out of her room a couple of days ago, and told her they removed it because she used it too much. The call light was observed on the floor in the middle of the room between two dressers, out of reach of the resident in bed. LVN M was called to the room, and she put on gloves and took the call light off the floor and gave it back to Resident #35 who wrapped it around her bedrail. LVN M said that she was the nurse for the hall on 10/14/2025 and had been at the facility for ten months. LVN M said everyone was responsible for putting call lights close to the residents. LVN M said Resident #35 was confused at baseline and did not use her call light, but the light should be near her. If residents did not have call lights nearby, then they could not call for help. LVM M said she would remind her aides to put call lights on beds. In an interview with the DON on 10/15/2025 at 3:33pm, she said that she did monthly in-services on call lights with staff. The DON said call lights should not be on the floor. If the lights were on the floor, residents would not be able to call for help and residents should always have access to staff. It was a safety concern so residents could tell staff what they needed. The DON said everyone was responsible for ensuring call lights were within residents' reach and to answer them. A call light policy was requested by email on 10/16/2025 at 9:36am with the DON who said the facility did not have a specific call light policy. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676258 If continuation sheet Page 4 of 4