Health inspection·December 5, 2025

F 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Allow resident to participate in the development and implementation of his or her person-centered plan of care. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure the residents were given the right to participate in the development and implementation of their plans of care for 1 of 9 residents (Resident #1) reviewed for participating in care planning. The facility did not conduct a meeting nor invite Resident #1 to participate in resident care planning meetings after his quarterly review assessments on 5/23/25, 8/22/25 and 10/29/25. This failure could place residents at risk for a loss of independence, psychosocial well-being and the opportunity for them to participate in the planning of their care. Findings Included: Record review of Resident #1's admission record generated on 12/5/25 revealed she was admitted to the facility on [DATE] and had diagnoses of mental disorder (characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior), vascular dementia (a decline in thinking skills due to reduced blood flow to the brain, often from strokes or damaged blood vessels, affecting memory, planning, judgment, and attention), multiple sclerosis (a chronic autoimmune disease of the central nervous system (brain, spinal cord, optic nerves) where the immune system mistakenly attacks myelin, the protective sheath around nerve fibers, disrupting nerve signals), and major depressive disorder (a serious mood disorder causing persistent sadness, loss of interest, and impacts daily life). She was [AGE] years old. Record review of Resident #1's MDS assessments revealed the facility staff completed quarterly assessments on 5/23/25, 8/22/25 and 10/29/25. Record review of Resident #1's quarterly MDS assessment dated [DATE] revealed she had a BIMS score of 14, indicating no cognitive impairment. Record review of Resident #1's care plan report (undated) included the following focus' and revision dates:- The focus of oral/dental health problems related to missing crowns (a tooth-shaped cap that covers and restores a damaged, decayed, weak, or misshapen tooth) was initiated on 8/3/25 and revised on 10/29/25. - The focus of psychotropic medication use (a medication that affects a person's mental state) was revised on 9/9/25.The focus of antidepressant medication use was initiated on 6/23/25 and revised on 9/9/25. Record review of Resident #1's Assessments dated between 2/28/25 to 12/3/25 in her electronic medical record revealed only one Care Plan Conference was listed. The Care Plan Conference was dated 3/3/25. Record review of Resident #1's nursing progress notes revealed there was no mention of a care plan meeting after 3/3/25 and before 12/3/25. In an interview on 12/4/25 at 11:00am, Resident #1 said she had never attended a care plan meeting to discuss her care. She said she was not sure what type of assistance they were providing, and she was not sure why she was still living there. She said she wanted help so she could be discharged . Further, she stated a dentist messed up her teeth and she was very upset with how they look. She was unsure what the facility was doing to help her fix her teeth. In an interview on 12/5/25 at 1:10pm, Unit Manager said, with the assistance of the DON, she set up the care plan meetings for new admissions. She said the MDS Nurse tracked the quarterly care plan meetings. She said she could not remember if they had a quarterly care plan meeting with Resident #1. She said (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: 676264 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 676264 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Lev at Winchester 1112 Smith Dr Alvin, TX 77511 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)