Health inspection·January 30, 2024

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 4 of 5 residents (Residents #1, #2, #3 and #4,) reviewed for infection. Residents Affected - Some 1. LVN C failed to clean the blood pressure cuff between Residents #1, #2, #3 and #4. 2. LVN C failed to clean the pulse oximeter between Residents #3 and #4. These failures could place residents at risk of cross contamination and exposure to infectious diseases. The findings include: During an observation on 01/30/24 from 9:06 AM through 10:35 AM of blood pressure checks, pulse oximeter checks, and medication pass with LVN C revealed the following: * LVN C sanitized hands, walked into Resident #1's room, put on gloves and did not sanitize the blood pressure cuff. LVN C took Resident #1's blood pressure, disposed of gloves and placed the blood pressure machine on top of medication cart. LVN C administered medications and washed hands. LVN C did not sanitize the blood pressure cuff before proceeding to Resident #2's room . *LVN C sanitized hands, walked into Resident #2's room and put on gloves. LVN C did not sanitize the blood pressure cuff. LVN C took Resident #2's blood pressure, disposed of gloves and placed the blood pressure machine on top of medication cart. LVN C administered medications and washed hands. LVN C did not sanitize the blood pressure cuff before proceeding to Resident#3's room. *LVN C sanitized hands, walked into Resident #3's room and put on gloves. LVN C did not sanitize the blood pressure cuff and pulse oximeter. LVN C took Resident #3's blood pressure, pulse and oxygen saturation. LVN C disposed of gloves, placed the blood pressure machine on top of medication cart, administered medications and washed hands. LVN C did not sanitize the blood pressure cuff and pulse oximetry before proceeding to Resident #4 room. *LVN C sanitized hands, walked into Resident #4's room and put on gloves. LVN C did not sanitize the blood pressure cuff and pulse oximeter. LVN C took Resident #4's blood pressure, pulse and oxygen saturation disposed of gloves, placed blood pressure machine on top of medication cart, administered medications and washed hands. LVN C did not sanitize the blood pressure cuff and pulse oximetry . (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: 676268 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 676268 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villages of Lake Highlands 8615 Lullwater Dr Dallas, TX 75238 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)