Health inspection·February 12, 2024

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure that the resident had the right to make choices about aspects of his or her life in the facility that were significant to the resident for 1 of 1 residents (Resident #1) whose care was reviewed in that: CNA A told Resident #1 she was going to go to bed even though Resident #1 did not want to go to bed. This failure could place residents at risk of psychosocial harm and a diminished quality of life. Findings included: Review of the face sheet for Resident #1 reflected a [AGE] year-old female admitted to the facility on 01/11/2024 with diagnoses of Cerebral infarction, pain, generalized anxiety disorder, disorders of the circulatory and respiratory systems, abnormalities of gait and mobility, unspecified lack of coordination, and cognitive communication deficit. Review of the annual MDS for Resident #1, date unknown, reflected a BIMS score of 8, indicating mild cognitive impairment. Review of the employee disciplinary form dated 11/01/23 reflected CNA A received a verbal warning because the DON received two complaints from residents because CNA A raised her voice at residents, told residents to be quiet, and spoke to residents as if they were children and told them what to do. Review of Future Performance Requirements dated 11/06/23 reflected CNA A's employment with the facility would be terminated if she did not maintain resident rights, remember she was coming into the residents' home, and not raise her voice to residents. Review of Record of Termination dated 01/23/24 reflected CNA A's employment was involuntary terminated because she failed to meet performance expectations, disregarded coworkers/ customer/clients, violated company policies/rules, violated company policies and failed evaluation period. (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: 676290 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 676290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spjst Rest Home 1 1810 Old Granger Road Taylor, TX 76574 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)