Inspection·January 14, 2025

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 ensure residents who were unable to carry out activities of daily living received necessary services to maintain personal hygiene for two (Resident #1 and Resident #2) of five residents reviewed for bathing. Residents Affected - Some The facility failed to provide showers to Resident #1 and Resident #2 in compliance with their shower schedules. This deficient practice could place residents at risk of a decline in their sense of well-being and level of satisfaction with life. Findings included: Review of Resident #1's admission MDS, dated [DATE], reflected a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including heart failure, disorientation, Encephalopathy (a change in brain function causing confusion and agitation that may leave temporary or permanent brain damage), muscle wasting and atrophy, and cerebral infarction (when blood flow to a part of the brain is obstructed). Resident #1 had a BIMS score of 10, which indicated moderately impaired cognition. She required substantial/maximal assistance for showers/baths. Review of Resident #1's care plan, created 12/02/2024, reflected she had an ADL self-care performance deficit with an intervention of requiring assistance with ADL care for showers. Review of Resident #1's general orders created by the ADON on 11/21/24 in her EMR reflected that she was to receive showers on Mondays, Wednesdays, and Fridays once an evening between the hours of 6:00 PM and 6:00 AM. Review of Resident #1's bathing tasks in her EMR, from 12/02/24 - 1/13/25, reflected that she did not receive a shower on the following dates: 12/2/24-NA 1 indicated activity did not occur at 12:15 AM and 7:56 AM, CNA B indicated activity did not occur at 11:53 AM. 12/3/24-CNA C indicated activity did not occur at 11:51 AM and CNA D indicated activity did not occur at 11:25 PM. 12/4/24-NA 2 indicated activity did not occur at 5:23 PM. (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 6 Event ID: 676295 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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)