Inspection·February 12, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for 1 (Resident #1) of 6 residents reviewed for quality of care. Residents Affected - Few The facility failed to document fluid intake for Residents #1 according to physician orders. This failure could place residents at risk of not receiving necessary medical care, and hospitalization. Findings included: Review of Resident #1's undated face sheet reflected a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including heart failure (occurs when the heart cannot pump enough blood and oxygen to the body), cognitive communication deficit (difficulty paying attention to a conversation, staying on topic, remembering information) essential primary hypertension (high blood pressure with no clear, identifiable cause), and Type 2 diabetes mellitus with diabetic neuropathy (complication of diabetes that causes nerve damage). Review of Resident #1's admission MDS, dated [DATE], reflected a BIMS score of 10, indicating moderate cognitive impairment. Resident #1 admission MDS also reflected she was dependent in the following areas: eating, toileting hygiene, lower body dressing, and putting on/taking off footwear. Resident #1 was substantial/maximal assistance in the following areas: oral hygiene, shower/bathe self, upper body dressing, and personal hygiene. Review of Resident #1's care plan, dated 02/12/25, reflected Resident #1 was care planed for resident is on a fluid restriction and is at risk for a fluid imbalance, amount of restriction: 1.5L per day r/t diagnosis CHF. Review of Resident #1's physician order, dated 02/12/25, reflected fluid restriction 1.5 liters daily every shift (day, night). Resident #1 had a previous discontinued physician order dated 02/06/25 - 2/09/25 of monitor fluid intake closely every shift - fluid restriction 48oz every 24 hours (day, night). Resident #1 had a previous discontinued physician order dated 12/17/24 - 02/06/25 of monitor fluid intake closely every shift fluid restriction 1 liter every 24 hours every shift (day, night). Review of Resident #1's Fluids in her EMR, dated 02/12/25, reflected Resident #1's fluids had not been documented from 12/17/24 - 02/12/25. (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: 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 02/12/2025 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)