Health inspection·April 4, 2025

F 0624 Prepare residents for a safe transfer or discharge from the nursing home. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide and document sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility for one resident (Resident #1) of three residents reviewed for discharge planning. Residents Affected - Few -The facility failed to provide or document sufficient preparation for an orderly discharge of Resident #1. This failure could place residents at risk of not receiving care and services to meet their needs upon discharge, which could cause physical and emotional harm. Findings included: Record review of Resident #1's face sheet, dated 04/04/2025, reflected the resident was a [AGE] year-old male admitted to the facility on [DATE] and discharged on 03/13/2024 with diagnoses that included: cerebral ischemia (a condition where the brain does not receive enough blood flow, resulting in a lack of oxygen and nutrients. This can lead to brain damage.), Generalized Anxiety Disorder (a mental health condition characterized by excessive, persistent, and often unrealistic worry about everyday things, which can significantly impact daily life and cause distress.), hypertensive urgency (is a condition where blood pressure is significantly elevated but there is no evidence of acute organ damage.) Lack of coordination, Cognitive communication deficit (difficulties in communication skills from cognitive impairments, attention, memory .). Record review of Resident #1's Quarterly MDS assessment, dated 03/12/2025, reflected in Section A0310 G was left blank for unplanned or planned discharge. Section A1010 was left blank for race. the resident had a BIMS score of 15 which indicated no cognitive impairment. The MDS assessment reflected Resident #1 was independent with most ADLs; however, the resident required moderate assistance and/or supervision with hygiene, and upper body dressing. Further review reflected Resident #1 had a mood of feeling down, depressed, or hopeless several days at a time. Resident #1 had a behavior of physical behavioral symptoms toward others and rejecting assessments care 1 to 3 days. Resident #1 was occasionally incontinent for urine and frequently incontinent with bowel. Section Q participation in assessment and goal setting .Q0610 referral to Local contact agency indicated no. Section I0620 Reason referral to local contact agency (LCA) not made reflected 5 (discharge date more than 3 months away. The MDS did not address resident returning to the community, due to this being his quarterly MDS. The quarterly MDS signature included LMSW signature for completion of Sections B, C, D, E, Q. However, section A was completed with entry discharge reporting (none of the above). The facility had not completed a discharge MDS for Resident #1. (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 5 Event ID: 676315 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 676315 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Hillcrest of North Dallas 18648 Hillcrest Rd Dallas, TX 75252 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)