F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited
to receiving treatment and supports for daily living safely.
Based on observation, interview and record review the facility failed to provide a safe, clean, comfortable
and homelike environment allowing the resident to use his or her personal belongings to the extent possible
for 1 of 1 shower reviewed for resident rights.
The facility failed to ensure the shower did not have trash on the floor on 5/24/24.
This failure could place residents at risk of an unsafe or uncomfortable environment and a decrease in
quality of life.
Findings included:
During an observation on 5/24/24 at 9:11 a.m. the facility's central shower had a disposable razor that was
on the floor next to the wall and trash in the floor of the shower room.
During an observation on 5/24/24 at 10:16 a.m. the central shower room had a disposable razor that was
on the floor next to the wall and trash on the floor of the shower room.
During an observation on 5/24/24 at 1:00 p.m. the central shower had a disposable razor, used gloves,
trash, and popcorn on the floor.
During an interview on 6/11/24 at 10:30 a.m., CNA A said the CNAs were responsible for cleaning trash
and razors off the floor in the showers. CNA A said trash and razors should not be left on the floor of the
showers. CNA A said the importance of ensuing the shower floor was free of debris was for infection control
purpose.
During an interview on 6/11/24 at 10:32 a.m. LVN B said the CNAs and nurses were responsible for
ensuring the showers were cleaned and free of trash on the floor. LVN B said razors and trash should not
be left on the shower floors. LVN B said trash left on the shower floors posed a fall risk and razors left on
the shower floor posed an injury risk which included a resident getting cut.
During an interview on 6/11/24 at 10:42 a.m. the DON said the CNAs were supposed to clean showers as
the go. The DON said as a CNA finished a shower, they should be picking up any trash off the floor. The
DON said leaving trash on the floor was an accident hazard.
Record review of the facility's Quality of Life-Homelike Environment Policy, revised May 2017, reflected,
Residents are provided with a safe, clean, comfortable, and homelike environment and encouraged to use
their personal belongings to the extent possible .The facility staff and management shall
(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:
676335
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
676335
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/11/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Broadmoor Medical Lodge
5242 Medical Drive
Rockwall, TX 75032
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)
F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
maximize, to the extent possible, the characteristics of the facility that reflect a personalized, homelike
setting. These characteristics include: 1. Clean, sanitary, and orderly environment
Record review of the facility's Shower/Tub Bath policy, revised October 2010, reflected, The purposes of
this procedure are to promote cleanliness, provide comfort to the resident, and to observe the condition of
the resident's skin .Steps in the Procedure .28. Pick up all towels, bath cloths, soiled clothing, etc.
Event ID:
Facility ID:
676335
If continuation sheet
Page 2 of 2
