Health inspection·January 10, 2024

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 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 grooming, and personal hygiene for one (Resident #1) of 5 residents reviewed for ADLs. Residents Affected - Few The facility failed to ensure Resident #1 received timely incontinent care. This failure could put residents at risk of impaired skin integrity, and decreased feelings of self-worth and dignity. Findings Include: Record review of Resident #1's electronic Face Sheet, dated 01/09/24, revealed the resident was a [AGE] year-old male admitted to the facility on [DATE]. Review of Resident #1's physician orders dated 01/2024 reflected diagnoses included diabetes mellitus (no type indicated) and end stage renal disease (a medical condition in which a person's kidneys cease functioning on a permanent basis leading to the need for a regular course of long-term dialysis or a kidney transplant to maintain life). Record review of Resident #1's admission MDS assessment, dated 12/18/23, revealed a BIMS score of 15 indicating intact cognition. Further review of the MDS assessment revealed Resident #1 was always incontinent of urine and bowel, dependent on staff for toileting, and required substantial/maximal assistance for bathing. Record review of Resident #1's care plan, dated 12/21/23, revealed self-care deficit, incontinence and the risk for skin breakdown were addressed. The care plan reflected the resident was confined to bed/wheelchair most of the time, experienced generalized weakness and required total extensive assistance with bed mobility and transfers. Interventions included providing assistance with self-care as needed, keeping skin clean, dry, and free of irritants. Care plan goals included Resident #1 would maintain self-care in the area of hygiene and maintain clean and intact skin. Interview on 01/09/24 at 11:02 p.m. Resident #1 stated during the night shift on 01/05/24 he was incontinent of bowel, activated his call light at approximately 12:00 a.m. and received no response or incontinent care until approximately 6:30 a.m. on the morning of 01/06/24 after the day shift arrived. The resident stated he had been incontinent of bowel and remained in feces that burned his skin until the day shift arrived and provided incontinent care. The resident stated during the night shift at approximately 11:00 p.m. CNA A told him she would not be able to provide incontinent care for (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: 676358 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 676358 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Villages on MacArthur 3443 N MacArthur Blvd Irving, TX 75062 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)