Inspection·March 28, 2024

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable environment for one (Resident #1) of eight resident rooms reviewed for homelike environment. The facility failed to clean Resident #1's bathroom for three days. The deficient practice placed residents at risk of negative psychosocial impacts, infection, illness, and room not feeling homelike. Findings included: Record review of Resident #1's Optional State Assessment MDS dated [DATE] revealed she was a [AGE] year-old female an initial admission date of 08/15/2023 and readmitted to the facility on [DATE] with diagnoses of severe obesity, cellulitis (bacterial infection) of abdominal wall, type 2 diabetes (difficulty managing blood sugar levels), major depressive disorder (mood disorder causing persistent feelings of sadness and loss of interest in activities) and a BIMS score of 14 (cognitively intact). Record review of Resident #1's care plan revealed Resident #1 was to be encouraged to sit on the toilet to evacuate bowels if possible. Observation on 03/26/2024 at 3:43 PM of Resident #1 revealed she was sitting up in bed wearing a night gown, watching television, with her call light within reach. Interview on 03/26/2024 at 3:45 PM with Resident #1 revealed housekeeping came and swept and mopped the floor of her main room but did not go into her bathroom. Resident #1 stated that housekeeping had missed cleaning her bathroom in the past and she was not sure why housekeeping did not regularly clean her bathroom. Resident #1 stated she was frequently incontinent of urine and mostly used the bathroom for bowel movements every 2 or 3 days and used baby powder afterwards. Resident #1 stated she usually could move herself from the bed to the wheelchair but sometimes she needed assistance. Resident #1 stated when housekeeping did not clean her bathroom multiple days in a row it increased her depression because she felt forgotten and self-conscious that housekeeping did not want to look in the bathroom because she was obese. Resident #1 stated she tried to tell housekeepers the bathroom needed to be cleaned but there was a communication barrier with housekeepers only speaking Spanish. Observation on 03/26/2024 at 4:29 PM of Resident #1's bathroom revealed a white powder like (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: 676363 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 676363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mustang Park Therapy and Living Center 4501 Plano Parkway Carrollton, TX 75010 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)