Health inspection·February 27, 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 observation, interview, and record review the facility failed to provide the necessary services for residents who are unable to carry out activities of daily living to maintain good grooming and personal hygiene for one (Resident #1) of five residents reviewed for ADLs. Residents Affected - Few The facility failed to ensure Resident #1 had his fingernails cleaned and trimmed. This failure could place residents who were dependent on staff for ADL care at risk for infections, and a decreased quality of life. Findings include: Record review of Resident #1's face sheet, printed on 02/27/24, reflected a 89-year-ild male who admitted to the facility on [DATE], with diagnoses of cognitive communication deficit, heart failure, generalized muscle weakness, vascular dementia (decline in thinking skills caused by conditions that block or reduce blood flow to various regions of the brain), age-related physical debility, hypokalemia (low potassium ); dementia(the loss of cognitive functioning), lack of coordination; spondylosis (abnormal wear on the cartilage and bones of the neck). Record review of Resident #1's annual MDS assessment, dated 02/21/24, reflected Resident #1 had a BIMS score of 10, which indicated he had moderate cognitive impairment. Section GG - Functional Abilities and Goals, question GG0130. Self-Care indicated Resident #1 required maximal assistance with ADL's of personal hygiene, dressing, bathing and toileting hygiene. Record review of Resident #1's care plan effective, 09/09/19 to present, reflected Self-care deficit Extensive assistance required with bathing, hygiene, dressing, and grooming R/T Alzheimer's . Intervention . Assist [Resident #1] with ADL's as needed . Clean and manicure fingernails as needed . In an observation and interview on 02/23/24 at 4:36 p.m., Resident #1 was observed lying in bed. Resident #1's fingernails on both hands were roughly a quarter of an inch or longer, with dried brown and yellow matter under each nail. Resident #1 stated he could not recall when his nails were last trimmed but he needed it done because he had scratched his scalp because they were so long. In an interview on 02/26/24 at 11:25 a.m., RN A stated she was Resident #1's day shift nurse, for roughly one month. RN a stated Resident #1 was dependent on staff for all ADLs, except to feed himself. RN A stated Resident #1's aides were able to cut his fingernails, as he was not diabetic. RN A (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: 676369 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 676369 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hollymead 4101 Long Prairie Road Flower Mound, TX 75028 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)