Inspection·January 10, 2025

F 0641 Ensure each resident receives an accurate assessment. 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 have assessments that accurately reflected the status for one (Resident #1) of five residents reviewed for assessment accuracy. Residents Affected - Few The facility failed to ensure Resident #1's transfer status was accurate in her MDS as it did not reflect she required a mechanical lift. This deficient practice could result in errors in care and treatment. Findings included: Review of Resident #1's undated face sheet reflected a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including displaced comminuted fracture of shaft of right femur (thigh bone), unsteadiness on feet, and muscle wasting and atrophy (wasting away). Review of Resident #1's admission MDS assessment, dated 11/04/24, reflected a BIMS score of 12, indicating a moderate cognitive impairment. Section GG (Functional Abilities) reflected she was dependent with transfers, utilized a manual wheelchair, and did not require a mechanical lift. Review of Resident #1's admission care plan, dated 11/06/24, reflected she had ADL self-care performance deficit related to impaired mobility with an intervention of requiring total assistance with transfers. Review of Resident #1's Daily Skilled with Self-Care Mobility Assessment, dated 01/09/25, reflected Limited ROM requires x2 persons assist to transfer bed to chair, bed and into the wheelchair. Mechanical lift to transfer [sic]. During an interview on 01/10/25 at 9:34 AM, LVN A stated Resident #1 required a mechanical lift transfer with two staff members assistance for all transfers as she was unable to bear weight. During an interview on 01/10/25 at 12:21 PM, the DON stated it was the nursing department's responsibility to ensure the MDS and care plan matched the residents' transfer status. She stated it was her expectation that they were up to date, matched, and staff knew how to properly transfer each resident. She stated it was important to ensure they were providing the best care to the residents. She stated a negative outcome of the assessments not matching would depend on the situation, but it was important for safety reasons. Review of the facility's Nursing Services - ADLs Policy, revised 05/2007, reflected the following: (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 3 Event ID: 676373 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 676373 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Manor Bee Cave 14058 Bee Caves Parkway, Bldg B Bee Cave, TX 78738 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)