Health inspection·March 20, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, which include measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for one of six residents (Resident #36) reviewed for comprehensive care plans. The facility failed to ensure Resident #36's care plan addressed that the resident received hospice service. This deficient practice could result in a loss of quality of life due to residents receiving improper care. Findings include: Record review of Resident #36's face sheet, dated 3/19/2025, revealed an [AGE] year-old female who was admitted to the facility on [DATE]. Resident #36 had diagnoses which included COPD (a lung disease which makes breathing difficult), chronic congestive heart failure (the heart is not able to pump enough blood to meet the body's needs), anxiety, pneumonia and type 2 diabetes. Record review of Resident #36's Hospice Informed Consent/Election of Hospice Benefit form, dated 12/31/2024, signed by the POA revealed Resident #36 would be receiving hospice service from [hospice agency] starting on 1/1/2025. Record review of Resident #36's physician orders, dated 1/1/2025, revealed a physician order of Admit to [hospice agency] with admitting diagnosis as COPD. Record review of Resident #36's care plan, dated 1/29/2025, revealed no care plan for hospice service. In an interview on 3/20/2025 at 1:36 PM, the ADON stated hospice service should be care planned because the care plan let staff know how to care for a resident. She stated the risk of a care plan not being up to date could result in residents not getting proper care . In an interview on 3/20/2025 at 1:42 PM, the DON stated if a resident was on hospice, it was considered a change in status. The DON stated she had to update the face sheet, make sure there was an order in place for hospice service, and update the care plan. She stated she and the ADON met every (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 4 Event ID: 676382 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 676382 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Falcon Ridge Rehabilitation 149 Klattenhoff Lane Hutto, TX 78634 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)