Inspection·August 9, 2023

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure 1 of 5 residents (Resident #7) reviewed for medications received the appropriate treatment and services to prevent complications of enteral feeding/medication administration including but not limited to aspiration pneumonia, diarrhea, vomiting, dehydration, and metabolic abnormalities. -The nurse failed to verify placement of Resident #7's G-tube prior to administering medications. This failure could place residents at risk for complications from medications not entering the stomach. Findings include: Record review of the admission Record for Resident #7 revealed a [AGE] year-old-female. She was admitted to the facility on [DATE]. Resident #7 had diagnoses which included, but were not limited to, hydrocephalus (accumulation of cerebrospinal fluid which causes pressure inside the skull), acute and chronic respiratory failure (difficult breathing), dysphagia (inability to swallow), and gastrostomy status (has a G-tube for nutrition). Record review of Resident #7's Care Plan (target date 11/17/23) revealed she had a feeding tube (G-tube) due to dysphagia. One intervention read, in part, .Check for tube placement and gastric contents/residual volume per facility protocol and record. Observation on 08/08/23 at 9:45 a.m. revealed LVN A prepared medications for Resident #7. The medications were dispensed at the medication cart in the hallway. There were 2 liquid medications and 6 tablets. Each tablet was crushed individually and placed in 30-cc medication cups. The medications were taken into the room and placed on the overbed table. LVN A washed her hands and donned gloves. LVN A placed the enteral nutrition pump on 'hold' and drew back the resident's gown to permit access to the G-tube. She then added a small amount of water (approximately 10 cc) each 30-cc cup that contained crushed medications. LVN A used a stethoscope to listen for bowel sounds of each quadrant of Resident #7's abdomen. She did not verify placement of the G-tube by placing the stethoscope on the abdomen and pushing air through the G-tube to listen for air delivery into the stomach. LVN A then used a 60-cc syringe to check for residual by connecting it to the tubing and drawing the plunger back. There was less than 5 cc residual. LVN A then flushed the G-tube with approximately 50 cc of water. LVN A administered Resident #7's medications via the G-tube, alternating between medications and small amounts of water. The medication administration concluded with a flush of approximately 50 cc of water. (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: 676384 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 676384 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Sugar Land, LLC 1803 Wescott Avenue Sugar Land, TX 77479 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)