Health inspection·February 15, 2024

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record review, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for three of three residents (Resident #21, #95, and #88) reviewed for infection control. Residents Affected - Some 1. MA A touched medications without gloves and administered to Resident #21. 2. MA A failed to clean the blood pressure machine while checking the blood pressure for Resident #21 and #95. 3. CNA B failed to complete hand hygiene while providing incontinent care to Resident #88. These failures could place residents at risk for contamination and infection. The findings included: Observation on 02/13/24 at 09:45 AM reflected MA A checked Resident #21's blood pressure and then proceeded to prepare the medications for Resident #21 and put them in the medication cart. While getting the medications from the medication bottle, MA A picked up the medications without gloves. MA A than administered the medications to the resident. MA A completed hand hygiene then proceeded to Resident # 95's room and checked her blood pressure. In an interview on 02/13/24 at 10:14 AM with MA A stated she was aware that she was not supposed to touch the medications with ungloved hands, but she forgot. MA A stated her hands were considered contaminated, so she was not supposed to touch medications without gloves. MA A stated she was not supposed to clean the blood pressure machine unless she had residents who were in isolation. She stated since there were no residents on isolation, she did not need to clean the blood pressure machine. MA A stated she was supposed to maintain infection control to prevent the spread of infection from one resident to another. Observation on 02/14/24 at 01:43 PM revealed CNA B providing incontinent care to Resident #88. The resident was in bed, CNA B went in the room gloved and positioned the resident. CNA B proceeded to (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: 676387 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 676387 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Meadows 1870 John King Blvd Rockwall, TX 75032 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)