Inspection·November 16, 2023

F 0686 Level of Harm - Actual harm Residents Affected - Few to the sacrum with moderate drainage, some eschar noted to wound bed, no s/s of infection noted. DON was notified of findings .wound care MD was made aware of pressure wound to resident sacrum, new wound care order rec'd and placed in the TAR. Record review of Resident #1's ADL Bathing Record revealed resident was bathed: 1 time on 10/09/2023, 2 times on 10/10/2023, 1 time on 10/12/2023, 1 time on 10/13/2023, 2 times on 10/14/2023, 1 time on 10/15/2023, 1 time on 10/17/2023, 1 time on 10/18/2023, 2 times on 10/19/2023, 2 times on 10/21/2023, 1 time on 10/23/2023 and 2 times on 10/24/2023. Record review of Resident #1's ADL Bathing Record revealed that resident was repositioned and turned : 1 time on 10/09/2023, 3 times on 10/10/2023, 2 times on 10/11/2023, 2 times on 10/12/2023, 2 times on 10/13/2023, 2 times on 10/14/2023, 1 time on 10/15/2023, 3 times on 10/16/2023, 2 times on 10/17/2023, 1 time on 10/18/2023, 2 times on 10/19/2023, 2 times on 10/20/2023, 3 times on 10/21/2023, 2 times on 10/22/2023, 1 time on 10/23/2023 and 1 time on 10/24/2023. Interview on 11/16/2023 at 1:13 PM, with LVN A revealed Resident #1 admitted to the facility on [DATE] without any pressure wounds or irritations to the skin. She stated that Resident #1 did not have any open wound to her heels and her heels were perfect . LVN A confirmed that she observed Resident #1 with a pressure wound to her bottom area. She reported that on 10/27/2023 she was made aware by a family member that Resident #1 had a pressure wound to her bottom area. She stated that she advised Resident #1's family member that there was not any documentation on Resident #1's medical record that advised that Resident #1 had a pressure wound. She reported that after she observed Resident #1 with a pressure wound, she notified the DON and notified the wound care doctor of her findings. LVN A stated that she scheduled an appointment for Resident #1 to see the wound care doctor during his next visit to the facility, which would have been on 10/28/2023. She reported that Resident #1 discharged from the facility on 10/28/2023, therefore there were not any measurements taken of the pressure wound because the facility's wound care doctor would have taken the measurements. She reported that after observing the pressure wound to Resident #1's bottom area a skin assessment was performed on Resident #1. Progress note revealed, findings: pressure wound to sacrum was noted with visible moderate drainage, some eschar noted to wound bed, no s/s of infection noted. LVN A stated that she documented her interaction with the family on 10/27/2023 in PCC. She stated that she did not understand how the staff at the facility who provide direct care to Resident #1 did not notice the pressure wound to Resident #1's bottom area. She stated that normal protocol is that when a resident is observed to have any issue or breakdown of their skin, they are given a head-to-toe Skin Assessment by staff and then herself and the DON would be notified. She stated that the staff would enter a note in the residents Medical Record and then she would observe the resident and schedule an appointment with the wound care doctor so the patient could be seen. LVN A stated that the beginning of each shift, direct care staff for the East and [NAME] hallways are assigned residents. She reported that each residents assigned direct care staff member is responsible for doing weekly skin assessments for non-pressure residents. LVN A stated that she is responsible for doing the weekly skin assessments for pressure residents LVN A reported that Resident #1 was continent because she had a catheter and was continent on the bowel. She stated that Resident #1 had some weakness on her left side, bedbound and would get out of bed with the assistance of therapy staff when and used a wheelchair . Interview on 11/16/2023 at 2:00 PM, Occupational Therapist (OT) A stated that Resident #1 attended therapy every day and she did not observe any pressure ulcers on the resident. She reported that OT and PT are not responsible for doing the skin assessments on residents. OT stated that the direct (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676395 If continuation sheet Page 2 of 4 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 676395 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Healthcare Resort of Plano 3325 West Plano Parkway Plano, TX 75075 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)

F 0686 Level of Harm - Actual harm Residents Affected - Few care staff are responsible for doing the skin assessments on residents. She mentioned that if there is a wound observed on a resident during OT/PT, there is a note made in the resident's file and the direct care staff is notified. She stated that there were not any notes regarding Resident #1 having any skin breakdowns or pressure wounds. She stated that Resident #1 was non-verbal but was able to make verbal sounds, but not communicate. She stated that Resident #1 did not appear to be in any distress from a pressure ulcer in her bottom area. She stated that the harm that could be caused by the resident not being treated for a pressure ulcer would be that she could experience some discomfort and her pressure ulcer could cause more breakdowns in other areas of her body. Interview with LVN B on 11/16/2023 at 5:03 PM, she stated that Resident #1 was a resident on her assigned wing at the facility. She stated that Resident #1 was bedbound and had issues swallowing and received therapy services several times a week. She stated that Resident #1 was non-verbal but was able to make sounds. She stated that Resident #1 was not observed with any bed sore or pressure wounds. She stated that if Resident #1 was determined to have a pressure wound, she would have given the resident a head-to-toe assessment and would have made documentation on the Medical Chart. She stated that she would notify LVN A and the DON and provide them with her assessment for Resident #1. She stated that the resident could receive harm of discomfort and further skin breakdowns in various areas if a pressure wound is undiagnosed. LVN B reported that herself and other staff members have been In-Serviced on Wound Care Treatment, Preventing Pressure Wounds, Abuse and Neglect. Interview on 11/16/2023 at 5:15 PM, the DON stated that she was informed about Resident #1 having a pressure ulcer to her bottom area by a family member. She stated that on 10/27/2023, she was informed that Resident #1 had a pressure ulcer. She stated that LVN A is the wound care nurse, and she was able to assess Resident #1 and confirm that Resident #1 had a pressure ulcer. She confirmed that Resident #1 did not have any skin irritations, breakdowns or pressure ulcers when she admitted to the facility. She stated that LVN A had scheduled an appointment for Resident #1 to be evaluated by the facility's wound care doctor on the same date that Resident #1 discharged from the facility. She stated that although Resident #1 did not have a pressure ulcer when she was admitted to the facility and was at the facility for a couple of weeks, she could have developed a pressure wound internally and then the pressure wound could have presented itself on the exterior or outside of the body. The DON stated that according to the facility's documentation (skin assessments and shower schedule), staff did not observe Resident #1 to have any pressure ulcers on her body. She stated that she could not definitively say that the staff did not notice that Resident #1 had a pressure ulcer on her body. She stated that the harm that could be caused to a resident can vary if the staff did not observe a pressure ulcer on a resident. She stated that the resident could be in distress or pain for an extended period if the pressure ulcer is not noticed in time, which could lead to the resident receiving other breakdowns of the skin in other areas. Interview on 11/16/2023 at 5:20 PM, the Executive Director stated that after Resident #1 discharged from the facility, he was notified by a family that the resident had a pressure ulcer. Resident #1 discharged from the facility on 10/24/2023 and was transferred to an acute care hospital. He stated that the family member provided photographs of the alleged pressure ulcer that Resident #1 received during her brief stay at the facility. He reported that he has seen some residents develop pressure ulcers quickly. He stated that some residents receive pressure ulcers or abnormal wounds to their bodies due to their nutrition and being dehydrated. He stated that he cannot speak to the fact that the staff did not observe the pressure ulcer to Resident #1. He stated that he is not a medical professional but is aware that pressure ulcers are harmful and can lead to other health issues if they are not treated by medical staff. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676395 If continuation sheet Page 3 of 4 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 676395 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Healthcare Resort of Plano 3325 West Plano Parkway Plano, TX 75075 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)

F 0686 Level of Harm - Actual harm Residents Affected - Few Interview on 11/20/2023 at 9:01 AM was advised that Resident #1 received a pressure wound while at the facility. Family member stated that on 10/23/2023, the DON, ADM and LVN A were notified about Resident #1 inquiring a pressure wound since being admitted to the facility on [DATE]. Family member stated that the resident was admitted to the facility without a pressure wound and management and staff were unaware of the pressure wound to Resident #1's sacrum area until she notified them. She stated that the facility could not provide a feasible explanation to how and why the pressure wound developed. Family member stated that she felt as though the facility neglected her family member and decided to discharge Resident #1 from the facility on 10/24/2023 to a hospital. Record review of the facility's current Skin and Wound Management for Quality Care Policy and procedure, dated 12.2019; 1.2022, revealed: Policy: It is the policy of this facility that: 1. A resident who enters the facility without pressure injury does not develop pressure injury unless the individual's clinical condition or other factors demonstrate that a developed pressure injury was unavoidable . Purpose: The purpose of this policy is that the facility provides care and services to: 1. Promote interventions that prevent injury Development; 2. Promote the healing of pressure injuries that are present (including prevention of infection to the extent possible); and 3. Prevent the development of additional, avoidable pressure injury. Prevention: In order to prevent the development of skin breakdown .from worsening, nursing staff shall implement the following The facility was unable to provide a policy regarding ADLs and Pressure Ulcers. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676395 If continuation sheet Page 4 of 4