Health inspection·September 18, 2025

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure that, based on the comprehensive assessment of a resident, the facility must ensure a resident with pressure ulcers received necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing for one of two residents) Resident #4 reviewed for pressure sores.The facility failed to ensure Resident #4 received treatment for a pressure sore to the sacrum according to orders. This failure could place residents at risk for worsening of the pressure sore and for infection. Findings included: Record review of the admission Record for Resident #4 revealed an [AGE] year old male who was admitted to the facility on [DATE]. Resident #4 had diagnoses which included, but were not limited to, protein-calorie malnutrition, weakness, and gastrostomy status (feeding tube). Record review of Resident #4's Physician's Order, dated 08/26/25, revealed Resident #4 had a Stage 2 pressure sore. The order reflected the wound was to be cleansed with Dakins solution, pat dry, have medihoney applied, followed by Calcium Alginate. The wound was to be covered with a bordered foam gauze. The treatment was to be provided every three days. Record review of Resident #4's Care Plan, dated 03/10/25, read, in part .Administer treatments as ordered and monitor for effectiveness. Observation on 09/16/25 at 12:55 p.m. revealed GVN B assisted Resident #4 onto his left side. GVN B loosened the resident's brief. The resident had a 4 x 4 inch bordered gauze dressing on his sacral area. The date on the dressing was 09/12 (2025). It appeared to reflect an initial of LVN E There was a second 4 x 4 inch bordered gauze dressing on the resident's left buttock. The date was reflected as 09/12 (2025) and an initial of LVN E. The date and the initials were verified by GVN B.In an interview on 09/16/25 at 1:01 p.m., ADON A said Resident #4 received Hospice Services, and the Hospice nurse provided the treatments. She said if the date on the sacral dressing was 09/12/25, it should have been changed on 09/15/25, the previous day. Observation on 09/16/25 at 1:14 p.m. revealed GVN B provided wound care for Resident #4, accompanied by CNA C,. ADON A was also present. When Resident #4 was turned onto his left side, the dates on the sacral and left buttock were visible. Both dressings were removed and discarded by GVN B. Observation revealed an open wound at the sacral area of approximately 1.5 cm diameter. There was yellow slough visible, making depth measurement unobtainable. Observation revealed an open area on the left buttock approximately 1.5 cm diameter, with superficial depth. Observation of wound care technique revealed no concern.In an interview on 09/16/25 at 3:50 p.m., ADON A said the initial documented on Resident #4's dressing would be for LVN E. ADON A said Hospice usually provided wound care for Resident #4, but the Hospice service was transitioning nurses, so the facility nurses were providing wound care. In an interview via telephone on 09/17/25 at 5:00 a.m., LVN D said she had not provided wound care for Resident #4 recently. She said when she worked on Sunday (09/14/25) she did not provide the scheduled wound care because it had been done PRN on 09/12/25. In an interview on 09/18/25 at 12:48 p.m., the DON said Hospice had been providing wound care Residents Affected - Few (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: 676396 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 676396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE S.P.J.S.T. Rest Home 3 248 Wisteria Lane El Campo, TX 77437 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)