F 0655
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being
admitted
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to develop and implement a baseline care plan for each
resident that included instructions needed to provide effective and person-centered care of the resident that
met professional standards of care within 48 hours of the resident's admission for two (Resident #86 and
Resident #87) of five residents reviewed for baseline care plans.
The facility failed to complete Resident #86's and Resident #87's baseline care plan within 48 hours of
admission that included the minimum required healthcare information including physician orders, dietary
orders, therapy services, and social services.
This failure placed residents at risk of not receiving effective and person-centered care.
Findings included:
1. Review of Resident #86's Face Sheet, dated 04/19/23, reflected he was a [AGE] year-old male who was
admitted to the facility on [DATE]. His diagnoses included a right femur neck fracture (hip fracture), type 2
diabetes mellitus (insulin resistance), hypertensive heart disease without heart failure (changes in the left
ventricle, left atrium, and coronary arteries as a result of chronic blood pressure elevation), and atrial
fibrillation (an irregular and often very rapid heart rhythm).
Review of Resident #86's Baseline Care Plan, dated 04/14/23, reflected it did not address therapy services.
In addition, the dietary/nutritional status and social services sections were not fully completed
(dietary/nutritional status was missing information including dietary preferences and dietary risks, as
applicable and social services was missing informaiton including PASRR recommendations). The Baseline
Care Plan was not completed until 04/18/23.
2. Review of Resident #87's Face Sheet, dated 04/19/23, reflected she was a [AGE] year-old female who
was admitted to the facility on [DATE]. Her diagnoses included dementia (a group of thinking and social
symptoms that interferes with daily functioning), osteoarthritis (a type of arthritis that occurs when flexible
tissue at the ends of bones wears down), anemia (a lack of red blood cells), hypothyroidism (low activity of
the thyroid gland), and hyperlipidemia (a condition in which there are high levels of fat particles or lipids in
the blood).
Review of #87's Baseline Care Plan, dated 04/17/23, reflected it did not address therapy services or social
services. In addition, the dietary/nutritional status section was not fully completed (dietary preferences and
dietary risks, as applicable). The Baseline Care Plan was not completed until 04/18/23.
(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:
676410
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
676410
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/19/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Pure Health Transitional Care at Texas Health Pres
8200 Walnut Hill Lane Main 5
Dallas, TX 75231
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 0655
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
During a telephone interview with the MDS Coordinator on 04/18/23 at 1:45PM, she stated she was
responsible for ensuring baseline care plans were completed upon resident admissions. She stated upon a
resident's admission, she generated a blank baseline care plan in the resident's electronic health record.
Each department (dietary, therapy, social services, etc.) was then responsible for completing their portion of
the baseline care plan. Upon completion, she and the DON reviewed the baseline care plan and saved it as
completed. The baseline care plan was then provided to the resident.
During an interview with the DON on 04/18/23 at 1:30PM, she stated baseline care plans were to be
completed within 48 hours of a resident's admission. She stated the MDS Coordinator generated a blank
baseline care plan in the resident's electronic health record, and then each appropriate department
completed their portion of the baseline care plan. Upon completion, the baseline care plans were reviewed
by herself and/or the MDS Coordinator and provided to the resident. The DON stated because this was a
short-term facility, there was not a risk to residents if the baseline care plan was not completed within the
regulatory guidelines. She stated the resident's care was implemented based off items such as the
resident's hospital orders and assessments.
Review of the facility's Care Plans - Baseline policy, dated 03/22, reflected, .A baseline plan of care to meet
the resident's immediate health and safety needs is developed for each resident within forty-eight (48)
hours of admission . and .1. The baseline care plan includes instructions needed to provide effective,
person-centered care of the resident that meet professional standards of quality care and must include the
minimum healthcare information necessary to properly care for the resident including, but not limited to the
following: a. Initial goals based on admission orders and discussion with the resident/representative; b.
Physician orders; c. Dietary orders; d. Therapy services; e. Social services; and f. PASARR
recommendation, if applicable .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676410
If continuation sheet
Page 2 of 2
