Health inspection·June 30, 2023

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to maintain clinical records that were complete and accurate, in accordance with accepted professional standards and practices for 1 of 4 residents (Resident #1) whose clinical records were reviewed in that: 1. The facility failed to document the circumstances of Resident #1's change of condition when found unresponsive and the staff's reaction and intervention of CPR to his medical emergency. This failure to maintain accurate records could affect all residents by receiving incorrect services because of confusion by staff in determining what part of the clinical record was accurate. Findings included: Record review of Resident #1's Face Sheet, dated [DATE], revealed a [AGE] year-old-male with an admission date of [DATE] and a discharge date of [DATE] after he expired. Diagnoses included Cerebral Infarction (occurs as a result of disrupted blood flow to the brain due to problems with the blood vessels that supply it), Abnormalities (abnormal features) of gait (manner of walking) and mobility (the ability to move), Coronary (relating to arteries) Atherosclerosis (thickening or hardening of the arteries) Heart Disease of Native Coronary Artery (15 angiographic segments and 3 arterial trunks for analysis of progression of coronary artery disease), and Hemiplegia (paralysis of one side of the body). Record review of Resident #1's quarterly MDS, dated [DATE], reveal Resident #1 had a BIMS score of 13, indicating intake cognitive response. In the section of functional status, Resident #1 minimum supervision and setup only in the areas of bed mobility, transfer, and eating. During an interview on [DATE] at 12:15 p.m., the ADON said she had worked at the facility since the facility had opened. The ADON said she was present at the facility on [DATE] when Resident #1 was found unresponsive and had passed away. The ADON said she had observed Resident #1 the morning of [DATE], but she could not remember the exact time and said he had no symptoms or complaints. The ADON said TNA A went into Resident #1's room and reported she found him unresponsive. The ADON said TNA A called for help and requested 911 be called immediately. The ADON said she checked the advanced directive book located at the nurses' station and determined Resident #1 was full code and immediately went down to Resident #1's room to report his full code status. The ADON said she assisted another staff to lower Resident #1 to the floor and TNA A started CPR procedure. The ADON said she called 911 on her cell phone. The ADON said she witnessed CPR performed on Resident #1 until the paramedics arrived. The ADON said she did not document the information in Resident #1's clinical records. (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: 676416 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 676416 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brightpointe at Lytle Lake 1201 Clarks Dr Abilene, TX 79602 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)