Health inspection·March 9, 2023

F 0759 Level of Harm - Minimal harm or potential for actual harm Observation/Interview on 3/8/2023 at 7:25am during medication administration of RN#1 revealed her going to administer a dose of Hydroxyzine to Resident #212, she looked through the medication cart and she could not locate Resident #212's Hydroxyzine. She said they were out of Hydroxyzine and the medication had to be ordered. She said they could not administer the Hydroxyzine until the facility filled resident #212's order for Hydroxyzine. Residents Affected - Few Resident #7 Record review of Resident #7 revealed a [AGE] year-old female with a diagnosis of Cerebral Infarction, Unspecified (Occurs because of disrupted blood flow to the brain). Heart Failure Unspecified (Heart cannot pump enough blood to support other organs). Record review of Resident #7's Care Plan dated 1/20/2023 revealed the resident had impaired cognitive function related to Dementia and was dependent on bathing, bed mobility, bedfast, dressing, eating, personal hygiene, toileting, and transfers. Record review of Resident #7's physician order dated 3/4/2023 revealed Potassium Chloride ER Oral Tablet Extended Release 10meq (Potassium Chloride) Give 1 tablet by mouth one time a day for Supplement. Record review of Resident #7's MAR dated, 3/1/2023-3/31/2023 revealed Code 9 (Not Available) was entered on the Potassium totaling 2 doses for the following dates and times: 3/8/2023 at 9:00am and 3/9/2023 at 9:00am. Observation of LVN #1 on 3/8/2023 at 7:56am revealed she looked at Resident #7's MAR and did not administer the potassium because she said she could not crush the medication so she would have to call hospice for an order. In an interview on 3/8/2023 at 7:56am LVN #1 said Resident #7 could not have the potassium because the resident could not swallow the pill and the medication could not be crushed. She said she called hospice on Sunday 3/5/23 for a new order, and she had not heard back from them. Surveyor pointed out that today was Wednesday 3/8/2023 and asked LVN #1 if she had followed up with hospice and she said no. In an interview on 3/8/2023 at 11:12am with NP#3, she said if a person does not get potassium their potassium could go low or if they have a cardiac condition their cardiac muscle could be affected. She said residents could go into A-fib (Fluttering of the Heart muscle) if they had A-fib previously. In an interview on 3/9/2023 at 12:16pm LVN#1 said she ordered the potassium on 3/5/23 but forgot to document in the nurse's notes. In an interview on 3/8/2023 at 12:30pm Chief Clinical Officer, he said the pharmacy makes three deliveries a day. He said the nurses were supposed to report to him if they did not get their medications. He said he in-serviced nursing staff in February on what to do if a medication was not available. He said the expectation for any medication was that he ordered that day by 9pm and the medications would be received by 5am the next morning. He said if the medication was not received the nurse was supposed to escalate to management so that it could be delivered as soon as possible. He said he was unaware the resident #212 had not received Hydralazine for 5 days and resident #7 had not received (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676420 If continuation sheet Page 2 of 3 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 676420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Brightpointe 604 S Conroe Medical Dr Conroe, TX 77304 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Potassium on 3/8/2023 and 3/9/2023 had missed medications due to physician orders not being filled timely. He said if this was not done it was a failure of communication from the nurses. He said that he became lax in his auditing of Code 9 which was what they use to see when medications were not administered. He said, Code 9 was what the nurses used to chart when a medication was missed. Record review of facility in-service titled, Charting Requirements, dated 2/8/2023 read in part . Educate staff on procedure if medication not available and To ensure medication are available for patients . Record review of facility's medication policy titled, Administering Medication, dated 2019, read in part . Medications are administered in accordance with prescriber orders, including any required time frame . Record review of facility's medication policy titled, Administering Medication, dated 2019, read in part . Medication administration times are determined by resident need and benefit, not staff convenience . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676420 If continuation sheet Page 3 of 3