Health inspection·April 30, 2024

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review the facility failed to ensure residents had right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences except when to do so would endanger the health or safety of the resident or other resident for 1 of 5 residents (Resident #1) reviewed for resonable accommodations. Residents Affected - Few The facility failed to ensure CNA A did not remove Resident #1's call light and beside table from within her reach which prevented the resident from calling for assistance when needed. This failure could place residents at risk of being neglected by staff if they were unable to call for assistance when needed. The noncompliance was identified as PNC. The noncompliance began on 3/20/2024 and ended on 3/27/2024. The facility had corrected the noncompliance before the survey began. Findings included: Record Review of Resident #1's face sheet, dated 12/5/2022, reflected an 82- year- old female who was, admitted to the facility on [DATE]. Resident # 1 had diagnoses which included exudative age-related macular degeneration (progressive blurring of the of the central visual which can be acute), left eye, Difficulty walking, / major depressive disorder (a persistently low mood an decreased interest in activities, and feelings of guilt) and insomnia (persistent problems falling and staying asleep). Record Review of Resident # 1's care plan, dated 2/15/2024, reflected Resident # 1 was at risk for Falls and had gait balance problems. The following interventions to help prevent falls were documented: ensure resident's call light is within reach an encourage the resident to call for assistance as needed, keep items water within reach. The care plan also reflected Resident #1 had a ADL self-Care performance deficit. Interventions included: assist with personal hygiene as required, bathing 1x staff assist, mobility 1x staff assist, and dressing required 1x staff assist. Record Review of Resident # 1's quarterly MDS dated [DATE], reflected a BIMS of 11, which indicated moderate cognitive impairment. Section GG, functional section, reflected Resident # 1 required extensive assistance with bed mobility, transfers and toileting. During an interview on 4/30/2024 at 1:23 p.m., LVN 1 stated on 3/20/2024, CNA A stated Resident #1 was banging on her bedside table with her silverware. LVN 1 stated CNA A went into the room and removed the bedside table and call light out of Resident #1's reach so she would not wake the other (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: 676427 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 676427 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Skilled Care of Mexia 501 E Sumpter St Mexia, TX 76667 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)