Health inspection·September 13, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 residents receive treatment and care in accordance with professional standards of practice, and the comprehensive person-centered care plan for 1 (Resident #3) of 6 residents reviewed for repositioning. Residents Affected - Few The facility failed to ensure Resident #3 was repositioned every 2 hours. This failure could affect others by placing them at risk of potential medical complications related to changes in condition. Findings included: Record review of Resident #3's face sheet dated 09/13/2023 revealed an [AGE] year-old female who was re-admitted on [DATE] with diagnosis of failure to thrive (general state of decline in elderly patient) and muscle weakness. Record review of Resident #3's MDS quarterly assessment dated [DATE] revealed she could not complete BIMS interview, she was severely cognitive impaired. Required extensive assistance with 2-person physical assistance for bed mobility and was at risk for pressure ulcer/injury risk with no pressure ulcer noted. Record review of Resident #3's care plan dated 02/25/2022 and last reviewed revealed a focus area for pressure ulcer development related to immobility with interventions that included follow facility policies/protocols for the prevention/treatment of skin breakdown and needs moisturizer applied to my skin. Do not massage over bony prominences and use mild cleansers for peri-care/washing. Record review of Resident #3's skin assessment dated [DATE] revealed no redness and/or pressure ulcer to sacrum (the large wedge-shaped bone, consisting of five fused vertebrae, in the lower part of the back). During observation on 09/13/2023 at 9:23 am, Resident #3 was not verbal, did not answer any questions. Resident #3 was in bed, lying on her back and head of bed was elevated 30 degrees. Three pillows noted at bedside on chair. During observation on 09/13/2023 at 11:32 am, Resident #3 was not verbal, did not answer any questions. Resident #3 was in bed, lying on her back and head of bed was elevated 30 degrees. Three pillows noted at bedside on chair. (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: 676428 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 676428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort El Paso, LLC 3421 Joe Battle Boulevard El Paso, TX 79936 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)