Health inspection·September 17, 2025

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 in accordance with accepted professional standards and practices that are complete and accurately documented for 1 (Resident #1) of 5 residents reviewed for accuracy of medical records in that: The facility failed to document Resident #1's blood pressure before she was transported to dialysis on 08/13/25. This failure could place residents at risk of a change in condition and not receiving proper treatment and care in a timely manner.Findings included: Record review of Resident #1's face sheet, dated 09/17/25, reflected a [AGE] year-old female with an admission date of 01/24/23. Resident #1 had a diagnosis of Stage 5 Chronic Kidney Disease (the most advanced stage of kidney disease), Acute or Chronic Heart Failure (sudden life-threatening or worsening heart condition), Bacterial Infection (harmful bacteria enter the body and can cause damage), End Stage Renal Disease (kidneys have lost most of the function), Type 2 Diabetes Mellitus (body cannot regulate blood sugar levels), Fluid Overload (excessive amount of fluid in the body), Cardia Arrhythmia (abnormal heart rhythm), Presence of Heart Assist Device, Chest Pain, Unspecified Dementia (cognitive decline and memory loss), and Hypotension of Hemodialysis (a drop in blood pressure that occurs during dialysis). Record review of Resident #1's quarterly MDS assessment, dated 07/16/25, reflected she had a BIMS score of 11 in Section C, which indicated she was moderately impaired. Section N of the quarterly MDS assessment noted Resident #1 had anticoagulant, antibiotic, and hypoglycemic medications. Section O of the quarterly MDS assessment noted Resident #1 received dialysis while she was a resident. Record review of Resident #1's physician orders reflected the following orders: 04/21/25Dialysis MWF11:00 AM 04/21/25Vital Signs Every Shift Record review of Resident #1's Dialysis Communication Form, dated 08/13/25, reflected the following: Dialysis date: 08/13/25 Most Recent Blood Pressure Blood Pressure 102/65 Date 08/12/25 18:22 (6:22 PM) Record review of Resident #1's care plan with an initial date of 05/15/25 reflected the following: Resident #1 required hemodialysis 3 times per week due to ESRD Monitor vital signs. Notify MD of significant abnormalities Resident #1 has an implanted cardiac pacemaker Monitor vital signs. Notify MD of significant abnormalities Record review of the progress notes on Resident #1's electronic record reflected not vital listed for 08/13/25. Record review of the main page of the electronic record, dated 09/17/25, reflected the last blood pressure vital was taken on 08/12/25 at 18:22 (6:22 PM), and Resident #1's blood pressure was 102/65. Record review of the Vitals tab on Resident #1's electronic record reflected the last blood pressure recorded was on 08/12/25 at 18:22 (6:22 PM) by Nurse A. Record review of the August 2025 NAR reflected no blood pressure vitals documented on 08/13/25. Record review of the August 2025 MAR reflected no blood pressure vitals documented on 08/13/25. Record review of the August 2025 TAR reflected no blood pressure vitals documented on 08/13/25. During an interview on 09/17/25 at 11:10 AM, with the Director of Clinical Services, the DON, and the Administrator, Resident #1's Dialysis Binder was requested but not (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: 676429 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 676429 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carrara 4501 Tradition Trail Plano, TX 75093 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)