Health inspection·November 5, 2024

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care for one (Resident #1) of three residents reviewed for baseline care plans. The facility failed to complete a baseline care plan for Resident #1. This deficient practice could place residents at risk of not having individualized need met, a delay in services, sustaining injuries, and not receiving adequate care. Findings included: 1. Record review of Resident #1's Face Sheet, dated 11/05/2024, reflected a -[AGE] year-old male admitted to the facility on [DATE] and readmitted on [DATE] with a diagnoses of sepsis, unspecified organism ( a medical condition where the body has an extreme response to an infection, but the type of organism causing the infection was unknown), type 2 diabetes mellitus with foot ulcer ( when the body does not respond properly to insulin, a hormone that helps move sugar from the blood into the cells. High blood sugar levels from diabetes can damage nerves and blood vessels in the feet, leading to foot ulcers), essential hypertension ( a condition of high blood pressure that is not caused by another medical condition), hiccup( repeated spasms or sudden movements in the diaphragm [has a major part in breathing] that a person cannot control), nausea and vomiting ( feeling sickness to your stomach causes eject matter from your stomach through your mouth), and local infection of the skin and subcutaneous tissue, unspecified ( a common condition that occurs when harmful bacteria or fungi enter the skin and cause inflammation and tissue damage). Record review of Resident #1's admission MDS Assessment, dated 06/26/2024, reflected Resident #1 had a BIMS score of 15 indicating his cognition was intact. Resident #1 was assessed to be dependent on staff for the following ADLs: personal hygiene, dressing, showers, toileting hygiene, chair to bed, and bed to chair transfers. Resident #1 required partial/moderate assistance ( helper does less than half the effort) with showers and repositioning in bed. He required substantial/maximal assistance (help does more than half the effort) with transfers, toileting hygiene and lower body dressing. Resident #1 required set up assistance with oral hygiene and upper body dressing. Resident #1 required set up or clean up assistance with personal hygiene. Resident #1 was diagnosed with medically complex conditions ( a chronic health issue that affect multiple organs or systems in the body, and often requires ongoing medical attention) (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: 676437 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 676437 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accel at College Station 1500 Medical Avenue College Station, TX 77845 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)