Inspection·January 13, 2026

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents' needs, as identified through resident assessments, and described in the plan of care for one resident (Resident #1) of four residents reviewed for dietary services. -CNA C was in her first day of orientation and was assigned to assist Resident #1 with eating with no supervision. -Resident #1 had a diagnosis of dysphagia (difficulty swallowing). The failure placed Resident #1 at risk for choking and/or aspiration.Findings Include:Record review of the Face Sheet (no date) for Resident #1 revealed she was [AGE] years old and was admitted to the facility on [DATE]. Diagnoses included, but were not limited to, dementia (decline in cognitive ability), muscle wasting, and dysphagia (difficulty swallowing).Record review of Resident #1's Quarterly MDS, dated [DATE] revealed the resident had severely impaired cognition. The resident had limited functional range of motion in both arms and both legs. She required substantial/maximal assistance for eating. Record review of the Care Plan for Resident #1 dated 02/06/2025 revealed the resident was at risk for choking and aspiration related to difficulty swallowing. The Care Plan read in part .Short Term Goal target date: 03/12/2026: _____ [Resident #1] will not choke or aspirate [draw something into the lungs] thru the next review date. Observation on 01/13/2026 at 09:06 a.m. revealed CNA A assisting Resident #1 with her breakfast. The head of the bed was at approximately 75 degrees elevated. The resident received a pureed diet. She was eating very slowly with the assistance of staff. Follow-up observation at 9:29 a.m. revealed the resident had consumed approximately 50% of her meal. In an interview on 01/13/2026 at 11:30 a.m. ADON D said the facility usually provided training for 2 to 3 days and then asked the new CNA if they were comfortable working independently. In an interview on 01/13/2026 at 11:35 a.m., ST E said Resident #1 required to have the head of the bed elevated more than 45 degrees, with 90 degrees optimal. In an interview on 01/13/2026 at 11:41 a.m. CNA F said she was assigned to provide orientation for CNA C. CNA F said on the first day of orientation, CNA C assisted Resident #1 with her meal. CNA F said the new CNA worked with Resident #1 for 15 minutes by herself. In an interview via telephone on 01/13/2026 at 1:32 p.m., a family member said she observed on video that on 01/08/2026 CNA C worked with Resident #1 for 45 minutes without supervision. Review of the personnel file for CNA C revealed her date of hire was 01/07/2026. An attempt to call CNA C on 01/13/2026 at 2:39 p.m. was unsuccessful. A message with contact information was provided. No return call was received.In an interview on 01/13/2026 at 3:45 p.m. ADON D said the first day of orientation should be with another CNA. Every resident has a profile that takes time to learn. The first day is usually not hands-on, just shadowing. At the end of the orientation they are asked if they're comfortable. She said a complication could be using the wrong technique, and lack of following the care plan if not properly trained. Review of the facility policy Certified Nursing Assistant Orientation (revised 01/12/2024) (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: 676450 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 676450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/13/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Terra Bella Health and Wellness Suites 12262 Cityscape Ave Houston, TX 77047 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)