Health inspection·February 13, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to implement a comprehensive care plan for each resident that includes measurable objectives and timeframes to meet a resident's medical, nursing, mental, and psychosocial needs that are identified in the comprehensive assessment and describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 (Resident #188) of 18 Residents reviewed for comprehensive care plans. -The facility failed to include care plans for Resident #188's use of oxygen therapy. This failure could affect residents receiving care per comprehensive person-centered care plans resulting in resident not being able to attain or maintain their highest practicable physical, mental, and psychosocial well-being. Finding include: Record review of Resident #188's face sheet dated 2-12-2024 revealed she was a [AGE] year-old female resident admitted to the facility originally on 3-27-2019 and readmitted on [DATE] with diagnoses to include acute respiratory failure with hypoxia (sudden failure of lungs to deliver oxygen to the body), Influenza ) a common, sometimes deadly viral infection of the nose, throat, and lungs, also called the flu), major depression (mental illness causing sadness due to lack of chemicals in the brain that cause happiness), falls, anemia (low red blood cell count), chronic kidney disease (longstanding disease of the kidneys leading to kidney failure), hypertension (a condition in which the force of the blood against the artery walls is too high), and Rheumatoid Arthritis (autoimmune inflammation of the joints). Record review of Resident #188's clinical record revealed her last MDS assessment was a quarterly completed 1-10-2024 listing her with a BIMS of 15 indicating she was cognitively intact, and she required the use of a walker and partial/moderate assist with her activities of daily living. Record review of Resident #188's Orders form with active orders as of 2-12-2024 revealed the following orders: May use oxygen @ 2 l/m via nasal cannula every day and night shift- Active 1-11-2024. Record review of Resident #188's Oxygen saturation log from 2-1-2024 to 2-11-2024 revealed that Resident #188 was wearing her Oxygen 26 of the 32 times that her oxygen saturation was checked. (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 6 Event ID: 676455 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 676455 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing and Rehabilitation 1625 Point West Parkway Amarillo, TX 79124 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)