Health inspection·March 13, 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 ensure medical records were maintained on each resident that were complete and accurately documented for 1 (Resident #2) of 5 residents reviewed for resident records. -The facility failed to ensure the accuracy of Resident #2's medical records. The physician said to hold Resident #2's medication Donepezil due to an interaction and this was not in the medical records. This failure could put residents at risk of improper medication administration based on inaccurate documentation. Findings included: Record review of Resident #2's admission Record dated 03/10/2025, revealed an [AGE] year-old male who was admitted to the facility on [DATE]. Record review of Resident #2's History and Physical (H&P) dated 10/31/2024, revealed resident diagnoses to include Lewy body dementia (a decline in thinking ability, especially in areas of attention, visual perception, and planning and organization). Plan read in part: Continue donepezil and reorient patient frequently. Record review of Resident #2's MDS assessment dated [DATE], revealed a BIMS not conducted as the resident is rarely/never understood. Resident #2 with short-term memory problem and was severely impaired in daily decision making. Record review of Resident #2's hospital Discharge summary dated [DATE], reads in part under medication instructions the medication Donepezil daily, with no information regarding dosage, or any other instructions. Record review of Resident #2's Care Plan initiated 11/05/2024 revealed focus area which included: (Resident #2) had cognitive impairment AEB: memory problems: short/long term, and diagnosis of dementia. Part of the intervention plan includes administer medications as ordered. Record review of Resident #2's PCP Progress Notes for the dates of 11/05/24, 11/11/2024, 11/19/2024, 11/29/2024, 12/06/2024, and 12/12/2024 included the following information: Plan: Continue donepezil and reorient patient frequently. (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: 676457 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 676457 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Bartlett Skilled Nursing and Assisted Living 221 Bartlett Drive El Paso, TX 79912 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)