F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited
to receiving treatment and supports for daily living safely.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review the facility failed to ensure all patient care equipment was in safe
operating condition for one (Resident #1) of five residents reviewed for safe operating patient care
equipment.
The facility failed to ensure Resident #1 had a functioning toilet.
This failure could place residents at risk of unsanitary conditions.
Findings included:
Record review of Resident #1's face sheet dated 6/18/25 revealed a [AGE] year-old male who admitted to
the facility on [DATE]. His diagnosis included age-related cognitive decline, cellulitis (bacterial infection of
the skin) of left lower limb, pain disorder, and cerebral infarction (stroke).
Record review of Resident #1's quarterly MDS assessment dated [DATE] revealed a BIMS score of 11 out
of 15 which indicated moderate cognitive impairment. He was always continent of bowel and bladder and
required assistance from staff with toileting hygiene and toilet transfers.
Record review of Resident #1's care plan edited 5/23/25 indicated he required assistance with ADL's, the
approach included toileting with assist of independent. His care plan also indicated he had periods of
socially inappropriate and verbal aggression. Resident #1 had a preference of using bags and bed pans to
defecate and urinate in rather than use the toilet, dated 6/17/25.
In an interview and observation on 6/17/25 at 9:21 a.m. in Resident #1's room revealed the sound of
running water coming from the toilet. The toilet was not in use. The Surveyor attempted to flush the toilet
and it would not flush. Resident #1 said his toilet had not been working since March (2025). He said he
used a urinal and a bed pan and had to dispose of his urine and feces in his trash can because his toilet
did not work. He said he did not want the staff to dispose of the urine and feces in his shower or sink. He
said he informed the Receptionist and Maintenance Director that his toilet was not working (unknown date).
In a telephone interview on 6/17/25 at 11:19 a.m. Resident #1's family member said the resident's toilet did
not work and staff complained because he used his trash can for his bodily waste.
In an observation and interview on 6/17/25 at 1:06 p.m. revealed CNA R attempted to flush Resident #1's
toilet and it would not flush. She said the resident used the toilet this morning and it was
(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:
676463
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
676463
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/18/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Crimson Heights Health & Wellness
19279 McKay Dr.
Humble, TX 77338
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)
F 0584
Level of Harm - Minimal harm
or potential for actual harm
working. She said Resident #1 used a bedpan and urinal and she would empty his urine in his toilet. She
said she would report the non-working toilet.
In an interview on 6/17/25 at 2:37 p.m. the Administration Assistant said Resident #1 informed her he had
concerns with the toilet in his bathroom on an unknown date.
Residents Affected - Some
In an interview on 6/17/25 at 4:52 p.m. the Maintenance Director said he was not aware that Resident #1's
toilet was not flushing. He said the Assistant Maintenance primarily repaired toilets.
In an observation and interview on 6/17/25 at 5:18 p.m. the Assistant Maintenance attempted to flush
Resident #1's toilet but it would not flush. He said no one informed him that Resident #1's toilet was not
working. He said to his knowledge the toilet was flushing previously and the aide said the resident did not
use the toilet. He said he would have to notify the Maintenance Director about the toilet.
In an interview on 6/17/25 at 5:25 p.m. CNA L said she was unsure if Resident #1's toilet was flushing
properly. She said sometimes it flushed properly but other times the water would go down slowly. She said
Resident #1 disposed of his waste in his trash can.
In an interview on 6/17/25 at 5:40 p.m. the Administrator said he expected residents' toilets to function
properly and for the Maintenance Director to address any problems. He said Resident #1's toilet not
working was new and was not on the maintenance log.
Record review of the facility's Maintenance Log for June 2025 revealed Resident #1's toilet was flushing
slowly on 6/17 and was resolved on 6/17.
Record review of the facility's Maintenance/Housekeeping - Routine Maintenance policy dated 3/2006
reflected in part, . the center performs routine maintenance on floors, walls, fixtures and equipment .
Record review of the facility's Maintenance/Housekeeping - patient/resident room checklist policies and
procedures dated 7/26/2017 reflected in part, . toilet . flush toilet to ensure adequate flow .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676463
If continuation sheet
Page 2 of 2
