Health inspection·April 26, 2023

F 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to allow residents to call for staff assistance through a communication system that relays the call directly to a staff member or to a centralized staff work area for two residents (Resident #1 and Resident #2) of 5 residents reviewed for the environment. Residents Affected - Some The facility failed to ensure Resident #1 and Resident #2 had a communication system to call directly to the facility staff. This failure placed residents at risk of not being able to get staff assistance when they needed it. Findings included: An interview with the ADM on 04/26/23 at 9:23 am revealed the facility had reported to the State Agency on 04/06/23, the facility's call light system had been struck by lightning, resulting in the outage of the system. As of 04/26/23, the facility had some residents' rooms with a functioning call light system. The residents' rooms that were not working were identified by the Maintenance Director. The facility had identified 15 rooms in which the call light did not work. The rooms and residents with no working call light system were provided bells and more frequent rounding . The facility awaited to hear from the service company when they would make the repairs. Record review of Resident #1;s face sheet dated 04/05/23 revealed an [AGE] year-old- female. She was admitted to the facility on [DATE]. Her diagnoses included Acute Respiratory failure with hypoxia, Dementia and Increased secretion of gastrin. Review of Resident #1's MDS dated [DATE] revealed a BIMS revealed a score of 07, indicating severe cognition impairment. Resident #1 was not interviewable. Observation of room [ROOM NUMBER] on 04/26/23 at 11:42 am revealed Resident #1's call light was located on the floor behind the bedside table while Resident #1 laid in bed. An interview and observation with the ADON on 04/26/23 at 11:45 am in Resident #1's room revealed Resident #1 call light was placed behind the bedside table. The ADON pressed the call light and revealed the call light was not functioning. The ADON stated she was not aware of room [ROOM NUMBER] call light not working. Resident #1 did not have a call bell to request staff assistance in the room. The ADON tested Resident #2's call light, who also resided in room [ROOM NUMBER] and Resident #2's call light was also not working. There was no call bell in the room for Resident #2. (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: 676464 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 676464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Las Brisas Rehabilitation and Wellness Center 3421 W Story Rd Irving, TX 75038 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)