Health inspection·May 25, 2023

F 0687 Provide appropriate foot care. 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 ensure that residents receive proper treatment and care to maintain good foot health for one (Resident #1) five residents reviewed for foot care. Residents Affected - Few The facility failed to ensure Resident #1, whose toenails were long, was seen by the podiatrist routinely. This failure could place residents at risk for not receiving foot care which is consistent with professional standards of practice. Findings included: Review of Resident #1's MDS dated [DATE] revealed the resident was a [AGE] year-old male admitted to the facility on [DATE]. The resident's diagnoses included diabetes, hyperlipidemia, non-Alzheimer's dementia, Parkinson's disease, and cognitive communication deficit. The MDS further reflected Resident #1 had long- and short-term memory impairment, was rarely understood, and rarely understood others. Review of Resident #1's care plan initiated on 04/13/22 reflected the resident required assistance with ADLs. Approaches included provide level of support to complete dressing and personal hygiene needs every shift. Interview on 05/25/23 at 1:48 PM with CNA A revealed the podiatrist made routine visits at that facility but Resident #1 was not being seen. The CNA stated they filled out a shower sheet for each resident and for about three weeks she had been marking that Resident #1 needed his toenails clipped because they were long. After the showers sheet were completed they were turned into the charge nurses for them to review. Observation on 05/25/23 at 3:45 PM of Resident #1 revealed he was sitting in the hallway in his wheelchair next to his room. LVN B took off Resident #1's sock to his left foot and his toenails were long on each toe measuring about a quarter inch. LVN B then took off the sock to the right foot and 2 of his toenails were observed to also be about a quarter inch long. The resident was asked if his toenails were hurting or bothering him and he shook his head no. Review of Resident #1's shower sheets dated 05/13/23, 05/16/23, 05/25/23, completed by CNA A revealed Resident #1 needed his toenails clipped. Interview on 05/25/23 at 2:52 PM with LVN B revealed the podiatrist made routine visits but she 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: 676466 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 676466 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cheyenne Medical Lodge 750 Highway 352 Mesquite, TX 75149 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)