Health inspection·December 20, 2022

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 observations, interview and record review, the facility failed to maintain a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infection for 1 resident of 8 (Resident #359) observed for physical environment. The facility failed to maintain sanitary, functioning and a clean restroom for Resident #359. This failure placed the resident at risk for discomfort, infection and diminished quality of life and diminished clean, homelike environment. Findings include: Observation on 12/18/22 at 9:43 AM of Resident #359's restroom revealed dried fecal matter on the toilet seat, on the outside of the toilet bowl and on the floor near the toilet. Fecal as matter also present on the resident's shower chair. Interview on 12/18/22 at 10:15 AM Resident #359 stated she had an accident (bowel movement) in the restroom on Friday, 12/16/22. The resident stated she asked staff to clean the restroom each day since the accident. Observation on 12/18/22 at 12:08 PM of Resident #359's restroom revealed dried fecal matter still present on and around the toilet and on the shower chair . Observation on 12/19/22 at 12:10 PM of Resident #359's restroom revealed the resident's toilet and shower chair to be clean. Interview on 11/09/22 at 9:44 AM, Housekeeper A stated she just started working at the facility 2 weeks ago. She stated she started her day at 6:00 AM and was assigned to hall 100 . She stated she was told to clean room [ROOM NUMBER] right away . She stated her typical routine was that after cleaning a resident room, she would then clean the bathrooms. She stated she would clean the sink and scrub the toilet. She then pointed to the scrub brush and cleaning solution in her cart. She stated she would go back to room [ROOM NUMBER] then work her way down the hall like usual, since she was done with room [ROOM NUMBER]. Interview on 12/19/22 at 03:20 PM the Housekeeping Supervisor stated that as the supervisor, she checks resident rooms for cleanliness 2-3 times a week. Housekeeping Supervisor stated housekeepers perform light cleaning on most days, but also heavy cleaning on scheduled days for each hall. (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 4 Event ID: 676476 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 676476 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/20/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Heights on Valley Ranch 23200 Valley Ranch Parkway Porter, TX 77365 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)