Health inspection·January 6, 2024

F 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that the transfer or discharge was documented in the resident's medical record and appropriate information was communicated to the receiving health care institution or provider for one (Resident #1) of 4 residents reviewed for facility-initiated discharges. The facility failed to provide documentation for an immediate facility-initiated discharge for Resident #1 that the resident's needs could not be met and attempted to meet the resident's needs. The failure could affect residents by placing them at risk of not having access to adequate care in a nursing home facility. Findings included: Review of Resident #1's admission record, dated 01/07/24, revealed the resident was a [AGE] year-old male, admitted to the facility on [DATE], and discharged on 01/02/24, with the diagnoses of hemiplegia (brain damage or spinal cord injury leading to paralysis), dementia, epilepsy (seizure), and acute kidney failure. Review of Resident #1's Quarterly MDS Assessment, dated 10/01/23, revealed Resident #1 had a BIMS score of 6, which indicated severe cognitive impairment. Review of Resident #1's care plan, revised on 01/05/24, revealed Resident #1 had a history of substance abuse and cannabis usage with interventions of observe for signs and symptoms of impairment. There were no other interventions listed. Interview on 01/06/24 at 10:15 AM with the Administrator revealed Resident #1 was admitted to the hospital on [DATE] for a possible seizure. Upon admission to the hospital, the resident tested positive for illegal substances (methamphetamine and cocaine). The Administrator stated APS was contacted and that based on the facility's drug policy, the resident was provided a notice to move. She stated that she suspected the family was bringing drugs to the resident. Interview on 01/06/24 at 10:33 AM with the DON revealed Resident #1 was sent to the hospital on [DATE] due to the family stating he was choking. She stated Resident #1 was verbal, even if his BIMS score was 6 (which indicated severe cognitive impairment). The DON stated the resident had been to the hospital before on 11/22/23 due to a stroke and tested positive for cannabis and methamphetamine. The second time the resident went to the hospital on [DATE], the resident was found with cocaine in (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: 676480 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 676480 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Village Wellness & Rehabilitation 825 W. Kearney Street 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)