Inspection·February 19, 2026

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of communicable diseases and infections for 1 of 6 residents (Resident #1) reviewed for infection control. RN A failed to properly dispose of used sharps on [DATE] and they were left hanging attached to an IV pole. On [DATE], EMS B was stuck by the used sharps when she grabbed the IV pole to utilize during CPR. This failure could place residents and staff at risk of exposure to communicable diseases and infections. Findings included: Record review of Resident #1' face sheet dated [DATE] indicated he was a [AGE] year-old male admitted on [DATE], and his diagnoses included encephalopathy (damage or disease that affects the brain), anemia (deficiency of red blood cells), diabetes (blood sugar is too high), depression (mental health condition), anxiety (excessive worry), heart disease, kidney disease, and liver transplant status. Record review of Resident #1's physician orders dated [DATE] indicated may insert IV on [DATE] and change to clysis (medical introduction of fluids into the body, typically by injection, to replace lost fluids, provide nutrients, or maintain blood pressure.) Record review of Resident #1's progress note dated [DATE] at 10:14 p.m. by RN A indicated the clysis that was inserted into the left upper arm was dislodged. The site was leaking clear fluid and was cleansed and patted dry. MD was notified. During an interview on [DATE] at 1:15 p.m., RN D said on [DATE] she attempted to insert an IV to administer IV fluids for Resident #1 and was not successful. She said she obtained order to change the IV to clysis. She said she left her shift on [DATE] at approximately 6:30 p.m. and Resident #1 was receiving fluids as ordered. She said she returned to work her shift at 6:00 a.m. on [DATE] and was informed the clysis had been dislodged. She said the MD did not order re-insertion of the clysis. She said on [DATE] Resident #1 was found unresponsive and emergency CPR was initiated. She said EMS arrived and took over. She said she heard EMS E tell EMS B there was an IV pole. She said EMS B grabbed the IV pole and screamed she was stuck. RN D said she removed the bag of saline and used sharps from the IV pole and disposed them into the garbage bin at the nurse station. She said she knew she should dispose of the sharps into the used sharps container but she was waiting until EMS looked over the bag and used sharps. She said EMS B and EMS E checked the bag to make sure there was no medications included in the saline solution. RN D said she then disposed of the used sharps in the sharps container and the bag of saline was disposed of into the trash. She said the used sharps should have been disposed of in the sharps container immediately and not left on the IV pole in Resident #1's room. She said Resident #1 did not have a room mate. She said other residents and staff were at risk of exposure to communicable diseases and infections if sharps were not disposed of correctly. During an interview on [DATE] at 1:43 p.m., the ADON said all used sharps should have been disposed of in the sharps container and not left on the IV pole in Resident #1's room. She said Resident #1 did not have a room mate. She said other residents and staff were at risk of Residents Affected - Few (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: 676484 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 676484 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/19/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mont Belvieu Rehabilitation & Healthcare Center 14000 Lakes of Champions Blvd Mont Belvieu, TX 77523 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)