Health inspection·September 1, 2023

F 0558 Reasonably accommodate the needs and preferences of each resident. 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 the resident had the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences except when to do so would endanger the health or safety of the resident or other residents for 1 of 7 residents (Resident #1) reviewed for resident rights . Residents Affected - Few The facility failed to ensure Resident #1 always had the call light within reach. This failure could place residents at risk of falling, injury, and unnecessary pain from not being able to call for help. Findings include: Record review of Resident #1's electronic face sheet, dated 08/31/23, revealed an [AGE] year-old male who was admitted to the facility on [DATE]. Resident #1 had diagnoses which included dementia with agitation (loss of cognitive functioning) and idiopathic peripheral autonomic neuropathy (damage of the peripheral nerves where cause cannot be determined) Record review of Resident #1's quarterly MDS, dated [DATE], revealed a BIMS score of 05, which indicated significant cognitive impairment. Record review of Resident #1's care plan, dated 01/23/23, reflected Focus- I am a risk for falls r/t gait/ balance problems. Goals- I will not sustain serious injury through review date. Interventions - Be sure my call light is within reach and encourage me to use it for assistance as needed. I need prompt response to all request for assistance. Follow facility fall policy. Record review of Resident #1 nursing notes, dated 07/31/23, reflected Staff heard the sound of a try fallen soon after resident starts screaming ' help'. Staff enters the room to find resident on the floor supine position on the left side of the bed. Rounds was done 15 minutes prior to incident. Resident stated, 'I fell out of bed . I don't know .I hit my head and it hurts. Full assessment done. Small hematoma noted to the left side of the resident's head. Neuro checks in place. Writer educated resident on the importance of utilizing the call light for assistance and a staff member would come assist as soon as they get a chance. Interview and observation on 08/31/23 at 11:45 AM with Resident #1 revealed he lived in the facility for 1 month and he had not had any falls while being in the facility. When asked how he would contact staff if needed Resident#1 began looking around the bed and tried to name an item however could not verbalize what he was trying to say. The call button was observed on the floor out of reach of (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 5 Event ID: 676488 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 676488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedar Hollow Rehabilitation Center 5011 North US Hwy 75 Sherman, TX 75090 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)