Inspection·May 31, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights and describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 of 8 residents (Resident #39), reviewed for care plans. The facility failed to ensure Resident #31's care plan was revised to reflect an order for an alarm guard. This failure could place residents at risk of current needs not being met. Findings include: Record review of Resident #31's admission record, dated 05/31/2024, reflected the resident was an [AGE] year-old female with an admission date of 04/11/23. Resident #31had diagnoses which included dementia (general decline in cognitive activities), diabetes (sustained high blood sugar levels), cognitive communication deficit (problems with communication), and anxiety disorder (mental disorder associated with stress.) Record review of Resident #31's significant change status MDS assessment, dated 05/24/24, reflected a BIMS score of 3, which indicated Resident #31's cognition was severely impaired and had no behaviors of wandering. Resident #31 used a wander/elopement alarm daily. Resident #31 used a wheelchair as a mobility device. Resident #31 was transferred from the secured unit to the general population on 05/07/24. Record review of Resident #31's physician orders reflected an order for an alarm guard, to the left arm, start date 05/07/24. An order, dated 05/29/24, reflected an order for the alarm guard to the left ankle. Record review of Resident #31's care plans reflected the resident required a wander guard (alarm guard) bracelet and was at risk for injury from wandering in an unsafe environment, as evidenced by dementia and Alzheimer's, date initiated on 05/29/24. Observation on 05/29/24 at 11:00 AM revealed Resident #31 in bed, wearing an alarm guard on her left ankle. Interview on 05/31/24 at 2:42 PM with the DON revealed Resident #31 was in the secured unit and 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: 676493 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 676493 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sun Valley Rehabilitation and Healthcare Center 2902 S 77 Sunshine Strip Harlingen, TX 78550 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)