Health inspection·January 4, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for 3 of 7 residents (Residents #1, #2, and #3) reviewed for comprehensive care plans. 1. The facility failed to ensure Resident #1's care plan included Hypertensive Heart Failure. 2. The facility failed to ensure Resident #2's care plan included Hypertension. 3. The facility failed to ensure Resident #3's care plan included Hypertension. These failures could place the residents at risk of not receiving the care and services to maintain their highest practicable physical, mental, and psychosocial well-being. Findings included: Record review of Resident #1's face sheet dated 01/04/24, revealed a [AGE] year-old female, with an initial admission date of 02/12/22, and a readmission date of 04/20/23, and a diagnosis of Alzheimer's Disease (disease in brain that controls thought, memory, and language), Dysphagia (difficulty swallowing), Hyperlipidemia (high level of fat particles in the blood), Hypertensive Heart Disease (problems with your heart due to untreated high blood pressure), Cerebral Infarction (disrupted blood flow to the brain), Persistent Mood (Affective) Disorder (depression that lasts for several years), Difficulty in Walking, Muscle Weakness, and Unspecified Lack of Coordination. Record review of Resident #1's care plan, dated 11/29/23, did not address her diagnosis of Hypertensive Heart Failure. Record review of Resident #2's face sheet dated 01/04/24, revealed a [AGE] year-old female, with an admission date of 01/11/22, and a diagnosis of Malignant Neoplasm of Brain, Epilepsy, Other Symbolic Disfunctions, Hyperlipidemia, Essential Hypertension, and Long-Term use of Antithrombotic/Antiplatelets. Record review of Resident #2's care plan, dated 11/29/22, did not address her diagnosis of Essential Hypertension. Record review of Resident #3's face sheet dated 01/04/24, revealed an [AGE] year-old female, with an admission date of 10/04/22, and a diagnosis of Lymphedema, Anemia, Hypothyroidism, Hyperlipidemia, Essential Hypertension, Cerebral Infarction, and History of other Venous Thrombosis and Embolism. (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: 745006 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 745006 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing and Rehabilitation 1901 N Hampton Rd Desoto, TX 75115 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)