Health inspection·September 13, 2023

F 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. 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 parenteral fluids were administered with professional standards of practice and in accordance with physician orders, the comprehensive person-centered care plan, and the residents goals and preferences for one (Resident #1) of three residents reviewed for intravenous medication administration. Residents Affected - Some The facility failed to ensure Resident #1 received the proper care for her peripherally inserted central catheter (PICC) line when: 1. Multiple facility staff failed to discontinue the PICC line when ordered by her physician from 8/22/2023 through 8/26/23, and 2. Multiple facility staff failed to ensure the dressing to her PICC line was changed weekly as ordered and stated in the facility policy. These failures placed the residents with parenteral/IV fluids and lines at risk for infection. Findings included: Record review of Resident #1's face sheet revealed she was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts; sepsis, unspecified organism [systemic infection in the bloodstream], unspecified staphylococcus; other Escherichia coli [types of bacteria]; presence of artificial hip joint; Type 2 diabetes; essential hypertension [high blood pressure]; and dependence on renal dialysis. Record review of Resident #1's MDS assessment dated [DATE] revealed she had a BIMS score of 14 indicating she was cognitively intact. Her functional status indicated she needed extensive assistance with bed mobility, dressing, and toileting. Record review of Resident #1's most recent Care Plan revealed: Focus: The resident is on IV ABT [antibiotic] therapy for wound infection. Goal: The resident will not have any complications related to IV Therapy . Interventions: .IV dressing: Observe dressing. Change dressing and record observations of site . Record review of Resident #1's Order Recap Report dated 8/01/2023-8/31/2023 revealed the following orders: (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 3 Event ID: 745017 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 745017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Lodge of Saginaw Health and Wellness 848 W McLeroy Blvd Saginaw, TX 76179 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)