Health inspection·August 3, 2023

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure resideents the right to be free from abuse and/or neglect for 1 (Resident #1) of 7 residents reviewed for abuse and/or neglect. CNA A yelled or spoke loudly at Resident #1. The facility's failure to provide a safe environment free of verbal abuse places residents at risk of psychosocial harm. Findings included: Record review of Resident #1's face sheet, dated 8/3/23, revealed Resident #1 is a [AGE] year-old female admitted to the facility on [DATE]. The resident's diagnoses included but are not limited to unspecified dementia with other behavioral disturbance (deterioration of memory, language, and other thinking abilities), systemic lupus erythematosus (autoimmune disease possibly causing skin rash, erosion of joints or kidney failure), hyperlipidemia (high cholesterol), hypothyroidism (underactive thyroid gland). Record review of Resident #1's MDS (Minimum Data Set), Section C (cognition), dated 6/1/23, revealed an absent BIMS (Brief Interview of Mental Status) score due to question C0100 being answered with 0. No (Resident is rarely/never understood). Record review of Resident #1 care plan, dated 3/8/23, reflected a goal of Behaviors: Impaired social Interaction: Resident #1 has impaired social interaction as evidenced by swinging and cursing at staff and refusing care. Record review of Resident #1 progress notes revealed incident of verbal abuse between Resident #1 and CNA A on July 25th, 2023 was not documented in patient chart. Record review of written witness statement signed by CNA B, dated 7/25/23, revealed that Resident #1 was standing in front of the television and CNA A approached Resident #1 yelling to sit down and take the book CNA A was offering. Resident #1 slapped the book out of CNA A's hand and CNA B told CNA A to leave her alone. CNA B also identified LVN A advised CNA A to leave resident alone. Record review of written witness statement signed by LVN A, dated 7/25/23, revealed LVN A heard CNA A speaking to Resident #1 in a loud voice. When CNA A offered Resident #1 a book, CNA A spoke loudly to Resident #1 and stated Sit down. Here. Here. LVN A had written that she verbally instructed CNA (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: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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)