Thunder Care And Rehabilitation

F 0600 Level of Harm - Actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

10/15/25.On 10/15/25 at 1:18 p.m., Resident #10 stated they were just recently in a verbal altercation, where CNA #7 had called them a (expletive), and told Resident #10 they were going to have someone beat them up. Resident #10 stated CNA #7 yelled at me like I was one of their kids, but [CNA #7] was fired.On 10/16/25 at 10:44 a.m., the administrator stated they were notified of the verbal altercation. CNA #7 was suspended pending investigation and had since been terminated. The administrator stated when they questioned CNA #7 over the phone, they did not deny any of the allegation. The administrator stated staff wrote witness statements after the incident and resident interviews were done.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

10/16/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Thunder Care and Rehabilitation

2120 North Broadway Moore, OK 73160

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)

F 0684

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Level of Harm - Minimal harm or potential for actual harm

Based on record review and interview, the facility failed to assess a resident after a fall for 1 (#9) of 6 sampled residents reviewed for assessing, monitoring and intervening for a resident with a change in condition.The administrator identified 115 residents resided in the facility.Findings:An Assessing Falls and Their Causes policy, revised March 2018, read in part, If a resident has just fallen, or is found on the floor without a witness to the event, evaluate for possible injuries to the head, neck, spine, and extremities.

Obtain and record vital signs as soon as it is safe to do so.If an assessment rules out significant injury, help

the resident to a comfortable sitting, lying, or standing position, and then document relevant details. Notify

the residents attending physician and family in an appropriate time frame.A quarterly assessment, dated 08/11/25, showed Resident #9's brief interview for mental status at a 13, indicated they were cognitively intact. The assessment also showed that Resident #9 had a diagnosis of history of stroke, had impairments

on one side of their body, and was dependent upon staff for toileting, dressing, transferring, bathing, bed mobility, and personal hygiene. A Health Status note, dated 09/21/25 at 4:38 p.m., showed Resident #9 was transported to the ER related to patient self-reported they rolled out of bed last night and hit left ribs.

Resident reported left sided pain and coffee brown emesis.There was no documentation of the fall anywhere in the medical record. A Health Status note, dated 09/23/25 at 2:57 p.m., showed Resident #9 returned to the facility from the hospital with a diagnosis of gastrointestinal bleed.On 10/15/25 at 1:42 p.m., RN #1 stated they sent the resident out because they had complained about pain. RN #1 stated they were not aware of the fall until the resident told them about it.On 10/16/25 at 2:39 p.m., the administrator stated

they had investigated the fall and spoke with CNA #4 and #5 that worked during the time frame of the fall.

The administrator stated CNA's #4 and #5 stated Resident #9 did fall out of bed and they put them back in bed. CNA's #4 and #5 told the administrator LPN #2 was in the room when they moved the resident back to their bed. The administrator stated they told LPN #2, they were supposed to do an incident report, and then

the administrator terminated the LPN #2 probably on the 22nd of September for failing to complete an incident report and follow procedures.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

10/16/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Thunder Care and Rehabilitation

2120 North Broadway Moore, OK 73160

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)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Based on record review and interview, the facility failed to administer medication as the physician ordered for 1 (#2) of 3 sampled residents reviewed for medication administration.The administrator identified 115 residents resided in the facility. Findings:An Administering Medications policy, revised April 2019, read in part, medications are administered in accordance with prescriber orders, including any required time frame.An Order Recap Report showed levothyroxine Sodium Oral Tablet 150 MCG for hypothyroidism was ordered to be started on 07/24/25 and was not discontinued until 10/08/24 when the resident discharged .A July medication administration record showed blank areas on 07/26/25 and 07/27/25.On 10/16/25 at 3:18 p.m., the quality coordinator stated they could not find a reason why the 07/26/25 and 07/27/25 levothyroxine dose was not given, but it should have been.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

10/16/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Thunder Care and Rehabilitation

2120 North Broadway Moore, OK 73160

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)

F 0925

Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review and interview, the facility failed to maintain an effective pest control program.The administrator identified 115 residents resided in the facility.Findings:A Pest Control policy, revised May 2008, read in part, this facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents.A Service Inspection Report, dated 07/24/25, showed cockroach activity was found in room [ROOM NUMBER]'s dresser. The cockroaches were physically removed from the room.A Service Inspection Report, dated 07/31/25, showed light cockroach activity was found in room [ROOM NUMBER] and 405. The cockroaches were physically removed from the room.A Service Inspection Report, dated 08/20/25, showed two baby cockroaches were found in the broom closet. The cockroaches were physically removed from the room.A Service Inspection Report, dated 08/28/25, showed 10 cockroaches were physically removed from a dresser in room [ROOM NUMBER].A Service Inspection Report, dated 09/09/25, showed 10 cockroaches were physically removed from a dresser in room [ROOM NUMBER]. The report showed activity was found behind the refrigerator and underneath baseboards in the kitchen.A Service Inspection Report, dated 09/24/25, showed room [ROOM NUMBER] and 117 had some cockroach activity. One cockroach was removed from room [ROOM NUMBER] and five cockroaches were physically removed from room [ROOM NUMBER]. rooms [ROOM NUMBER] were also treated for cockroaches.On 10/15/25 at 1:18 p.m., Resident #10 stated their room (room [ROOM NUMBER]) was just sprayed due to finding a bed bug in their bed. On 10/15/25 at 1:27 p.m., Resident #1 stated they had seen cockroaches in their room (room [ROOM NUMBER]) about a week ago. On 10/15/25 at 1:38 p.m., CNA #2 smirked, shook their head, and then stated yes there were cockroaches.On 10/16/25 at 11:02 a.m., the administrator stated some residents hoard stuff or kept their stuff in cardboard boxes but get mad when staff tried to help them declutter. The administrator stated the pest guy came out every time they called them and it was not always

in the same area, and it was an effective pest control program as a whole, but they had to stay on top of residents that hoard.

Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet