Accel At Crystal Park

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review and interview, the facility failed to ensure baseline care plans were completed for 2 (#4 and #5) of 9 sampled residents whose baseline care plans were reviewed.The DON identified 52 residents resided in the facility. Findings:1. Resident #5's 5-day PPS scheduled assessment, dated 08/31/25, showed

the resident was re-admitted on [DATE REDACTED]. The assessment showed the resident had a diagnosis of other major orthopedic surgery.There was no documentation a baseline care plan was completed upon re-admission to the facility on [DATE REDACTED].On 10/13/25 at 2:00 p.m., the traveling DON stated they could not locate a baseline care plan for Resident #5. 2. Resident #4's 5-day PPS scheduled assessment, dated 04/19/25, showed the resident was admitted on [DATE REDACTED]. The assessment showed the resident had diagnoses which included diabetes, hypertension, and abnormalities of gait and mobility.There was no documentation a baseline care plan was completed upon admission to the facility on [DATE REDACTED].On 10/15/25 at 8:25 a.m., the traveling DON stated Resident #4 did not have a baseline care plan. They stated nurses were responsible for completing baseline care plans on admit.

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

Event ID:

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

Accel at Crystal Park

315 SW 80th Street Oklahoma City, OK 73139

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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Based on observation, record review, and interview, the facility failed to ensure a resident had a care plan for the use of a PICC line for 1 (#5) of 9 sampled residents whose care plans were reviewed.The DON identified 52 residents resided in the facility. Findings:On 10/07/25 at 8:23 a.m., Resident #5 was observed with a PICC line in their right arm.Resident #5's 5-day PPS scheduled assessment, dated 08/31/25, showed the resident had central IV access. The assessment showed the resident had diagnosis of other major orthopedic surgery.Resident #5's care plan, revised 09/08/25, did not document the use of a PICC line.On 10/13/25 at 1:57 p.m., RN #1 stated the resident had a PICC line since admit to the facility.On 10/13/25 at 2:27 p.m., the MDS coordinator stated all PICC lines should be included in the resident's care plan.On 10/13/25 at 2:29 p.m., the MDS coordinator stated Resident #5's care plan did not include the use of a PICC line.

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

Accel at Crystal Park

315 SW 80th Street Oklahoma City, OK 73139

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 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

physician #1 stated Resident #7 was not their resident. They stated they were rounding on [DATE REDACTED] and the facility had asked for some blood work and abdominal x-ray because Physician #3 was not there. Physician #1 stated if a resident had a necrotic stoma with odor that was not present before, they would send them to

the emergency room. They stated it was an immediate intervention.On [DATE REDACTED] at 11:28 a.m., physician #2 stated if a resident had a necrotic stoma with odor, that was not bleeding, and the resident did not have pain and nausea, the nurse needed to call the provider and if the provider wanted to assess the resident themselves. Physician #2 stated the stoma could get discolored and if the middle was pink and the patient was asymptomatic, they needed to monitor the resident closely because things like that could happen. They stated they would order KUB and blood work. Physician #2 stated if the resident got worse like having a fever, bloody stool coming from the stoma, tenderness to abdomen, those were symptoms they were getting infected or ischemic and needed to be sent to the emergency room.On [DATE REDACTED] at 1:05 p.m., the DON stated the admission assessment, dated [DATE REDACTED], showed Resident #7's stoma was normal and protruding and bowel sounds active.On [DATE REDACTED] at 1:13 p.m., the DON stated colostomy care meant cleaning the bag and switching out the bags. They stated the nurses signed off on the care.On [DATE REDACTED] at 1:24 p.m., the DON stated the Colace was not ordered and should have been.On [DATE REDACTED] at 1:25 p.m., the DON stated it appeared the normal saline was not administered at 1:00 p.m. They stated the reason documented was the resident was not available. The DON stated the resident was still in the facility at that time.On [DATE REDACTED] at 1:31 p.m., the DON stated not receiving the ordered Colace and polyethylene glycol could contribute to the results seen on the abdominal x-ray.On [DATE REDACTED] at 1:34 p.m., the DON stated Resident #7 received ondansetron twice on [DATE REDACTED] and twice on [DATE REDACTED].On [DATE REDACTED] at 1:36 p.m., the DON stated Resident #7 received as needed tramadol twice on [DATE REDACTED] and once on [DATE REDACTED].On [DATE REDACTED] at 4:08 p.m., the DON stated the only assessment the nurse completed on [DATE REDACTED] after observing the stoma to be black, necrotic with an odor was the information on the nurse's notes. The DON stated they would have expected to see an assessment of Resident #7's vital signs, pain, bowel sounds, and document what the stool looked like in the bag. 2. Resident #3's 5-day PPS scheduled assessment for a Medicare Part A Stay, dated [DATE REDACTED], showed the resident was admitted on [DATE REDACTED].A Daily Skilled Note, dated [DATE REDACTED], showed Resident #3 had diagnoses which included malignant neoplasm of the mandible, malignant neoplasm of mouth, malignant neoplasm of anus, and pressure ulcer of the sacral region stage 3.There was no documentation daily skilled notes/assessments were completed from [DATE REDACTED] through [DATE REDACTED].On [DATE REDACTED] at 10:25 a.m., the traveling DON stated they could not locate the daily nursing assessments for the dates above.On [DATE REDACTED] at 1:58 p.m., RN #1 stated assessments were completed daily and involved observing and communicating with the resident. They stated the assessments had pre-generated questions to ask the resident in areas like pain, skin issues, assistance needed, and oxygen use.On [DATE REDACTED] at 2:02 p.m., RN #1 stated the last daily assessment completed on Resident #3 was on [DATE REDACTED]. They stated the assessment was supposed to be completed by night shift.On [DATE REDACTED] at 1:02 p.m., the DON stated they expected the daily assessments to be completed.

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

Accel at Crystal Park

315 SW 80th Street Oklahoma City, OK 73139

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 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

Based on observation, record review, and interview, the facility failed to administer IV medication as ordered for 1 (#5) of 2 sampled residents reviewed for IV therapy.The travelling DON identified seven residents received IV therapy in the facility. Findings: On 10/07/25 at 8:28 a.m., LPN #1 was observed to start Resident #5's infusion. The rate was set at 125ml/hr on the dial of the IV tubing.A policy titled INTRAVENOUS FLUID AND DRUG ADMINISTRATION GENERAL POLICIES, dated 10/2024, read in part,

The nurse should assess the rate of the solution/medication ordered .The nurse will verify that the container's label coincides with the prescriber's order. Verify contents, dose, prescribed rate, and expiration date of the solution.A physician's order, dated 09/20/25, showed meropenem (an antibiotic) 1gm powder for solution one intravenous every eight hours related to atherosclerosis of native arteries of right leg with ulceration. There was no rate of infusion Resident #5's antibiotic order in the physician's order and medication administration record.On 10/07/25 at 8:28 a.m., LPN #1 stated there was no specific ordered rate by the physician for the meropenem. They stated they would infuse the antibiotic at a rate of 125ml/hr because that was what they do. On 10/07/25 at 8:30 a.m., Resident's #5's meropenem bag was observed infusing. The bag showed to infuse at a rate of 100ml/hr every eight hours. On 10/07/25 at 8:47 a.m., LPN #1 stated they were to double check orders for the right medication, right route, allergies, and date of birth prior to administration.On 10/07/25 at 8:48 a.m., LPN #1 stated if an IV medication did not have a rate, they would contact the physician. They stated they had not contacted the physician. LPN #1 stated the physician should be contacted prior to infusing the medication. On 10/07/25 at 8:49 a.m., LPN #1 stated they had reviewed the medication bag prior to infusing and it had the resident's name, date of birth , and dose.On 10/07/25 at 8:51 a.m., LPN #1 stated they did see the rate on the bag and did not infuse the medication at

the rate of 100ml/hr. They stated they would change the rate.On 10/07/25 at 12:49 p.m., the DON stated nurses were to verify orders against the bag for IV medication administration. They stated they were to follow the five rights of medication administration.On 10/07/25 at 12:50 p.m., the DON stated an IV infusion needed to have the rate to be administered.On 10/07/25 at 12:51 p.m., the DON stated Resident #5's antibiotic order did not have the rate for infusion, but they mostly infused them over 30 minutes. They stated their policy showed the label should have the rate to be infused.On 10/07/25 at 12:54 p.m., the DON stated

the importance of having rates on the resident's order was for interactions and side effects.

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

Accel at Crystal Park

315 SW 80th Street Oklahoma City, OK 73139

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 - Some

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

p.m., CMA #1 stated H on the resident's MAR meant the medication was held.On 10/15/25 at 1:39 p.m., CMA #1 stated if a medication was not available, they were to let the nurse know and call the pharmacy.

They stated if the pharmacy did not have the medication, they were to let the physician know about it.On 10/15/25 at 1:46 p.m., CMA #1 stated they could not see why the medication was held on 05/23/25 at 7:00 a.m. and 1:00 p.m.On 10/15/25 at 1:48 p.m., CMA #1 stated the dose for 05/23/25 at 7:00 p.m. was held because the medication was not available. They stated they could not locate any notes showing staff communicated with pharmacy or the facility staff.On 10/15/25 at 1:53 p.m., CMA #1 stated the dose for 05/24/25 at 7:00 a.m. was held because the medication was on the nurse's cart. They stated there was no documentation why the dose on 05/24/25 at 7:00 p.m. was held.On 10/15/25 at 1:58 p.m., CMA #1 stated it was important for residents to receive their pain medications because they could be in pain and may have been on their pain medications for years.On 10/15/25 at 3:26 p.m., the DON stated medications were held for reasons not on the orders, they should notify the physician.

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

Accel at Crystal Park

315 SW 80th Street Oklahoma City, OK 73139

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 0880

Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, record review, and interview, the facility failed to handle intravenous tubing to prevent cross contamination and follow EBP protocol during IV medication infusion for 1 (#5) of 2 sampled residents reviewed for IV therapy.The travelling DON identified 21 residents on EBP in the facility.

Findings

On 10/07/25 at 8:01 a.m., IV tubing was observed without an end cap and hanging about 2 to 3 inches above the floor in Resident #5's room. The tubing was connected to a new bag of meropenem 1 gram /50 milliliters (an antibiotic medication). The tubing had no date. Two empty bags of meropenem and a white syringe cap were observed in the trashcan. There was a small amount of clear liquid in the trashcan.On 10/07/25 at 8:23 a.m., Resident #5 was observed with a PICC line in their right arm. LPN #1 was observed to pick up the IV tubing and pole and bring it closer to resident. With gloves on, LPN #1 wiped the end tubing with an alcohol prep wipe. LPN #1 wiped the PICC hub with an alcohol prep wipe and connected the tubing to the PICC line.On 10/07/25 at 8:28 a.m., LPN #1 was observed to start Resident #5's infusion.LPN #1 did not have a gown on while administering the IV medication.A policy titled ADMINISTRATION SET CHANGE, revised 10/2024, read in part, For intermittent administration sets that are used more than once in 24-hour period, attached a new single use sterile cap on the end of the set

after each intermittent use .Label the administration set with the date, and time hung, date set is due to be replaced, and initials .Change intermittent primary and secondary sets every 24 hours.A policy titled ENHANCED BARRIER PRECAUTIONS, revised 03/2025, read in part, This facility utilizes Enhanced Barrier Precautions (EBP) as a strategy to decrease transmission of CDC [Centers for Disease Control and Prevention]-targeted and epidemiologically important MDROs [multidrug-resistant bacteria] when Contact Precautions do not apply .Device care or use: Central line.Resident #5's 5-day PPS scheduled assessment, dated 08/31/25, showed the resident had central IV access. The assessment showed the resident had diagnosis of other major orthopedic surgery.Resident #5's physician's order, dated 09/20/25, showed meropenem 1gm powder for solution one IV every eight hours related to atherosclerosis of native arteries of right leg with ulceration.On 10/07/25 at 8:00 a.m., LPN #1 stated they just set up Resident #5's antibiotic for when they returned to their room for infusion.On 10/07/25 at 8:58 a.m., LPN #1 stated they were not sure of the frequency of IV tubing change in the facility. They stated it was their fifth day of work. They stated IV tubing was usually changed every 24 hours. LPN #1 stated they did not change Resident #5's IV tubing and it had no date.On 10/07/25 at 9:00 a.m., LPN #1 stated they were not sure if the resident was supposed to be on EBP and did not know what it meant.On 10/07/25 at 9:01 a.m., LPN #1 stated the IV tubing was supposed to have an end cap for infection control. They stated Resident #5's tubing did not have

an end cap. They stated the tubing initially had a normal saline syringe white cap on it, so they discarded it.

On 10/07/25 at 12:37 p.m., the DON stated the IV tubing should be discarded after use if used once in 24 hours. They stated if the tubing was used for multiple administrations in the day, the tubing should have an end cap and discarded after 24 hours. The DON stated the tubing should have the date and time it was hung, and date and time it should be changed with staff initials.On 10/07/25 at 1:14 p.m., the DON stated a gown and gloves were needed for EBP.

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet