Harmony Care At Beaumont

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

completed as required. He said the Regional MDS Coordinator was terminated and a new one was recently hired. He said the leadership of the facility (the Administrator and the DON) were supposed to ensure the MDS was completed on time and accurate. He said residents were at risks of not receiving care and services and required if the MDS was not completed as required. Record review of Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual dated October 2024 indicated .SECTION I: ACTIVE DIAGNOSES Intent: The items in this section are intended to code diseases that have a direct relationship to the resident's current functional status, cognitive status, mood or behavior status, medical treatments, nursing monitoring, or risk of death. One of the important functions of the MDS assessment is to generate

an updated, accurate picture of the resident's current health status. 0100-I8000: Active Diagnoses in the Last 7 Days Item Rationale Health-related Quality of Life Disease processes can have a significant adverse effect on an individual's health status and quality of life. Planning for Care This section identifies active diseases and infections that drive the current plan of care. Check the following information sources in the medical record for the last 7 days to identify active diagnoses: transfer documents, physician progress notes, recent history and physical, recent discharge summaries, nursing assessments, nursing care plans, medication sheets, doctor's orders, consults and official diagnostic reports, and other sources as available.

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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

08/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Harmony Care at Beaumont

2660 Brickyard Rd Beaumont, TX 77703

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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

urinary tract symptom (enlarged prostate), unspecified lack of coordination (difficulty in executing controlled, purposeful movements), repeated falls, and cognitive communication deficit (difficulties in communication0. Record review of Resident #4's admission MDS dated [DATE REDACTED] and signed as completed by MDS Coordinator B on 07/10/25 indicated he was usually able to make himself understood, usually understood others, had severe cognitive impairment (BIMS-3), signs and symptoms of delirium included fluctuating inattention and disorganized thinking, Record review of Resident #4's care plan dated 08/25/25 indicated he was at risk for malnutrition, was completed 46 days after the MDS was signed as completed by MDS Coordinator B on 07/10/25. There were no other care plans available for review in Resident #4's clinical record. During an interview on 08/28/25 at 4:40 p.m., the DON said the MDS Coordinator was responsible for completion of the resident care plans within the required 7 days. She said the Regional MDS Coordinator, DON, and the Administrator were responsible to ensure the care plans were accurate and completed as required. She said she had previously advised the Administrator that resident care plans were not completed but she did not recall when she advised the Administrator or the names of the residents. She said residents were at risk of not receiving individualized services if their care plans were not completed as required. During an interview on 08/29/25 at 10:26 a.m., the Administrator said the Regional MDS Coordinator was supposed to review the MDS completed by the facility MDS Coordinator for accuracy and timeliness of completion. She said she was not aware the resident care plans were not competed as required. She said she did not recall the DON making her aware of the care plans not being completed. She said the previous MDS Coordinator was terminated on 07/23/25. She said the facility policy for the resident care plans says the IDT will complete the care plan. She said it was her expectation was the DON would ensure the MDS and care plans were completed as required. She said residents were at risks of not receiving care and services and required if the MDS and care plans were not completed as required During

an interview on 08/29/25 at 10:50 a.m., the VPO said the facility hired a new MDS coordinator who fell ill and was not able to complete her duties. He said the Regional MDS Coordinator was supposed to fill in and ensure the residents MDS assessments were completed as required. He said the Regional MDS Coordinator was terminated and a new one was recently hired. He said the leadership of the facility (the Administrator and the DON) were supposed to ensure the MDS and care plans were completed on time and accurate. He said residents were at risks of not receiving care and services and required if the MDS and care plan were not completed as required. Record review of the facility's Comprehensive Person-Centered Care Plans policy dated 2001 indicated .2. The comprehensive, person-centered care plan is developed within seven (7) days of the completion of the required MDS .

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

08/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Harmony Care at Beaumont

2660 Brickyard Rd Beaumont, TX 77703

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

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

supplies on barrier sheet. LVN A knocked on Resident #1's door, notified she would be providing wound care and Resident #1 consented for surveyor to observe. LVN A applied prepared supplies on sanitized bedside table, washed hands in resident's bathroom, and applied gloves, and removed old dressings and disposed properly. LVN A hand sanitized and applied new gloves. LVN A provided wound care to left forearm, left outer knee, and left upper thigh as prescribed. During wound care LVN A did not have on a PPE gown and her uniform touched the resident's bed and his left side while she leaned to provide wound care to left outer knee. During an observation and interview on 08/28/25 at 10:00 a.m. Resident #1 was lying in his bed with bandages to left outer knee, left upper thigh, left hip, left shoulder, right upper arm and right shoulder. He said he had been at the nursing facility for about 2 weeks, and he had fallen in his home and sustained head injury and multiple wounds. He said he was not found in his home for 2-3 days after his fall and was hospitalized for 2 months after the fall. He said he was admitted to the nursing facility for rehabilitation and wound care management. During an interview on 08/28/25 at 10:05 a.m., LVN A said Resident #1 was on EBP because he had multiple wounds. LVN A said EBP should be followed for direct contact for residents with wounds, indwelling catheters, suprapubic catheter, PICC lines, central lines, feeding tubes, and any known infections. LVN A said she forgot to put on her gown during providing wound care to Resident #1, she should have worn a gown when providing wound care to Resident #1, because that was considered a direct contact. She said not wearing a gown increased the risk of spreading infection and germs. During an interview on 08/28/25 at 4:45 p.m., ADON said she expected the staff to follow EBP precautions on all residents identified needing EBP. EBP residents not receiving EBP precautions was at increased risk of infection and spread of germs. During an interview on 08/29/25 at 12:20 p.m., the Administrator said she expected the staff to follow EBP precautions on all residents identified needing EBP.

During an interview on 08/29/25 at 12:24 p.m., the DON said she expected the staff to follow EBP precautions on all residents identified needing EBP. Record review of the facility's policy titled, Enhanced Barrier Precautions, revised March 2024, indicated, Enhanced barrier precautions (EBPs) are utilized to reduce the transmission of multi-drug-resistant organisms (MDROs) to residents. 1. Enhanced barrier precautions (EBPs) are used as an infection prevention and control intervention to reduce the transmission of multi-drug-resistant organisms (MDROs) to residents, 2. EBPs employ targeted gown and glove use in addition to standard precautions during high contact resident care activities when contact precautions do not otherwise apply. a. Gloves and gown are applied prior to performing the high contact resident care activity (as opposed to before entering the room); b. Personal protective equipment (PPE) is changed

before caring for another resident; c. Face protection may be used if there is also a risk of splash or spray.

1. 3. Examples of high-contact resident care activities requiring the use of gown and gloves for EBPs include:

a. dressing; b. bathing/showering; c. transferring; d. providing hygiene; e. changing linens; f. changing briefs or assisting with toileting; g. device care or use (central line, urinary catheter, feeding tube, tracheostomy/ventilator, etc.); and h. wound care (any skin opening requiring a dressing). 5. EBPs are indicated (when contact precautions do not otherwise apply) for residents with wounds and/or indwelling medical devices regardless of MDRO colonization. a. Wounds generally include chronic wounds.

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If continuation sheet