Spanish Meadows

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

admission. The MDS nurse said once it was complete, the DON takes over with any follow-ups. The MDS nurse said he was not responsible for submitting the NFSS in the LTC Online Portal. The MDS nurse said

the DON deals with that. In an interview on 9/16/25 at 3:50 pm the DON said he was responsible for PASSR submission in the online portal. He said once the original meeting was done by TTBH, they must notify the MD. Once they received the MD order for services such as PT, PT would then evaluate for habilitation services, then the NFSS would be completed with the recommended services, and he would submit the NFSS in the online portal. The DON said to his understanding, the submission of the NFSS form

in the online portal were submitting within 21 business days of the IDT meeting. The DON said he recently took over the task in March of this year. The DON said the previous MDS/RN Coordinator oversaw the NFSS submissions in the online portal in collaboration with the DOR. The DON said they submitted the NFSS for Resident #1 and it was denied. The DON said he talked to someone in March, but he could not remember who, and he was told to submit the NFSS within a certain time frame, but it was denied because

it was submitted incorrectly. The DON said the resident did receive the PT and OT services, but not through PASSR. The DON said they had a recent IDT meeting on the 3rd of September. The DON said PT and OT already did their assessments and they were pending MD signature. The DON said he the NFSS would be submitted within the 20 business calendar days. In an interview on 9/16/25 at 4:47 pm with the Administrator, he said it was his understanding that upon approval of services for PASSR, they had 20 business days to update that information onto the online portal. He said he believed the DON was in charge with the assistance of the DOR. He said he knew of the 20-business day requirement because he overheard it said by the DON in a discussion regarding the urgency of the time frame. Record review of the facility's admission Criteria policy revised December 2016 reflected: Policy Statement: Our facility will admit only those residents whose medical nursing care needs can be met. Policy Interpretation and Implementation: .8. Nursing and medical needs of individuals with mental disorders or intellectual disabilities will be determined by coordination with the Medicaid Pre-admission Screening and Resident

Review program (PASARR) to the extent practicable.9. Potential residents with mental disorders or intellectual disabilities will only be admitted if the State mental health agency has determined (through the preadmission screening program) that the individual has a physical or mental condition that requires the level of services provided by the facility.10. The acceptance of resident with certain conditions or needs may require authorization or approval by the Medical Director, Director of Nursing Services, and/or the Administrator.12. The Administrator, through the Admissions Department, shall assure that the resident and

the facility follow applicable admission policies.

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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

09/16/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Spanish Meadows

440 E Ruben Torres Blvd Brownsville, TX 78520

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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

stated was trained over the completion and documentation of skin assessment when she first got hired in September of 2023. LVN B stated she did not recall the facility skin policy. LVN B stated it was important to document on the body diagram for things to be reported and treated when noticed and stated not documenting a resident skin assessment could negatively impact them because something could go unnoticed or intreated. Record review of LVN A's skills verification checklist dated 05/07/24 indicated she had met the skill for skin assessment sheet. Record review of facility policy titled, Pressure Ulcer Injury/Injury Risk Assessment with a revised date of July 2017 stated, .b. Once inspection of skin is completed document the findings on a facility- approved skin assessment tool.The following information should be recorded in the resident's medical record utilizing facility forms: 1. The type of assessment (s) conducted.5. The condition of the resident's skin (i.e., the size and location of any red or tender areas), if identified.11. Initiation of a (pressure or non-pressure ) form related to the type of altercation in skin if new skin alteration noted.

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